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RE: MNSure - House GOP Should Just Quit Trying To Help

Category: Health Care
Posted: 01/11/15 13:09, Edited: 01/11/15 13:16

by Dave Mindeman

As I look at some of the initial proposals coming out of the Minnesota House, it is hard to understand exactly where they are trying to go.

Take for example, MNsure (KSTP's Tom Hauser's favorite subject).

The Minnesota House is backing off all the talk of doing away with it - probably because they knew all along that it wasn't going to happen with a Democratic governor and a Democratic Senate.....but in addition, they have no alternative plan for health insurance in the state - nothing.

But, they have to make it look like they are reforming it. So, the first things out of the gate are....

-more legislative oversight
-cap on bonuses
-restrictions on executive salaries

How in the world is that going to help MNsure?

Frankly, all this will guarantee is that we will never be able to attract quality personnel to lead the MNsure program.

But let's look at how MNsure is doing without all of this Republican help.

First, they are staying on budget. They have not needed extra budget dollars and now are receiving an additional $34 million from the Feds to keep improving the website. So that situation seems to be resolving itself.

Second, the current sign-up process has gone exponentially better this year as compared to last. Scott Leitz seems to have righted the ship, although improvements are still needed.

Third, rates are still good. Even though there has been some additions and subtractions to the insurance carriers, the overall numbers are still showing very modest increases, if any.

One of the things the House Republicans think they need to do is to expand the availability of Federal subsidies to insurance offerings outside of MNsure.

Here is the problem with that. The state exchanges that are set up through the ACA with the help of the Federal government have direct verification methods with the IRS. Setting this up has been complicated and may have been one of the reasons the Fed site had so many problems.

But what this accomplishes is to verify eligibility for individuals and to avoid fraud. Since outside carriers would have much more limited access to IRS verification, the fraud possibility increases.

It would be ironic that the House Republicans "remedies" for MNsure could actually cause a bigger problem than we have now.

The lead legislator on MNsure oversight is going to be Rep. Tara Mack... and so far she has been less than impressive in how she handles this. For the most part, she considers oversight to be synonymous with being a partisan critic. Which is not going to be helpful in actual problem solving. She has yet to offer anything remotely constructive - and so far has only put forward more Republican talking points as her contribution.

To me, it looks like we would all be better off if the House Republicans just quit trying to "help" when it comes to MNsure.
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Senator David Hann and The Gruber Effect

Category: Health Care
Posted: 11/20/14 12:00, Edited: 11/20/14 12:05

by Dave Mindeman

If Sen. David Hann (Senate Minority Leader) would concentrate as much on Minnesota transportation issues as he does on MNSure, we might have some of those problems resolved. But in Senator Hann's world, MNSure is THE paramount issue.

In a Star Tribune Op-Ed, he uses the Jonathan Gruber "gaffe" as a means to rehash all the old arguments and take us backwards once more.

Hann laments the lack of transparency (which Gruber proves I guess) as the deception for getting the ACA passed. Of course, Hann probably doesn't remember the passage of the Medicare Part D act under President George W. Bush and the "surprises" involved with the infamous donut hole and the prohibition of negotiation with drug companies. I guess transparency issues are only a problem when Democratic bills are involved.

Senator Hann uses a Gruber analysis to knock MNSure as well. Yes, Minnesota asked for a report and they used some of those assumptions to move the MNSure bill forward. But that doesn't necessarily mean all of the information was wrong and the source was deceiving the state.

Hann picks out some of the assumptions that MNSure used and then slants the analysis as if it was rigged from the beginning. But let's look at his criticism:

And let's remember that all of the information is predicated on a horrible software system roll out that no one could have predicted.....

1. The exchange would serve 1.3 million people by 2016.

In the first year (2014), MNSure sign-ups hit 371,000. With a smoother, more usable exchange site and a continuation of interest similar to 2014, that goal is within reach for 2016.

2. Over 600,000 people would be purchasing individual plans (as opposed to taxpayer-subsidized plans).

Obviously that did not happen...in the first year only about 55,000 signed up for individual plans. However, a large number of people signed up outside of the exchange....away from the horrible website which wasn't very usable....and got some of the same insurance plans through other venues. Remember, if you weren't eligible for the tax subsidy, it didn't really matter where you bought the insurance.

3. Overall premium costs for individual plans would fall by 34 percent.

Premium costs did go down in the exchange. I am not sure if the 34% figure was realistic, but Minnesota had some of the lowest premiums in the nation. But using Hann's source (Kaiser Family Foundation)... the recent data indicate this:

An early look at the cost of health insurance in 16 major cities finds that average premiums for the benchmark silver plan - the one upon which federal financial help under the Affordable Care Act to consumers is based - will decrease slightly in 2015.

Kaiser also points out that if you sign up for the same plan as you had last year, you could see an increase. Kaiser encourages..."Consumers should go into the open enrollment period prepared to shop for the best deal all over again." Sounds like a free market?

4. Household budgets would improve by $500 to $700.

Again, I'm not sure of Hann's context but many, many Minnesota budgets improved by $500 to $700. I know mine improved by more than that. I doubt anyone guaranteed that every budget would meet that number, but on an average basis, that is probably a fair figure.

5. The number of uninsured would decrease by 60 percent by 2016.

Well, let's quote a June, 2014 MNSure statement...."Between September 30, 2013, and May 1, 2014, the number of uninsured Minnesotans fell by 180,500, a reduction of 40.6 percent. The number of uninsured in Minnesota fell from 445,000 (8.2 percent of the population) to about 264,500 (4.9 percent of the population)." It would seem that we are on track for that target.

6. There would be a large rise in non-employer insurance coverage, and little change in employer-provided coverage.

The purpose of the ACA was to allow competitive rates for people who did not have employer based health coverage. Again, the website issues made that difficult in the first year, but early indications for the current period seem to say that those software glitches are over and individual sign-ups can be obtained much more efficiently. Employer based plans continue as usual. The ACA didn't affect those plans except for one important point. Those policies have to meet a better standard of coverage....and they do.

I know it is hard to resist discrediting everything Gruber says because of some off the cuff remarks made over a year ago. Democrats do that sort of thing as well. Its the political thing to do.

But Gruber is one advisor.....who worked for Republican Mitt Romney in Massachusetts, developing the RomneyCare health plan. And yes, he advised a lot of different entities. But he was only that - an advisor. His opinions and projections had flaws. The law has flaws. But taking everything into account, the law is succeeding.

If Senator Hann has the true better interest of Minnesota in mind, he would work to improve MNSure....a health care system that has been a success in its main purpose....to get health care to those who couldn't get it before.

Play the political game if you must, but in the end, let's all work to make MNSure better and keep Minnesota a model for the nation in health care.
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About Those MNSure Weighted Rate Increases

Category: Health Care
Posted: 10/25/14 10:58

by Dave Mindeman

Republicans have latched onto this idea of MNSure rates being calculated by a "weighted average".

Let's examine that.

The weighted average assumes that the same people will renew the same policy they chose last year. If Policy A is chosen by 10 times more people than Policy B, then the increase in Policy A is more relevant.

Here is the problem with that.

The MNSure exchange is a market place. If the policy holder thinks that the increase in premium is unwarranted, they can shop for a new policy at a different price. The number of people renewing policies could be completely different.

So the weighted averages would then be meaningless.

Sure, you can calculate a hypothetical number from that scenario and yes, it could be valid. But using a straight average like the Commerce Department did also has merit and is just as valid a number.

Also, let me address this idea that the administration "coerced" lower rates from the insurance carriers.

Well, I sure as hell hope they did.

You have regulators for a reason. Utility rates are always subject to intervention by the utility commission. They affect the final rates. The ACA also has regulators watching insurance rates - I'm not sure they have the regulatory power that the utility regulators have, but there job is oversight on rates that gouge.

They should be offering their opinions on rates and pointing out problem areas.

That is the whole idea in keeping rates affordable.

I know it is important and desperate for the MN GOP to keep attacking MNSure....after all, they have virtually nothing else of actual relevance to attack, but it is a convoluted one at best.
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