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Biggest test of MNsure’s success may still lie ahead

By Christoper Snowbeck

St. Paul Pioneer Press

It’s halftime for MNsure, and it’s tough to tell what the score is.

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Last Wednesday, the state’s health insurance exchange passed the second of four enrollment deadlines for people seeking 2014 coverage through the new government-run marketplace. The next comes in mid-February, followed by an expected flurry of activity before the current open-enrollment period ends March 31.

Between October 1 and January 4, nearly 71,000 people moved into the final stage of enrolling in government or commercial health insurance programs through MNsure. Whether the tally is a lot or a little depends on the yardstick.

Legislators sounded alarms this month over a possible budget deficit in MNsure’s future due to both low commercial enrollment trends and low premiums. But one health policy group’s analysis provides a somewhat favorable impression of enrollment trends in Minnesota compared with the nation.

Insurers point out that success depends on more than numbers, since the exchange must attract enough young and healthy consumers this year to prevent premiums from spiking next year. That’s why it’s critical, they say, that MNsure solve lingering problems with its website and call center before March rolls around.

“My expectation would be: As many people are going to enroll in the last 10 days in March as are going to enroll between now and the middle of March,” Scott Keefer, vice president of policy and legislative affairs at Blue Cross and Blue Shield of Minnesota, said during a Tuesday interview. “I think it’s so important to be prepared for that surge of people, so you’re not experiencing long wait times and delays — and people can largely get into the system.”

Minnesota launched the MNsure online marketplace last year to implement the federal Affordable Care Act, which requires almost all Americans to have health insurance or pay a tax penalty. When evaluating MNsure’s performance thus far, some factors are tough to gauge.

For individual consumers, the process of trying to obtain MNsure coverage has varied dramatically. Some have gotten insurance after spending just an hour or two on the computer. Others have experienced weeks of agony, including website glitches and hours of waiting for help from MNsure’s overwhelmed call center.

MNsure has not released any figures that show whether the health exchange has reduced the number of Minnesotans who lack health insurance — a primary goal of the federal health care overhaul.

Because of benefit changes mandated by the federal law, many consumers faced steep premium increases in 2014 to maintain their existing health insurance policies. It’s not clear how many stayed the course, shopped for a cheaper option or dropped coverage altogether.

LOOKING AT NUMBERS Enrollment numbers released thus far point in different directions.

As of January 4, about 26,000 people were in the final stage of enrolling in a commercial health insurance plan through MNsure. At that pace, commercial enrollment is falling short of even the low end of MNsure’s projections, state officials said this month.

MNsure’s funding during 2015 and 2016 comes from withholding up to 3.5 percent of commercial premiums sold through the exchange. So, officials currently project that the low enrollment trend — combined with lower-than-expected premiums — could result in a $3 million deficit by 2016.

Consumers use the health exchange to find out whether they qualify for the MinnesotaCare or Medicaid public health insurance programs, and the state has had more success getting people into Medicaid. The state already has exceeded enrollment projections for Medicaid but isn’t yet halfway to its goal for MinnesotaCare enrollees by March.

It’s difficult to compare enrollment numbers across states for Medicaid, because different states have different income cut-offs for the program. More broadly, the number of potential health exchange customers varies significantly among the states.

In Minnesota, there are relatively few exchange customers because the state has a low rate of people who previously lacked health insurance and a high rate of employers who provide coverage, said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

The California-based health policy group took these factors into account last year when developing state-by-state estimates for the total number of people who would be eligible to shop each state’s health exchange. A new foundation analysis based on exchange enrollment numbers released Monday suggests that Minnesota is doing relatively well, with 8.7 percent of the potential market having selected a commercial health plan, Tolbert said.

Across the country, 7.8 percent of the potential market had selected an exchange plan, according to the foundation’s analysis.

“In a ranking of states, Minnesota comes in at about 14th,” Tolbert said. “By that measure, it’s not doing that poorly.”

The performance is a far cry from Vermont and Washington, where the foundation’s analysis show that those states have enrolled 33.4 percent and 28.3 percent of their potential markets, respectively. The rate was 8.5 percent in Wisconsin, where the federal government operates the state’s health exchange.

While Minnesota enrollment looks a little bit above average in the Kaiser survey, the performance looks a little bit below average relative to state-by-state targets released in September by the federal government.

According to the federal targets, Minnesota should have enrolled 31,490 people in commercial exchange plans by the December cut-off. But the actual MNsure tally for enrollments by Dec. 28 was 19,420 — about 38 percent shy of the federal target.

By late December, the nation as a whole fell about 35 percent short of its target. Wisconsin, meanwhile, exceeded its federal target with 40,752 enrollees, according to a report released Monday by the federal government. The federal report included an important asterisk with the Minnesota numbers.

State residents with incomes slightly above the poverty level are being steered into the MinnesotaCare program. People with comparable incomes in other states, however, are getting federal tax credits to purchase commercial health plans sold on their state insurance exchanges.

As a result, the take-up rate for commercial plans in Minnesota could look artificially low because there are fewer potential customers. Considering all the variables, Sarah Dash, a research fellow at Georgetown University, said, “It’s going to be hard to benchmark state-to-state.”

CONSUMER EXPERIENCE Scott Leitz, interim chief executive of MNsure, said cross-state comparisons are difficult because performance doesn’t involve just enrollment statistics. Consumer experiences also are key, and MNsure must improve its website and call center, Leitz said.

Wednesday’s enrollment deadline at MNsure wasn’t nearly as busy as a previous deadline on December 31, yet it still resulted in call center wait times that exceeded one hour on average. On Thursday, MNsure officials said they are considering whether to use in the future an external call center that would handle a portion of all calls.

“We’re going to add resources to the call center — and they’re going to be substantial resources,” Leitz said.

To insurers, the success of an insurance exchange depends on the mix of healthy and unhealthy people who sign up for coverage. If a marketplace attracts a disproportionate number of people with costly health problems, that means insurance premiums for 2015 likely will jump.

Age is a proxy for health status, so there’s been considerable interest in how many young adults are signing up for coverage through the health exchanges. In Minnesota, the share of adults age 19 to 34 signing up for policies through MNsure is comparable to the rate doing so through marketplaces across the country, according to the federal report released Monday.

But the report also showed Minnesotans were much more likely than people elsewhere in the country to sign up for “platinum” policies that have the richest benefits.

The preference might simply stem from the fact that premiums are low in the state, so more Minnesotans can afford premium policies, said Geoff Bartsh, vice president of public policy and government relations with Medica, a health insurer based in Minnetonka.

But Keefer of Blue Cross said it’s also possible that more people are buying platinum plans here because they have expensive health problems, which would be best covered by a premium insurance policy.

“It could be indicative of the fact that we have a population that’s much less healthy than what’s at the national level,” Keefer said, referring to exchange users. “It’s not conclusive, but it suggests that we may have a pool that isn’t as balanced as we had hoped at this point.”

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The Pioneer Press is a media partner with Forum News Service.