Consumers howled in anger and frustration last fall and winter because the MNsure website could not reliably process their health insurance applications. And a recent evaluation by Deloitte Consulting found the site's software still can't reliably perform nearly two thirds of all necessary functions.
And yet, despite the seriously hobbled website, various workarounds, including lots of manually filled out paper applications, allowed a quarter of a million people to enroll in a health plan and reduce the number of Minnesotans who have no coverage by 41 percent.
Could Minnesota have achieved those results without the troubled website? Yes, said Dannette Coleman, a senior executive with the Medica health plan. She said the Affordable Care Act's provision of marketing campaigns, one-on-one assistance from so-called "navigators," and a more expansive Medicaid program played key roles. "A lot of what was in the ACA — funding for the outreach programs ... expanded eligibility for Medicaid — were really critical to achieving what's been achieved so far."
The ACA also included an important financial incentive to sign up for insurance: There's a tax penalty for most Americans who lack coverage. So if those factors played starring roles in getting Minnesotans insured, does the state even need its $100 million, yet-to-be-fully-fixed online health insurance marketplace?
"We really don't," said Steve Parente, a health insurance expert and associate dean of the University of Minnesota's Carlson School of Management.
Minnesota could have relied on the federal exchange as most states did, he added, though he acknowledged it would have required some other way to integrate MinnesotaCare, subsidized coverage for people who can't afford private insurance but earn too much to qualify for Medicaid. MNsure's backers say the site itself also played an important role. MNsure CEO Scott Leitz contends MNsure deserves credit for making coverage more affordable because consumers could compare plans on the website.
"Having transparent information available led to competition among health insurers, which was exactly what the marketplaces and exchanges were intended to do," said Leitz. "It very clearly did that in Minnesota."
The website can't be separated from the marketing and other activities that surrounded its launch and led to the wave of enrollments, he added. They were all facets of a coordinated effort.
While the MNsure site's ability to function has improved over time, a separate site for county employees continues to frustrate workers who process applications for government-sponsored coverage such as Medical Assistance. For example, it doesn't allow county workers to make basic changes such as updating an applicant's address.
MNsure and exchanges around the country are needed and will run smoothly given some time to work out the bugs, said Joel Ario, a consultant who oversaw insurance exchanges for the U.S. Department of Health and Human Services.
"When the first cars didn't work well, it wasn't time to return to horses and buggies," Ario said. "It was time to improve the cars."