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Minnesota's health insurance exchange: What's next?

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Gov. Mark Dayton has signed into law the contentious health insurance exchange bill that was approved by the House and Senate.  The legislation creates a new online marketplace where more than one million Minnesotans will obtain health insurance starting in October.  But that's only the beginning of the exchange story.  Here's are several next steps to watch for as the health exchange takes shape.

 Who will the governor appoint to serve on the seven-member board of directors?   

This powerful board will oversee the exchange's operations, and in 2015 will decide which plans will be sold on the online marketplace. In 2014, plans that meet federal and state certification will be guaranteed to appear on the exchange. Dayton appoints six board members. The Commissioner of Human Services or a designee is the seventh.

 If Minnesota builds an exchange, will health insurers come?  

Insurers have until May 17 to submit their plans to the state for approval to be sold on the exchange.  That's a nano-second compared to the amount of time insurers usually take to create new policies.  State officials are concerned that some insurers will let the deadline pass, and decide to wait to sell plans on the exchange until later. That concern gained credence when the sponsor of the House exchange bill wanted to change the legislation to guarantee insurers could sell plans in the first year of the online marketplace.

 What will the plans look like and will they be affordable?  

The federal health care law is ushering in many new changes to the insurance market, including one that requires carriers to take all comers --  called "guaranteed issue." Insurers can't turn down applicants for pre-existing medical conditions. Insurance plans say premiums will go up, but the question is whether the federal government's subsidies will offset out-of-pocket costs and higher premiums.

 Will the exchange work on Oct. 1, as planned? 

Gov. Dayton has already called the Minnesota exchange a "gamble" and other experts caution that with such a big undertaking, there will be glitches from day one.  The state has invested more than $100 million in federal dollars to create the exchange -- from creating the technology backbone to planning outreach.

 Will Minnesotans use the exchange?  

The fine for individuals who disregard the federal health care law's mandate is $95 the first year.  One question is whether young people, who are typically healthy, will buy insurance on the exchange or whether they'll simply pay the fine. The exchange is counting on those younger people to balance out the cost of typically riskier older consumers on the exchange.

 Is the projected cost to fund Minnesota's exchange realistic?

Right now the projected cost is between $50 million and $60 million a year.  That'll be paid for through a kind of user fee. In the first year, 2014, the exchange will withhold 1.5 percent, or $1.50 from every $100 of total premiums. In 2015, the exchange may withhold up to 3.5 percent of premiums.