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The main reason for establishing health insurance exchanges such as MNsure is to provide coverage to people who lack insurance and need assistance paying for it. 

But initial numbers from the state's new online marketplace suggest that the site is attracting attention from people outside its target audience.

Nearly two thirds of the nearly 49,000 people who have completed insurance applications through MNsure will not receive financial assistance. That's because they don't qualify for federal subsidies or didn't bother to find out if they qualify for assistance.

Many of those applicants have yet to make a final commitment and pay for a plan. Nevertheless, the numbers surprise state Department of Human Services Commissioner Lucinda Jesson, who also sits on MNsure's board.

"We thought the large, large majority of those who are part of the individual market today would be people who came because they qualify for subsidies," Jesson said. "But we are also starting to see a lot of people come through who either didn't ask for or didn't qualify for tax credits who see it as a good place to get coverage."

Jesson said there's an obvious reason people are shopping on the site: 

MNsure boasts some of the lowest premiums in the country.

 Plans must include a minimum level of coverage and deductibles can't exceed $6,350 for an individual or $12,700 for a family.

Among those who found a better deal on MNsure, even though she doesn't qualify for a federal subsidy, is Paula Fleming, a freelance editor in Minneapolis. She and her husband have paid $500 a month for a family plan with a $10,000 deductible.

Fleming said their current policy doesn't cover much.

"The only way to have premiums that were affordable was to get coverage that would keep us from losing the house if something really terrible, terrible happened, but otherwise was of no value," she said.

Fleming and her husband found a plan on MNsure that will cost them $50 more a month, but has more comprehensive coverage and comes with a $4,000 family deductible.

That surprised Fleming, who was initially concerned about the Affordable Care Act's exchange model.

"There was nothing in [the law] that said they couldn't charge us an arm and a leg," she said. "I thought we were going to be between a rock and a hard place. As it turns out, the competition, at least this year, is working. It's fantastic. It's tailor made for self-employed people like us."

People who buy coverage for their dependents through their employer's plan also may be able to find cheaper insurance on the exchanges, said Larry Levitt, senior vice president at the Kaiser Family Foundation. As health care costs have risen, some employers have been making employees pay a growing share of the cost of family coverage.

Take a separate provision in the Affordable Care Act that allows parents to keep their children on their plans until they are 26.

"That insurance doesn't come free. It often requires a significant contribution by the family," Levitt said. "So even though these young adults who have been able to get insurance on their parents' policy, they may be able to find a better deal by buying through the exchange."

The high level of interest from people not seeking subsidies is playing out in other states as well, Levitt said. In part, that's because the process of applying for subsidies may be so difficult that people don't bother.

"Or it could just be that the early purchasers are people who were already in the market," Levitt said. "So someone who was already buying individual insurance and had that policy cancelled, probably started first in the exchange."

Nationally insurers have canceled millions of plans or are making them more expensive because they fall short of the new minimum requirements. Some people will be paying more for their plans next year as a result.

As the enrollment period comes to an end, Levitt said he expects more people who do qualify for subsidies will buy insurance through the exchanges.  

Levitt also theorized the ability to compare plans in one place may be attracting a wider variety of users. Before the Affordable Care Act, it was almost impossible to comparison shop for health insurance.

"You couldn't see all the plans available and what they would charge in one place," Levitt said. "And there was no way to know what you would pay until you went through the application process and filled out a detailed medical history because plans vary premiums based on your health status."


Exchanges like MNsure have two audiences: people who need financial help buying insurance and people who are just looking for a better way to compare prices, said consultant Jon Kingsdale, who ran the Massachusetts health insurance exchange between 2006 and 2010. It served as a model for the federal and state exchanges authorized by the Affordable Care Act.

"A primary focus and particular objective would be to cover the uninsured and that's what the tax subsidies were designed to do," said Kingsdale, now a director at the Boston office Wakely Consulting Group. "Above and beyond that there's a value - at least potentially - to present a better channel for shopping. In some ways, that's actually the real test of how good the insurance store part of reform is."

While some Minnesotans were happy with the prices they saw on MNsure, they also complained that the final enrollment process was riddled with problems. They were frustrated by error messages that ultimately discouraged them from buying a plan through the site. 

Many purchased policies directly from an insurer - an option that's not available to people who want to take advantage of the federal subsidies. 

Among those who bought a plan directly from the insurance company after getting fed up with the site is Steve Boland, who runs a business in St. Paul that helps non-profit organizations.

Earlier this year, Boland testified to the MNsure board that the exchange would allow him to run a small business and obtain affordable coverage. But after trying to use the exchange, he said he's disappointed with the website's execution.

"We're in December and I need coverage Jan. 1, and I just can't wait anymore," he said.

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Health

Business and Economic News

Health Care Reform

Catharine Richert

Author

Initial numbers from the state's new online marketplace suggest that the site is attracting an unexpected audience: Those who already carry insurance coverage, but are looking for a better deal.

Already covered, many still seek -- and find -- better options on MNsure

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