MNsure: Six crucial questions

MNsure call center
Loretha Cager talks with an applicant at MNSure's call center in St. Paul, Minn., Monday, March 31, 2014. Monday is the open enrollment deadline for signing up for insurance under the health care act.
Ann Heisenfelt/AP

Even though the open enrollment period to buy commercial insurance for individuals and families is over, many questions loom over MNsure, the state's online health plan marketplace.

What happens to people who tried but couldn't enroll?

During April, MNsure's staff will be processing 36,000 "enrollment attempt forms" filled out by people to show they'd made a good-faith effort to enroll in health coverage by the March 31 deadline. Doing so allowed them to stave off the federal health care law's penalty for not meeting the deadline.

Now the state has to wade through those surveys, contact the people who filled them out and enroll them in coverage. The state says the coverage will be retroactive. But what happens when someone has to go the hospital before their coverage is sorted out. How will providers respond? Who pays the bills and when?

Who will take over as general contractor?

This is a key decision that will set MNsure's future direction. As MPR News reported in February, the state took over the general contractor's job early last year. The new general contractor will oversee the $100 million website for the next two years.

Whoever it is will have ultimate responsibility for ensuring MNsure meets deadlines, stays within budget, and meets quality benchmarks.

Scrap or fix MNsure?

With guidance from the new general contractor, MNsure's leaders and board will decide whether to mend its current online marketplace or simply start over from scratch.

After analyzing MNsure's operations in January, an independent consultant, Optum Health, laid out three options. Two involved fixing the current system, which could take up to two years to complete. The third option involved getting the system minimally functional for the next enrollment period while building a new system from scratch.

MNsure's interim CEO Scott Leitz has said MNsure isn't limited to just those options. Meanwhile, Maryland this week decided to scrap its troubled exchange software and buy the Connecticut system.

What will the Legislative Auditor find?

Minnesota's internal government watchdog, Legislative Auditor James Nobles, has already sharply criticized MNsure in his review of a security breach. He has yet to weigh in on the myriad problems MNsure's software caused for users and state employees alike. Saying, "this year is going to be the year of...oversight and accountability (for MNsure)," Nobles has launched two examinations and may expand to a third, if the Legislative Audit Commission agrees.

One audit is part of a required audit of MNsure's use of more than $100 million in federal grant funds. The second audit will examine MNsure's website security.

Are the uninsured actually getting health coverage?

Nobody seems to know. MNsure does not ask everyone enrolling in coverage through the website whether they are uninsured. But MNsure does ask about insurance status if a person is eligible for Medical Assistance, MinnesotaCare or for a premium tax credit.

Even so, the state's count of uninsured residents appears likely to change, according to University of Minnesota health economist Lynn Blewett. Minnesota's uninsured population amounts to about half a million people, or about 9 percent of the state's total.

With MNsure having signed up nearly 170,000 for insurance as of March 31, Blewett says the state's uninsured rate is likely to drop. The question is, by how much?

Rate hikes next year?

Insurance carriers had to do some guesswork to set premium rates for this year because of new requirements enacted by the Affordable Care Act.

One of the law's major provisions bans insurers from charging higher rates or denying coverage to Americans with pre-existing medical conditions. This is the first year insurers have had to live under that requirement.

It will take them a while to find out whether their current premium rates bring in enough revenue to pay for the health services people wind up using. It's also unclear at this point, whether there will be enough younger, healthier people in the so-called risk pool to help pay for the care of older, likely more costly policy-holders. If this year's premiums leave insurers without enough money to cover whatever they're paying out, rates will very likely rise.

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