If a Republican is elected the next governor of Minnesota, chances are good that the new administration will seek to overhaul MNsure, the state's online health insurance exchange.
Each of the four Republican candidates for governor wants to make major changes to MNsure, which their party has criticized since its inception.
Minnesota created MNsure to implement provisions of the federal Affordable Care Act. But its $100 million website was plagued from the start with technical problems that made it difficult for consumers to navigate.
Although 200,000 people enrolled in health insurance through the exchange, MNsure is paying a consulting firm nearly $5 million to advise leaders on how the site can better operate.
Given the GOP consensus that the MNsure website is flawed, none of Republican gubernatorial candidates wants to tinker around the edges. But they do differ on the best approach to fix it.
Orono-based businessman Scott Honour said Minnesota should not spend any more money on MNSure. Instead, the state should scrap the system and adopt the federal exchange.
"You're seeing other states making the smart decisions. You've got to know when to cut your losses," Honour said. "That's one of the things that we learned in business. There's a concept of a sunk cost. We've spent this money. It wasn't wise to do it, we made a poor decision, but we have to recognize that it was a poor decision. Let's make the right decision now."
Hennepin County Commissioner Jeff Johnson disagreed. Johnson said it's better to have a state exchange than to use the federal system. "I don't think it's realistic to say that we're just going to eliminate it and shove everyone over to the federal program," Johnson said. "That doesn't solve a problem at all."
But Johnson said he'd push to exempt the state from the Affordable Care Act altogether. He'd also ask the federal government to grant Minnesota a waiver to allow the state to create a separate system.
"If we can go in and say, 'look at the system we have, we were actually better off before MNsure and ObamaCare and that's what we'd like to return to.' Let's give it a shot," Johnson said. "I will be very aggressive about that. If we can't get the whole enchilada, let's get at the pieces that aren't helpful."
No state has been allowed to opt out of the federal mandate that everyone have insurance, and after the battle to pass the Affordable Care Act the Obama White House is unlikely to allow it.
Still, Johnson isn't the only candidate who is suggesting the state seek a waiver.
State Rep. Kurt Zellers also insists a waiver is possible. He predicts Democrats in the Minnesota Legislature will join him in his push for one.
"Time is going to be on our side. You look at it. The federal system isn't working," Zellers said. "We were supposed to have everybody insured. We were supposed to keep our doctor. We were supposed to keep our clinic. All of those things aren't coming to pass. There will be a lot of Democrats in Minnesota, especially ones in the Senate who will be up for re-election in 2016, that want a Minnesota solution."
But Democrats aren't showing signs of abandoning MNSure. Instead, they've started campaigning on its successes -- including a sharp drop in the percentage of Minnesotans without health insurance.
Former state Rep. Marty Seifert, another Republican candidate running for governor, wants to include more insurance companies in the exchange. He said allowing for-profit and out of state companies to offer insurance on the exchange would lower costs and improve quality.
"When you have more companies bidding for business, quality of service goes up and price goes down," Seifert said. "I don't care if you're selling hamburgers, T-shirts or car tires. MNsure needs to be opened up."
Seifert and Johnson are also criticizing Gov. Mark Dayton for not releasing the 2015 MNsure rates until November. They accuse the governor of deliberately keeping a rate increase secret until after the election because health insurance costs will go up dramatically.
Dayton said state officials are unable to release the rates because the state Department of Commerce has only started negotiating the prices with the insurance companies.
The governor, who defended MNsure, has a big role in shaping its policies, as he appoints the members of the MNSure board. The Legislature confirms those appointments.
"The facts of MNSure are well known," Dayton said. "We got off to a bad start but we have the second lowest rates of any state in the nation and the second lowest uninsured. We're on the right path and we're going to continue to make it better."
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