Starting Wednesday, people can begin buying non-group health insurance for next year. For people in most states this open enrollment period will be entirely different than in past years. But not in Minnesota.
Minnesota is among 11 states and the District of Columbia that run their own Affordable Care Act market places. Each has a website where people can buy coverage if they don't get health insurance through their job or a government program.
They're in charge of their own marketing and enrollment assistance programs, so they're largely immune from Trump administration actions that critics warn will reduce 2018 individual-market enrollment.
"We're in a very different position than the federal government," said Allison O'Toole, who runs Minnesota's exchange, MNsure. "I see a lot of the action designed to destabilize the market and to hinder enrollment. I have the exact opposite goal in Minnesota."
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In its first year managing the sign-ups, the Trump administration slashed the marketing budget for the federally run exchange most states rely on by 90 percent. The open enrollment period ends a month and a half earlier than past years, and healthcare.gov, the federal web site, will curb its hours on all Sundays during the sign-up period, except the last one.
A recent analysis by the chief marketing officer of healthcare.gov under President Obama concluded the marketing cuts alone will drop next year's enrollment by at least 1.1 million people nationally.
In contrast, MNsure is planning another all-out annual enrollment push in ads and on social media, as well as paying other organizations to help spread the word.
"We were able to staff up in anticipation of open enrollment, larger than we've been before, to really meet the demand," said Meghan Kimmel, who runs Portico Healthnet, a St. Paul-based nonprofit that got $500,000 for its sign-up efforts. "We are anywhere we can be where we can talk with people about access to coverage."
The picture is very different in states that aren't running their own exchanges. In Mississippi, open enrollment is shaping up to be much different under President Trump than it was under President Obama.
"We're still enrolling, but we're not aggressively outreaching and educating" because there isn't enough money, said Ginni Tran, who works for Mercy Housing & Human Development in Gulfport, Miss., and helps Gulf Coast seafood industry workers find health plans on healthcare.gov. Cuts to federal enrollment assistance translated to a 70 percent budget cut for Mercy's open enrollment activities.
Under Mississippi Gov. Phil Bryant his state's uninsured rate has fallen to 12 percent but remains tied for third worst in the country. Bryant has staunchly opposed the Affordable Care Act, and rejected the Medicaid expansion.
Kimmel and others says what's happening in states using healthcare.gov underscores the value to Minnesota having its own exchange. At least one longtime MNsure critic, however, remains unpersuaded.
State Rep. Greg Davids, R-Preston, dismissed the notion that cutting back on the open enrollment period and slashing the promotional budget will discourage enrollment.
"We need to get rid of MNsure. We need to go to the federal exchange," he said. "They're an unnecessary duplicate layer of government that hasn't worked."