The October 25 dinner meeting room was filled as more than 60 people listened intently to Rep. Matt Dean’s vivid, clear explanation of what led to the current health insurance crisis and the Republican strategy to resolve it.

The melt-down of the individual insurance marketplace for 2017 impacts more than 250,000 Minnesotans . 

Many in this group are facing:

• Only 1 insurance option
• Massive premium increases
• Doubled deductibles, and
• Narrowed clinic/hospital networks that exclude essential specialty care centers such as the Mayo Clinic and U of MN hospital.  

Despite monthly premiums of $1,400 - $1,700 per couple, and yearly deductibles of $ 6,500 per person ($13,100 per couple), people out-state may need to drive 100 miles to a covered clinic.  MNSure or independently purchased individual insurance will not cover treatment at MN’s premier destination medical facility, the Mayo Clinic, in 2017.

Photo at left: Rep Chad Anderson listens intently to Rep Matt Dean’s comments on MNSure

Any solution comes too late for Charlie Dunker, whose wife died in 2015.  A video documenting the MNsure failures that delayed her care can be seen at stopmnsure.org.  SD49 and SD50 Legislative candidates Rep Chad Anderson, Mike Lehmann, and Max Rymer joined Matt Dean in reporting what they have heard directly from voters with serious medical conditions who are experiencing higher costs and less access to care.

How did we get here?  Bad choices by those who implemented MNSure.

1. Implementing at all rather than filing for a waiver.  In 2008, Minnesota had effective solutions already in place for the key goals of the ACA:

• Goal of 5 choices of insurance coverage.  In MN, individuals outstate had 8 choices in 2008, now have 1.
• Goal of 90% covered by insurance.  In MN, 94% covered in 2008, now FEWER are covered,
• Coverage thru age 26 on parents’ policy – MN had coverage thru age 25.
• Affordable insurance, including for those with serious pre-existing conditions – MN had a high-risk pool where insurance was subsidized and medical bills paid by taxes spread across all in MN.

2. Grouping the most-ill with other individuals for insurance.  MNSure’s implementation is at the root of the financial woes:

• Combined the high-risk pool of individuals with all others who buy individual health insurance (self-employed, farmers, early retirees, small business owners, small business employees whose companies don’t offer group insurance).
• Removed the broadly-funded high-risk subsidy
• Required that insurers set equal premiums for everyone of the same age/gender
• Expanded Medicaid eligibility so a larger number of healthy, modest-income individuals no longer were included, leaving even fewer to foot the bills of the most-ill / high-risk.

Even with the premium increases, insurance companies were not collecting enough to cover the medical and administrative costs.  Promised Federal funds to cushion losses were never paid.  By May 2016, ALL MN insurers chose to exit the individual marketplace for 2017, sending out cancellation notifications.  To entice a few insurers to offer any plans for individuals in 2017, MN had to agree to significant clinic network restrictions, yet more premium increases, and caps on the number of individuals a company would be required to sign-up.

3. Continued use of failed computer programs / processes.  The technology selected to support MNSure enrollment and administration was another bad choice for implementation. A few examples of continued failures of basic processes in 2016 include: 

• Each individual enrollee must be entered separately.  If one family member’s address varies even slightly (e.g Rd vs Road), coverage for the entire family is declined.
• The state did not verify income levels before paying subsidies.
• Able to send bills, but not accept payments.
• Capacity to serve only 600 people online at once – clearly inadequate for the 250,000 who need to renew or change yearly during an 8-week open-enrollment span and thousands more who may review options and check whether they’re eligible for subsidy.
• Inadequate security protection for confidential personal data.

All other states that chose the same packaged computer programming have now abandoned it and either moved to use the Federal Exchange or scrapped it and started over.  After spending almost $300 million trying to fix this, it’s past time to scrap it.

4. Failure to utilize industry expertise.

The MNSure Board intentionally excluded doctors and those from the insurance industry – i.e., anyone who had an in-depth understanding of the complexities and typical pitfalls of the processes needed to provide, bill, and pay for care.

The Strategy to Resolve MN Health Insurance Problem

Rep. Matt Dean’s solution: 

• Replace MNSure with the effective system MN had in 2008. 

  • Subsidizing high insurance premiums without addressing the cause of those high premiums just prolongs the problem.

  • “Single payer” (state take-over of individual health insurance) increases tax-payer costs rather than relying on a competitive market

• Require MN’s legislators to be covered by MN’s individual health insurance program

Those who agree can sign a petition on Dean’s website, stopmnsure.org.  We can also write to the Governor and our Legislators to encourage them to adopt the solutions proposed by GOP leaders.  Some of those solutions were described at an October 5 press conference as highlighted by previous SD49 reporting