MNsure unaccountable to Minnesota lawmakers and citizens; did staff lie to the media?
Yesterday the MNsure board deliberated over whether or not MNsure—Minnesota’s insurance exchange—should take an “active purchaser” approach, which would empower MNsure to limit the health plans and choices available in the exchange. The board did not adopt the active purchaser approach, at least for now.
We posted a blog yesterday arguing “the Obama administration’s latest ‘fix’ to the new health care law offers a powerful lesson on why the MNsure board should not adopt an active purchaser approach.” Last week the administration “encouraged” insurers to enroll people retroactively and to pay out-of-network providers in-network, among other requests, and threatened to not include them in the exchange in 2015 if they didn’t comply. Basically, the administration threatened insurers to “cooperate or else,” which has been likened to a mobster demanding protection money.
This Obama administration’s actions deliver a revealing example of what active purchaser looks like. Any effort to exclude health plans will be political and, by its very nature, will be threatening and adversarial.
Some of the MNsure board members appear to understand this. At the meeting, Brian Beutner, the board chair, characterized active purchaser as the power to exclude and went so far as to call it the “nuclear option.” When he asked a MNsure employee if that was a correct characterization, the employee suggested a more positive spin, characterizing the active purchaser as more about saying yes to certain plans.
Lucinda Jesson, another board member and the Commissioner of the Minnesota Department of Human Services, recommended the board should be clear that the active purchaser approach remains in the tool box. The Commissioner, a key Dayton appointee, is not likely to give up the power to pick and choose health plans for the exchange.
But Beutner’s comments show he likely understands why even holding on to the option can be a problem. You can’t ask insurers to come to the table and collaborate in good faith and say, “Oh by the way, if you don’t cooperate we always have the active purchaser hammer in the toolbox.” Active purchaser and the threat of active purchaser will indeed create an adversarial situation, which, in turn, will make the exchange even more political than it already is.
But we shouldn’t even be in this position.
We argued in the Pioneer Press today that it was a terrible mistake to federalize health care. And we can see that playing out here in Minnesota, where every day, sometimes twice a day, there are revelations of mistakes, glitches, cancelations and loss of coverage. We have a federal and state policy that is collapsing and real Minnesotans, most of whom had coverage, are facing the New Year with no idea if they have health care coverage, or if they do, at what price.
We never needed to create a new insurance marketplace. A marketplace already exists. In fact, MNsure.org looks quite similar to eHealth.com, even a similar color scheme.
Asking the state to create a new health insurance marketplace was always asking too much, not only because of the technical details, but because it’s just not something government should be doing.
The seven-member MNsure board may all be highly qualified people in their respective fields, but they are Governor Dayton’s political appointees who have never created a market. The legislative oversight committee has no power; the Governor is the only person who can hire, fire and direct the board. Why would we delegate the important task of creating an exchange and controlling access to health care for one out of five Minnesotans to a seven-person, unaccountable board?
Now we’re beginning to hear MNsure staff may be misleading us. Pat Kessler, a long-time Capitol reporter for WCCO said the following yesterday: “I think they lied to us. . . . I believe that this is one of the most closed, obtuse, misdirecting, camouflaging agencies I have ever dealt with.” He said this in an interview with Dan Barreiro on KFAN (you can listen to interview excerpts here and the unfiltered interview here).
This should be no surprise. Politics, being what it is, will never allow MNsure to lay all their cards on the table, which is one of the main reasons government should not be doing this. While there is no guarantee of honesty in a free market, consumers at least have the power to switch to a competitor when incompetence and corruption surface. There is no such choice for people scrambling to shop for health insurance through MNsure.