Star Tribune’s health care “realities” need their own dose of reality

The Star Tribunal Editorial Board recently tried to clear up a few “misunderstood health-care realities” about Minnesota’s troubled individual insurance market.

Their editorial took subtle aim at countering criticisms of President Obama’s health care law and the role Minnesota Democrats’ have played in its disastrous roll out.emergency-help-sign

All in all, they misfire and the realities they’re pushing need their own dose of reality.

The editorial lists the following “realities” readers should know.

  1. MNsure is not a health plan or provider.
  2. It’s the individual health-insurance market, not MNsure, that’s in crisis.
  3. The state’s old high-risk pool was not health-care nirvana.

By pointing out MNsure is not a health plan, the editorial seems to be trying to disentangle MNsure—the state’s Obamacare exchange—from the crisis unfolding in the individual insurance market.

While MNsure is not a health plan, it does influence the type of health plan people can access with tax credits.  Some health plans offer different insurance products on and off MNsure while other health plans refuse to offer products through MNsure.  Generally, there is less choice through MNsure and the available choices are becoming more restrictive with narrower provider networks.

This limited choice is one reason why Republicans in the state legislature have asked the Dayton administration to request a waiver from the federal government so that people and small businesses can use tax credits to buy a health plan both inside and outside MNsure.

The editorial’s next claim—it’s the individual insurance market, not MNsure, in crisis—again tries to deflect blame from MNsure, which conveniently deflects blame for the ongoing mess in the insurance market away from the Democratic lawmakers who created MNsure.

But the fact is, MNsure has been in crisis ever since it launched back in the fall of 2013 and, in 2016, it continues to be one crisis after another.   This year Minnesota’s Legislative Auditor found that 38 percent of people who enrolled in public health care programs through MNsure were not eligible for the program, resulting in net overpayments of health care benefits ranging from $115 to $271 million.  MNsure’s IT system failed to automatically send out tax forms for thousands of enrollees, which then required manual processing to get the forms to people just days before the April 18 filing deadline.  Counties continue to report to the legislature that many enrollees still to need “manual processing of paper applications instead of the automated processing promised.”  Most recently, the Minnesota Department of Human Services admitted a data mismatch forced 45,000 Minnesotans to reapply to retain their coverage.

MNsure’s ongoing crisis does impact the individual market.  After facing serious difficulties in buy insurance through MNsure, many people just give up.  The trouble is, it’s only the healthy people that can really afford to give up, which is part of why the individual pool has attracted people with more expensive health conditions.

Recognizing MNsure’s dysfunctional reality, a number of critics of Obamacare have called for Minnesota to scrap MNsure and move to using the federal insurance exchange.

As for the editorial board’s final reality, the state’s high risk pool may not have seemed to be nirvana a few years ago, but it sure feels like nirvana now for all those facing premium increases between 50 and 67 percent.

Prior to Obamacare, Minnesota insurers could reject people with preexisting conditions—the people that waited to buy insurance until their proverbial house was on fire—and the state operated a high risk pool to guarantee that even these people got coverage.  This coverage was also affordable, only around 20 percent higher than private premiums.

The state’s high risk pool helped guarantee a stable market by balancing the need for insurers to manage risk with the health coverage needs of people with preexisting conditions.

Based on this successful balance, as reported in the Washington Post back in 2008, Sen. John McCain held up Minnesota’s high risk pool as a model in his presidential campaign.  And as the health care debate rolls on, critics of Obamacare have called for reinstituting high risk pools in some form to help regain that balance.

To the extent the editorial board’s alternate reality aims to dismiss health care solutions coming from critics of Obamacare, this is a mistake.  Allowing people to purchase insurance with tax credits outside MNsure, scrapping MNsure altogether, and reinstituting a high risk pool are all real solutions that deserve careful consideration.