Amid a rocky national rollout for President Obama's health care law, enrollments in publicly subsidized plans in Minnesota have significantly outpaced private insurance purchases so far on the state's new insurance exchange.
The early trend, which has been mirrored nationally, is feeding a debate about the viability of health care reforms that depend on a major influx of new and healthy customers to keep premiums in check.
But state officials and industry analysts say it is little surprise that, in the early going at least, those eligible for free or subsidized public programs would outnumber premium-paying customers shopping on the private insurance market.
Of about 11,000 sign-ups so far on MNsure, the state's insurance exchange, nearly 9,200 qualified for public insurance plans — either Medicaid or MinnesotaCare. That compares with fewer than 1,800 who have applied for private insurance plans.
Health care analysts warn that the trend, if it continues, would be unsustainable. But most view the disparity as a temporary phenomenon that is likely to balance out as the enrollment period gets closer to the Dec. 15 deadline to obtain coverage.
In Minnesota, for example, about two-thirds of the 31,447 people who have submitted applications on the exchange since Oct. 1 are expected to land in the private insurance markets, but have not yet selected or enrolled in a plan.
"They're still shopping," said MNsure Executive Director April Todd-Malmlov. "I think for most people who do have to pay a premium, they're going to wait until they have to."
Nationally, some experts point to the impact of the widely reported malfunctions on the federal government's health exchange website, healthcare.gov. "There have been lots of problems getting people enrolled," said Matt Salo, executive director of the National Association of Medicaid Directors. "It's been a little harder getting people enrolled in the exchange side [for private plans] than on the Medicaid side."
The glitches, Salo said, are more likely to dissuade those who are healthy and less in need of financial help. "If you're young, you're healthy, or a 28-year-old waiter, your motivation to sign up early is probably not great," he said. "But if you've got chronic conditions and you need health care and haven't been able to get it, you're the guy who's going to be there on Oct. 1."
'Too early to know'
Critics of the Affordable Care Act, widely known as Obamacare, say that while enrollments in public plans continue apace, projections about who will and who won't obtain private insurance under the dictates of the new law remain uncertain.
"My question is, if we don't get healthy people signing up, is the whole thing going to collapse under its own weight?" said Republican strategist Ben Golnik, chairman of the Minnesota Jobs Coalition.
MNsure has not been directly affected by the technological problems that have plagued the federal government's health exchange website. State officials also have been heartened by a tripling in the number of sign-ups on the exchange in the second half of October.
Still, projections hover around a low-end estimate of 102,000 Minnesotans expected to buy private market insurance by the end of 2014.
One advantage Minnesota has over other states is that it has some of the lowest premium prices in the nation. "Any concerns I had dissipated when I saw the low premiums," said Minnesota Human Services Commissioner Lucinda Jesson.
With growing anxiety in Congress about the faulty federal rollout of the new law, combined with a nationwide controversy over canceled policies, partisans on both sides are keeping a wary eye on enrollment metrics in places like Minnesota, one of 14 states plus the District of Columbia that have built their own insurance marketplaces.
"It is simply too early to know how significant the disparity is between public and private plans, as people have until March 31st to sign up for health insurance," said U.S. Sen. Amy Klobuchar, D-Minn. "While the MNsure website has been working better, right now the administration's focus needs to be on fixing the national website so that Minnesotans can be confident that all parts of the system are working correctly."
Said fellow Democratic Sen. Al Franken: "The reality is that purchasing health insurance is an important decision, and it's not always an easy one. There are lots of factors to consider, so I think a lot of folks are going through their options and making sure they make the right decision for themselves and their families."
'Priming the pump'
Some conservative groups such as the St. Paul-based Citizens' Council for Health Freedom are actively discouraging Minnesotans from enrolling in the exchanges, either by buying private insurance on their own or paying what they call the "uninsured tax" ($95, or up to 1 percent of income in 2014).
At the same time, state health officials have been targeting low-income people who qualify in public plans. "They're priming the pump a little bit," Salo said. "They're aggressively reaching out to people who are predisposed to coming on Medicaid."
Altogether, about 60 percent of the estimated 500,000 uninsured people in Minnesota qualify either for Medicaid or MinnesotaCare, the state program for people slightly above the poverty line who can afford to pay nominal premiums.
With the expansion of Medicaid under the new health care law, an estimated 349,000 Minnesotans are expected to be added to the program by 2015. Many are people who were in the MinnesotaCare program until now.
For most, the switch will be automatic. But many others may not know they qualify, a perennial problem that public health workers have tried to address with "navigators" who serve as guides to affordable insurance on the exchange.
Viewed from that perspective, some analysts welcome the crush of people finding public insurance on MNsure. "Getting people to sign up for public programs has never been the easiest thing to do," said Eileen Smith, a spokeswoman for the Minnesota Council of Health Plans. "That's who they need to be reaching."
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