New legislation that would scrap MNsure’s independent governing board and turn it into a new state agency should be viewed as a starting point — not the end point — in a much-needed debate over how to improve the new health insurance marketplace.
MNsure, a key reform launched by the 2010 Affordable Care Act (ACA), made its cringeworthy debut in late 2013, with a balky website and an inadequate phone support center generating widespread criticism. More than a year later, the marketplace appears to be running more smoothly after expensive technological fixes. But its operations are still far from ideal as consumers continue to sign up for 2015 coverage.
As with any new venture, it’s sensible to scrutinize what improvements are needed. It’s in that spirit that legislation to jettison the board of directors is welcome. The bill has been introduced by state Sen. Tony Lourey, DFL-Kerrick. He was one of MNsure’s chief proponents, doggedly pushing through the bill to authorize its operations in 2013 after Republican majorities in the previous two years did nothing to advance or shape the marketplace.
Focusing on MNsure’s governance structure is a natural place to start legislative debate over the marketplace’s future. The seven-member board should be held accountable for MNsure’s flaws. It’s worth asking the question whether the board structure has worked for MNsure and whether there is a better alternative. This week, Lourey emphasized more direct authority over MNsure by the governor and state lawmakers as a key reason to make the change he has proposed.
But making MNsure a state agency should not be a foregone conclusion. It’s worth noting that some of MNsure’s most critical mistakes — particularly in its hiring and supervision of vendors — were made when it was acting as a virtual state agency before the board was appointed or providing hands-on oversight. The website’s development began long before the authorizing legislation passed in 2013.
With the shift to a state agency mode, it’s possible that the public would lose the window into its operations that monthly board meetings have provided. While these have often been painful to watch, it’s likely the process of improving the board has been more transparent than internal improvements made by a state agency would have been.
It’s also become clear that the private-sector members of the board have made valuable contributions. Improvements to MNsure’s call center and adjustments to its budget reflect this expertise. Rather than going to the Legislature for more money, board members dove into the details and identified cuts. Initiative like this isn’t seen often enough in state government.
It may well be that a state-agency approach is the best path forward for a new and improved MNsure. But the debate over its governance needs to explore what trade-offs are involved. Several key questions need answers:
Could shrinking MNsure’s independence threaten the marketplace’s existence? Minnesota Republicans have long opposed the marketplace. While they control only the state House right now, the governor’s seat and the Senate are up for grabs in 2016.
And what happens to MNsure’s “active purchaser” authority — wielding its buying clout to drive a better bargain with insurance companies — if the shift to a state agency is made? In this page’s view, state agencies have been too cozy with insurers in the past and reluctant to wield the state’s clout to drive a better bargain in paying the plans to administer public programs.
A report and recommendations on MNsure’s performance and governance are expected next month from the state’s respected Office of the Legislative Auditor. Lawmakers should read the report with care and ensure that the debate over MNsure’s future puts the needs of consumers first.