Every once in a while a tough issue comes along that has the potential to split a community. Today’s issue is health care reform, and more specifically, MNsure — Minnesota’s state health care exchange.

In a break from conventional wisdom, and putting myself at risk for significant criticism, I believe that MNsure should and will be an important part of health care reform in Minnesota.

That isn’t to say the launch of MNsure has been smooth. Far from it. It is expensive, complicated and overengineered. We now know that we tried to do too much too fast, when simplicity would have been the better path.

The health care exchange comes to us as one part of a large and unwieldy package of legislation known as the Affordable Care Act. This legislation includes nearly 1,000 pages of law that has already generated more than 20,000 pages of rules and regulations. It is worth noting that many of these regulations contributed to the complexity of MNsure.

Moreover, a bill that was touted as a remedy for runaway health care costs will do little to stem the tide of cost increases. In fact, the state of Massachusetts — which is often touted as the model for the ACA ­— has experienced significant growth in health care costs post-reform, with costs 15 percent higher than the national average.

So what is there to like about the ACA? Two things. First, the fact that we will provide health care coverage for most Americans is a good and proper goal. In the long run, universal coverage should reduce health care spending. As the uninsured develop durable and proactive relationships with primary care teams, we should see more care provided at the right time and place.

The second constructive change is the launch of health care exchanges. While the implementation of MNsure has been rocky, there are some notable wins. With the exception of Olmsted and Dodge counties, we have the lowest exchange-based insurance rates in the country. This is a direct outcome of competition among health plans and health systems.

Minnesota is also one of a few states that lead the nation in the number of health insurance options offered for individuals. From high-deductible health plans to those with full coverage, one can choose. There are limited-network options and open-access health plans. The choices are many, providing a high level of customization to our state.

MNsure also brings to our market meaningful progress toward health care transparency. It’s early, but this platform has the potential to turn a nation of passive health care users into active consumers. We know that an activated patient will do more to reduce health care costs than any public or private institution.

There will be a day when we are thankful we have a functioning health care exchange. Good things don’t always come easy, and this is one of those things. With patience and a little luck, we will look back at this time as an important one, and MNsure will be viewed as a long-term success.


Kenneth H. Paulus is chief executive officer of Allina Health.