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As MNsure officials scramble to eliminate the problems bedeviling the state’s health care exchange, they are facing a growing swirl of constituencies demanding accountability.
Gov. Mark Dayton has strongly criticized one major vendor and publicly demanded improvement since the bumpy rollout of the website in October. The state legislative auditor launched a review Tuesday to determine to what degree vendors and state officials are responsible for the problems. And a committee of state legislators will convene Thursday demanding answers for a program envisioned as a gateway to health insurance for more than 800,000 Minnesotans this year.
“We thought Minnesota would have been one of the top 10 — if not top five — states that would have launched successfully on Oct. 1,” said Dan Schuyler of the health care consulting firm Leavitt Partners. “I was quite surprised they were having these issues.”
MNsure board members have questioned whether the technical issues are fixable malfunctions or whether more fundamental problems exist, which could ultimately lead to scrapping parts of the system and starting over. Scott Leitz, MNsure’s interim chief executive, is scheduled Wednesday to present the first public assessment of the website operation to the MNsure board.
The exchanges are a key component of the Affordable Care Act, aimed at helping individuals and small businesses get health coverage through a competitive marketplace. The online system is supposed to make the process as simple as buying a plane ticket.
Minnesota chose to build its own exchange, one of 14 states to do so. Some states, particularly Hawaii, Oregon, Maryland and Vermont have had significant problems. States having the best success with their exchanges — such as Connecticut and Nevada — hired vendors with existing technologies, just as Minnesota did, said Schuyler, who is director of exchange technology at Leavitt Partners.
Minnesota’s vendors were “very capable,” Schuyler said. Still, he noted, the MNsure exchange was developed at warp speed, and questions about a lack of adequate testing are legitimate.
“You can’t test enough,” Schuyler said. “Even though Minnesota did lead out fairly quickly, it’s apparent they didn’t have enough time or an adequate testing methodology. If they had, these issues may have been mitigated before Oct. 1 or at the very least they may have delayed enrollment.”
Dayton and top state leaders said Tuesday they welcomed scrutiny from Legislative Auditor Jim Nobles, who aims to devote unusually broad scrutiny to MNsure.
Make experience ‘better one’
The new agency has drawn $155 million in federal grants to construct the site, hire staff and launch a marketing and community outreach effort. Nobles plans to assess MNsure’s IT security, the performance of vendors and how well the state managed the work of the contractors.
“We are squarely focused on making the consumer experience through MNsure a better one,” MNsure spokeswoman Jenni Bowring-McDonough said about the audit. “We hope this review is able to identify additional strategies for improvement.”
Ghita Worcester, a senior vice president of UCare, said the openness and communications with the insurers has “significantly heightened” since Leitz took over, which has led to positive changes amid continued challenges.
“The functional processes at MNsure are improving, but they have a long road to go to be at the operational status they’d like to be,” Worcester said.
Worcester stressed that while much of the hand-wringing before the Dec. 31 deadline focused on the scramble to get people enrolled at the last minute, insurers are old hands experienced at dealing with such situations.
What the carriers can’t handle is not getting accurate information from MNsure at a timely basis, Worcester said. That includes something known as an 834 file, which is a key handoff link insurers need to start coverage. MNsure is still failing to master that piece of the transaction, Worcester said.
“It’s like when you take on something that seems straightforward and then, oh my gosh, five things come into play that you didn’t think about that make things more complex,” she said. “And it seems they’re bumping into this every time they try to do something like produce a normal 834 file for us.”
Wednesday’s board meeting may provide some much-needed insight into the past and present, but many observers are anxious toward the future.
A renewed crush of activity is expected between now and March 31, when consumers will face penalties for not having insurance and won’t be able to buy coverage until the end of the year.
“It would be nice to have more clarity as to what is hobbling the exchange and who is responsible,” Schuyler said. “Is it a specific vendor? Is it the result of a poor integration and development strategy? A combination of both?”
Schuyler said he is anxious to know what the strategy will be. “If there’s no comprehensive contingency plan,” he said, “then we shouldn’t expect immediate changes.”