June started with news about big proposed premium increases on health insurance sold to individuals, including those buying on the state's MNsure health insurance exchange. In some cases, the proposals call for rate increases of more than 50 percent. By month's end, the U.S. Supreme Court is scheduled to rule on a legal challenge to the health law that launched MNsure. Plaintiffs argue that the federal Affordable Care Act only allows tax credits for people who buy through state-based exchanges like MNsure, but not the federal HealthCare.gov exchange that covers 34 states. It all makes for exciting times at MNsure, where Allison O'Toole got the chief executive job on an interim basis in May.
Q: What impact could the Supreme Court ruling have on MNsure?
A: Minnesotans don't have anything to worry about with this ruling. My biggest fear is that it may cause confusion for them, but the states that are running state-based exchanges aren't going to be impacted by this.
Q: If the court rules that tax credits aren't available on the federal exchange, there's been talk of an administrative fix that might create a state-based regional exchange based on existing marketplaces. Has MNsure been a part of any such plans?
A: There are a lot of hypotheticals out there. … If we are approached to engage in those conversations, we will. But our focus is really on making sure the system works for Minnesotans and that they get the tax credits that they deserve.
Q: A ruling for plaintiffs in the cases could prevent discussion of a state partnership with the federal HealthCare.gov platform, which is being used by Oregon and considered in Vermont. Obviously, there was discussion at the Legislature this session about whether the state should use HealthCare.gov. Could a ruling against the government be a loss for Minnesota, because it would block a partnership?
A: These are all hypotheticals, so it's hard to comment. During the session … there was talk about HealthCare.gov, [but] it's just not that simple. We just have a totally different [system] — we have a policy in place right now that consumers have one front door for their health care, so that's with MinnesotaCare and Medical Assistance and the private plans. HealthCare.gov doesn't do that.
Q: The proposed rate increases in the individual market apply to more than 240,000 people. To what extent do they apply to people in MNsure policies, vs. off-exchange policies.
A: We're not sure yet. From our perspective, every year there's probably going to be a change. Rates are going to go up, rates are going to go down.
As a consumer protection organization, we offer transparency. It's important for consumers to come back in, shop and compare [to] see if they can save more money based on rates.
The final rates will be posted Oct. 1, so consumers will have a full month before open enrollment to shop and make some decisions.
Q: What role does MNsure play in determining the final rates that get posted on Oct. 1?
A: We have no role. It is truly a regulatory process that's handled by the Department of Commerce.
Q: The health exchange is the only place for individuals to tap federal tax credits that discount premiums. If rates increase, do you think more people might turn to MNsure?
A: We hope so. And I think there's great benefit in doing so, if [premiums] do go up.
Just one reminder: The proposed rates that were posted are only the [premiums] that increased more than 10 percent. So, we're not getting a full snapshot of the market yet, and we won't until October.
Q: Do you have information about whether new insurers are coming into the market?
A: We don't. We don't have that full picture.
Q: MNsure covers some of its costs by withholding 3.5 percent of premiums. If premiums go up, that could help MNsure's revenue, right?
A: Yeah, but I think primarily it could help people save more money, too, with tax credits.
Q: The budget projects that MNsure will end 2016 with 95,000 commercial enrollees. The number of enrollees paying premiums as of March was about 52,000. What's your plan for bridging that gap?
A: In addition to our statewide media campaign, that will be largely similar to what consumers saw last year, [we will] focus on our lead agencies, our broker enrollment centers. … We're also going to expand that program to have a [small-business] focus …
You're going to see a consumer decision support tool that we're going to add to the site. And we're doing a series of short videos for consumers to help them navigate the process.
I think about it as lifting the fog. This is not an easy decision for folks. And it's a big decision — it's both financial and it's about our health. It's never going to take five minutes for people, but we are here to lift some of the fog around this decision.
Christopher Snowbeck • 612-673-4744
Twitter: @chrissnowbeck