On a recent weekday evening, Ibrahim Hassan was pacing the narrow corridor outside a Somali mosque in south Minneapolis, buoyantly shaking hands and waving like a politician at a campaign stop.
His mission: To sign up every eligible uninsured person he met for public health coverage through the state’s MNsure website. His mobile “office” consisted of a foldout table, a laptop and a small sign that read, “We can help you” in Somali and “Obama Care.”
Though much attention has focused on the March 31 deadline to buy private health insurance — and the consumer frenzy that resulted — federal health reform and the debut of MNsure have also led to a historic surge in the number of Minnesotans enrolling in public programs.
All told, nearly 99,000 Minnesotans have signed up for subsidized coverage through Medical Assistance, the state’s version of Medicaid, since MNsure’s launch six months ago. Average monthly enrollment in the program is projected to reach 835,000 this fiscal year, up 13 percent from 2013 — the largest year-over-year surge in at least 15 years and, percentage-wise, one of the largest in the nation.
And the numbers almost certainly will climb higher. While open enrollment has closed for private coverage, eligible Minnesotans can still apply for public programs such as Medical Assistance and MinnesotaCare, and the strenuous push to reach poor and uninsured Minnesotans is still forging ahead. Most of MNsure’s 800 trained helpers, known as “navigators,” continue to fan out to libraries, shopping malls, barber shops and other locations in a sustained effort to reach the estimated 440,000 Minnesotans who lack insurance.
‘We’re still here’
“There was a perception that we were going to fold up our tents and go home” after April 1, Hassan said. “But we’re still here.”
The resulting expansion of public coverage is unprecedented in scope. Supporters of President Obama’s 2010 health law cite it as a victory, noting that it has cut the number of uninsured Minnesotans and arguing that it will improve the health of vulnerable families and children.
“I am celebrating that we have so many people signing up for public programs,” said Human Services Commissioner Lucinda Jesson. “We made it easier for people to enroll, and now we’re staying on them as long as they are eligible.”
Skeptics warn it could pose a long-term threat to the state’s fiscal health. Although the federal government will pick up more than 90 percent of the cost of expanding Medicaid coverage in the first nine years, state spending on the program is forecast to reach $4.57 billion this year, double the amount spent a decade ago.
MNsure does not track the percentage of new enrollees who previously lacked insurance. But state officials say the surge of enrollments almost certainly is driving down the state’s rate of uninsureds. After rising sharply during the Great Recession, from 7.2 percent in 2007 to 9.1 percent in 2011, Minnesota’s uninsured rate fell to 8.2 percent in 2013.
That experience is mirrored across much of the country. Researchers at the Urban Institute in Washington, D.C., estimate that the Affordable Care Act (ACA) has reduced the number of uninsured adult Americans by 5.4 million through early March of this year. The nation’s uninsured rate has fallen by 2.7 percentage points, to 15.2 percent, since September 2013, the month before ACA open enrollment began — the first measurable drop in years.
Navigators such as Hassan played a big role, but so too did looser eligibility requirements contained in the federal law. One key change was the elimination of Medicaid’s so-called “asset test.” People can now qualify for public coverage based purely on their incomes, without having to list the value of cars and other possessions.
But it was the intense publicity surrounding MNsure — even the negative attention over the frustrating technology glitches — that likely played the biggest role in the expansion, by raising the profile of insurance among people who qualify but might not have known it. Some 60 percent of Minnesotans who lack health insurance potentially qualify for coverage through a public program, but they are not enrolled because of real or perceived barriers, according to Minnesota Department of Health surveys.
“By raising the public profile of [health] insurance in general, a lot of people who may have been unaware they could qualify signed up,” said Julie Sonier, deputy director of the University of Minnesota’s State Health Access Data Assistance Center (SHADAC).
Higher coverage, higher costs?
State officials have taken steps to control the rising outlays in Medical Assistance in the last two years, but say they have yet to estimate the long-term impact on the state budget. “It’s too early to project where we’ll be two years from now,” Jesson said.
Some lawmakers consider the challenge urgent.
“We’re at a crossroads,” said Rep. Tara Mack, a Republican from Apple Valley and member of the Legislature’s MNsure oversight committee. “We’ve expanded access without making critical reforms [to Medicaid]. If we do nothing to address costs, then we’re heading to a pretty steep cliff where the spending is going to bleed other areas of state government.”
For now, however, many of the new Medical Assistance enrollees are enjoying the benefits of having coverage.
Mary Hierlinger, 57, credits MNsure with saving her life. The Anoka resident was recently diagnosed with ovarian cancer, and said she would be unable to pay for $30,000 in medical bills if she had not been approved earlier this year for Medical Assistance. Were it not for that, she said, “I might not be talking to you right now.”
Last week, as he walked past the colorful stalls of East African clothing at the Village Market on E. 24th Street, Hassan could barely take 10 steps without someone stopping to ask him about MNsure.
“This is my territory,” he said proudly.
Hassan stroked his goatee and laughed as people lavished him with thanks for signing them up after years without insurance. Hassan’s employer, Somali Health Solutions, has helped enroll 1,200 people since last fall.
“Without this man, I would not have insurance,” said Abdiqani Muhamed, 25, embracing Hassan as he spoke. “Now, I don’t have to live in fear of going to the hospital and not being able to pay my bills. It’s a new day for me.”