Tuesday's debut of MNsure, the state's online health insurance exchange, is giving Minnesota Management and Budget Commissioner James Schowalter a mild case of jitters -- or so it seemed when we chatted Monday about the new insurance marketplace he headed in its early stages.

Schowalter turned over MNsure's reins to an appointed board of directors in mid-August. But it was his baby long enough for him to be mindful of the pains associated with the birth of a large government undertaking.

Social Security's start in the mid-1930s, Medicare and Medicaid's beginning 30 years later, and the rollout of Medicare Part D for prescription drug coverage in 2006 all initially created confusion and some frustration for the people they aimed to help. "That’s the path of change. It takes a while for people to understand new systems," Schowalter said.

The saving grace for MNsure could be that "Minnesotans, in their hearts, are really patient and understanding. Within a few days of us getting started, people will find that health care will still be delivered, sick people will still get treated, and the health insurance market has expanded in a way that is good for everybody. We’ll sort it out."

The tightening labor market in Minnesota may tamp down any employers' impulse to use MNsure's arrival as an excuse for dropping health insurance from employee benefit packages, Schowalter added. Minnesota's 5.1 percent unemployment rate in August was the 10th lowest among the 50 states. 

"Businesses are competing for talent right now. They'd have to think twice" before eliminating health insurance benefits for employees.

Businesses may find that MNsure is their ally, he said. It will allow small employers to offer their employees more options, while restraining costs for larger employers, who now pay an added premium for uncompensated health care for the uninsured.