Portico navigator Victoria Quiroz worked with a client on the phone, Wednesday, October 16, 2013. Portico has been working since 1995 to help low-income people get publicly funded health care through programs like Medicaid and MinnesotaCare.
ST. PAUL, Minn. — The number of people who signed up for insurance through Minnesota's online exchange nearly tripled from its first two weeks of operation to its second two weeks, but it's impossible to say whether MNsure is succeeding in the key goal of the federal health overhaul: reducing the number of people without insurance coverage.
MNsure officials said Wednesday that about 10,940 people signed up for insurance in the site's first month of operation and an additional 4,328 people completed the application process but haven't yet picked an insurer. What's lacking is an accounting of how many of those enrollees previously did not have insurance.
The reason? MNsure isn't asking.
"Our application itself does not ask what someone's previous coverage was," said April Todd-Malmlov, MNsure's executive director. "It's not a required question to ask if someone previously had coverage."
Todd-Malmlov acknowledged that reducing rates of the uninsured was among the chief goals of the health care law championed by President Barack Obama and passed by Congress in 2009. While Minnesota is one of 14 states operating its own exchange rather than deferring to federal control, Todd-Malmlov said MNsure's application was based on a standard federal application that also doesn't ask whether enrollees previously had insurance.
"What we were really focusing on, given a compressed timeline, was making sure we could get our application approved in time," Todd-Malmlov said. "We didn't really look at things other than what we thought was necessary."
At least a handful of states similarly operating their own exchanges are asking applicants if they are insured. Those include Nevada, Oregon and Washington state.
For Minnesota, that means a key measure of MNsure's success or failure won't be available until March 2016. That's when the state Department of Health will release its biennial survey of uninsured rates in Minnesota. The survey that will come out in March 2014 will cover 2012-2013, meaning it will only serve as a "baseline" for pre-MNsure rates, Todd-Malmlov said.
"I think most people would agree the main objective from Day 1 was that those without health insurance would be getting covered," said state Rep. Tara Mack, R-Apple Valley. "If we're not going to get answers about that for several years, that big question that begs is, who will be held accountable for whether or not this massive health care reform has met its main objective?"
The last Department of Health survey, released in March 2012, found that 9.1 percent of Minnesota residents were uninsured — an estimated 490,000 people, including 70,000 children. A 2011 study for the state Department of Commerce estimated that 300,000 uninsured Minnesotans would be able to obtain coverage through the new federal law. Many more people who have been buying insurance on the private market are also eligible for shifting to MNsure.
Todd-Malmlov said MNsure's board could reconsider what information it asks of potential enrollees.
MNsure officials said they were pleased with the pace of enrollment a month into the site's launch. Because many of the plans purchased will cover more than one person, the 10,940 people who signed up represent an estimated 31,447 people who will be covered. Of the 10,940, there are 1,774 people purchasing private plans. The remaining 9,166 are on public insurance plans.
In addition, 894 small businesses have set up accounts.
Todd-Malmlov has said she expects the pace of enrollment to accelerate as a Dec. 15 deadline approaches for having coverage in place starting on Jan. 1.
At a meeting Wednesday, the MNsure board unanimously approved a 1.5 percent withhold on premiums sold on the exchange, to help cover 2014 expenses. That was the highest possible rate allowed under the legislation that created Minnesota's online exchange.