A nonpartisan review of MNsure's lapses

A much-anticipated report released last week confirmed what many Minnesotans who spent hours trying to buy health insurance on MNsure already knew: The online marketplace performed miserably during its first months of operation.

From a call center that was understaffed to software vendors who overpromised and underdelivered, an expensive website intended to make it easier for Minnesotans to buy health insurance instead complicated the process in late 2013 and early 2014. It also induced migraine headaches for counties and health insurers that work with MNsure to enroll Minnesotans in medical assistance or private health plans.

The 181-page report, released Tuesday, was the work of the state's respected nonpartisan Office of the Legislative Auditor. James Nobles and his staff provided a valuable service to the state with their unflinching look at what went wrong during the marketplace's rollout.

MNsure and other health "exchanges" like it are a cornerstone of the 2010 Affordable Care Act. If the law is to succeed in its core mission — expanding coverage and controlling costs — MNsure and other exchanges must perform far better. Pinpointing what went wrong is worthwhile even as the website improves during its second year of operation.

But policymakers reacted predictably — and regrettably, in our view — to the report. DFL lawmakers, who have long supported President Obama's signature health reform law, circled the wagons, pointing out the strides made in reducing the state's uninsured rate.

At the same time, Republican schadenfreude over the report was palpable. State Republican Party Chairman Keith Downey issued a call to shut down the exchange — a conclusion that the auditor's report noticeably does not reach. Downey and others who want to scrap MNsure are badly out of touch with the state's health care and business leaders. Among the organizations that oppose a shutdown: the Minnesota Medical Association, the Minnesota Hospital Association, the Minnesota Council of Health Plans and the Minnesota Chamber of Commerce.

These organizations generally are pushing for specific MNsure fixes. They need to make that abundantly clear so that the coming debate is productive. As hearings over the auditor's report made clear last week, there's still an alarming amount of work left to do. MNsure CEO Scott Leitz merits praise for being forthright about remaining challenges.

The recommendations the report does make should be embraced by lawmakers. These include greater oversight of MNsure by the state's information technology agency, as well as clarification of the executive steering committee's authority.

The report also tees up a debate over MNsure's governance. Right now, the exchange has an independent board of gubernatorial appointees with staggered terms. The board selects the CEO. The auditor's report offers a clear-eyed review of various other options, such as making MNsure a state agency or taking a hybrid approach where MNsure would have a governor-appointed CEO and a citizens board to provide transparency and private-sector expertise.

There's one other serious matter the report raises that policymakers need to acknowledge. Minnesota's vision for MNsure was unique and unrealistic. Lawmakers, at the urging of many health care stakeholders, sought not only to build a health insurance marketplace but to take on the monumental task of updating the state Department of Human Services' antiquated electronic eligibility system for public assistance programs.

The state had already tried its hand at this with the costly, failed HealthMatch program during the last decade. But the availability of federal funds for MNsure's development led to the decision to try it again as a MNsure component. Although it made sense — more federal dollars meant fewer state dollars would be needed — the decision added enormously to the new marketplace's expense and complexity. There wasn't the time or the technological resources to pull this off, which is why other state-run exchanges didn't attempt the same thing.

There's an argument to be made that the overly grand vision set up the exchange for failure. Proposed fixes must address this ongoing eligibility challenge and ensure that the time, resources and technology are available for MNsure to succeed.