Back to basics after MNsure shakeup

The board of directors at MNsure has serious work ahead to regain Minnesotans' confidence as glitches mount and as the health insurance marketplace suddenly finds itself without a top leader.

April Todd-Malmlov, the executive director of the website at which Minnesotans may shop and sign up for insurance under the Affordable Care Act, resigned under fire Tuesday evening. She is being replaced on an interim basis by Scott Leitz, an assistant commissioner at the Department of Human Services.

The seven-member board, which held a closed meeting yesterday to discuss Todd-Malmlov's two-week trip to Costa Rica in the midst of MNsure's launch, needs to ensure it does nothing further to undermine the fledgling effort.

Postponing a vote on whether to dramatically revamp the site's insurance offerings in the future would be a good start. That was true before Todd-Malmlov's departure. It's even more critical now that MNsure will have to conduct a search for a permanent replacement in a hard-to-fill post requiring a rare combination of technical savvy, health care expertise and a willingness to work long hours on a start-up project caught up in toxic political crossfire.

It's becoming clearer by the day that the rocky reality of MNsure's launch badly lags the initial expectations of the board and staff — and more importantly, of the public — with the site so close to the Dec. 23 cutoff for coverage that begins Jan. 1.

MNsure's board was expected to vote Wednesday on "active purchaser" — an approach for 2015 (the site's second full year of operation) that could help control coverage costs by pushing consumers to a limited number of plans that deliver quality, low-cost care. Premature consideration of that kind of significant overhaul only underscores concerns that the leadership of the new marketplace hasn't adequately adjusted its agenda to the sobering realities of late 2013.

The board needs to table the measure and make it abundantly clear to the entire state that improving MNsure's performance and finding a top-notch new executive director is its immediate focus. Right now, the marketplace is a long way from completing work on the foundation it needs for success — a website that works reliably and thousands of satisfied customers.

More recently came reports that 1,000 customers need to redo their applications because they were told incorrectly that they didn't qualify for subsidies to help pay for premiums. And data from MNsure needed to properly enroll consumers in their chosen health plans still has troubling gaps, according to insurers.

On Tuesday, an editorial writer on hold for an hour to the MNsure call center found out through the automated hold-time message that another problem has surfaced. Some consumers have received material indicating that coverage will start Feb. 1 instead of Jan. 1, likely the result of computer systems not being adjusted to reflect a recent move by the federal government to extend by about a week the deadline for coverage starting New Year's Day.

The steady drip of problems undermines past reassurances from MNsure leaders that the majority of consumers have enrolled without snags. It also makes officials sound like they're disturbingly disconnected from the site's operations and tone-deaf to consumer frustrations. The timing of Todd-Malmlov's vacation with Jim Golden, a top state human-services official working on MNsure's rollout for medical-assistance enrollees, added to the sense that the site's top brass are out of touch.

Todd-Malmlov provided otherwise steady leadership on a complex project with tight deadlines. With her departure, it falls to Leitz and MNsure Board Chair Brian Beutner to make sure the board is focused on the site's performance and doesn't get ahead of itself on the active-purchaser question. (The state's insurers and Chamber of Commerce are urging the board not to move to such a model).