Editorial: Health exchange questions linger

Unlike many other states, Minnesota will probably escape having a one-size-fits-all "health exchange" imposed on it by the federal government. That's largely due to the state's Commerce Department, which has energetically tackled the challenge of building a Minnesota-made version of the online health insurance marketplace and meeting the aggressive deadlines set by the 2010 Affordable Care Act.

But a recent dust-up over the exchange strongly suggests that Commissioner Mike Rothman and his talented staff have room for improvement when it comes to this intangible but critical component of building the exchange: community relations.

For all of the daunting information technology challenges this project involves, creating buy-in from the consumers and businesses who will purchase coverage through the exchange beginning in 2014 is the most important task of all. That's why a recent critical letter from the Minnesota Chamber of Commerce is troubling.

The July 20 letter, signed by Chamber President David C. Olson, is polite. But it also constructively conveys the organization's frustration over unanswered questions about the exchange's cost and governance as a federal deadline looms for submitting the state's plan in November. If states haven't made adequate progress on their exchanges by 2013, federal officials are preparing to step in with a more generic exchange to ensure that one is ready to go in 2014.

"Minnesotans have not been told who will run the exchange, the scope of what the exchange will regulate, what functions the exchange will perform, how much the exchange will cost, how the state will pay for the exchange, or even what the state legally needs to do to establish the exchange," Olson wrote.

Another influential stakeholder, a coalition of state insurance agents groups, also sent a letter to the Commerce Department earlier this year with questions about the exchange. It's still awaiting a response to its May 29 query, though department officials said Thursday a response is being sent out.

These groups deserve answers about why this information is not yet available. The exchange is a key component of the Affordable Care Act. In addition to helping consumers shop, it will determine their eligibility for subsidies to buy coverage. It's much more than a comparison-shopping site.

Unfortunately, the inaction means the Commerce Department has to work harder to engage the public and stakeholders in the exchange's creation. While department officials deserve credit for setting up advisory groups and holding meetings around the state, important details have yet to be finalized or communicated clearly. It's understandable that with scant months before the November deadline, the chamber and other stakeholders are growing anxious.

State officials said Thursday that some of the information sought by the chamber is available. For example, a recently signed $41 million information technology contract provides insights into the cost to build the exchange, and the department also released information showing that more than 93 percent of it will be paid by the federal government. A fiscal note attached to unpassed exchange legislation from the past session also provided a cost range for running it.

State officials said some of the information sought by the chamber isn't yet available because work on the exchange is still underway.

Commerce officials would do well to heed a suggestion in Olson's letter and publish a more specific plan. Centralizing the information that's available and providing a clear, written explanation for data that isn't would help allay stakeholders' concerns as work continues on this important and historic project.

Going forward, proactive communication will be a critical component in building the best possible exchange for Minnesota.