MNsure is gaining steam as key dates near

Advocates of building a Minnesota-made health exchange — the new Affordable Care Act insurance marketplace — repeatedly brought up a key advantage of the do-it-ourselves approach over relying on the federal government.

When consumers, small businesses, health plans, insurance brokers and others encountered snags, it would be Minnesotans standing by to help — not staffers in a faraway call center juggling responsibility for more than 30 states that shortsightedly chose not to construct their own.

In the wake of the federally built HealthCare.gov's disastrous but improving launch, the decision to build the state's customized marketplace, now known as MNsure, was not only prescient but underscored Minnesota's global reputation as a health care leader. MNsure's launch hasn't been perfect, either, but it has been far more respectable than HealthCare.gov's.

Credit not only the hardworking MNsure staff and vendors, but also the state's respected health care community, particularly its health insurers and the staff at state agencies specializing in public health programs. While these organizations' employees have put in long hours this fall, their continued dedication is needed to ensure MNsure's success.

This week, state officials reported that the number of people signing up for coverage rose dramatically from the end of October to the end of November. More than 32,000 applications representing about 72,000 Minnesotans have been completed.

Almost 49,000 of them applied for private health insurance. That's laudable, but there's still work to be done to meet projections that 102,800 people in the state would buy private plans through the new marketplace for 2014. Fortunately, there's still time to meet that goal.

While consumers need to enroll by Dec. 23 and pay their first premium by the end of the year to start coverage on Jan. 1, March 31 is the cutoff date for buying 2014 coverage in time to avoid the tax penalty for failing to purchase a plan.

Massachusetts' experience in launching health reform suggests that a significant spike in enrollment will occur the month before the state's mandate to buy insurance kicks in. Many people, particularly healthy people, put off buying coverage in Massachusetts until they had to, according to a 2011 New England Journal of Medicine article.

The MNsure staff still has heavy lifting to do to improve the site's reliability and accurately move enrollee data to insurers so that health plans can enter consumer information into their systems. That process just got underway late last month, so state health plan staff will have to scramble to ensure that people who purchase coverage through MNsure by Dec. 23 and pay for it before the end of the year will have coverage beginning Jan. 1.

The state's health plans are worthy of this challenge, but a letter sent Friday to MNsure officials raising serious concerns about the accuracy of the data suggests it won't be easy. Insurers are also understandably concerned that many people who have enrolled but have not yet paid are just now receiving invoices. They won't have a traditional 30 days to pay these bills if they want Jan. 1 coverage. The invoice and payment is critical; these steps have to happen before consumers get the cards they need to be assured they have coverage.

This week also marked the launch of the federal government's retooled HealthCare.gov site. While the site appears to be working more reliably for consumers wanting to buy insurance, news reports suggest it's still experiencing delays and glitches.

Whether it can handle the glut of consumers rushing to sign up by the Dec. 23 deadline to start Jan. 1 coverage is unclear. And whether the site's so-called "back end" issues — getting coverage information to insurers for timely processing — remains another troubling question.

While both systems remain a work in progress, Minnesota lawmakers were smart to enlist the state's world-class health expertise in building the new marketplace. The state has a long history of coming together to overcome challenges. Making MNsure work is one of those "everybody on deck" situations, but the new availability of affordable coverage for all is worth the effort.