MNsure must react to sobering diagnosis

It was a painful Wednesday in a state long known for its world-class medical care and nation-leading health reforms.

In measured, almost clinical tones, outside experts called in to review the state’s new MNsure insurance marketplace delivered a grim diagnosis of the fledgling website’s condition. Just two months before another key deadline to sign up for 2014 coverage, MNsure has deep technical design flaws, unreliable functionality and a woefully understaffed call center — problems that make it unlikely initial enrollment projections will be met.

Optum’s review of the site’s governance, which covered the time period before interim executive director Scott Leitz was installed, also concluded that “structure and process is nonexistent” in program management and that decisionmaking was made in “crisis mode.”

The problems plaguing the site weren’t altogether surprising given the high-profile news coverage of MNsure’s mounting problems as consumers raced late last month to meet an end-of-the-year deadline for coverage beginning Jan. 1. Still, the big picture provided by Optum, a subsidiary of Twin Cities-based UnitedHealth Group, was sobering.

Even though the state has spent millions (mostly from federal grants) building its customized marketplace, it now appears even more is needed to make the site reasonably functional.

No estimates on how much it will cost to fix MNsure were offered during the Wednesday board discussion of Optum’s pro bono “end to end” review. But the price tag will be substantial for this in-demand expertise.

According to a Dec. 29 MedCity News report, Maryland hired Optum “on an emergency basis for a two-month, $4 million stint” to fix its troubled insurance marketplace. Timelines given Wednesday by Optum, which has cultivated a healthy business repairing these online marketplaces, to fix or overhaul MNsure ranged from 16 to 24 months.

One note to state officials evaluating MNsure options: A “large infusion” of federal funds is reportedly helping to pay for Maryland repairs. Whether similar aid is available for MNsure is unclear, but this is an avenue to be promptly pursued given current demands on the state budget.

Some of the initial descriptions of the Optum report, particularly on social media by health reform opponents, misleadingly suggested that the firm had recommended scrapping MNsure entirely. The clear message from Optum is that the site is fixable.

The firm laid out three options for doing so. The first two offered varying intensities of repair to the current framework. The third option is the equivalent of replacing a car engine during a vehicle repair: rebuilding the site’s technical architecture, something that could be done in 12 to 18 months, while still leaving the current site operational for consumers. Optum also recommended beefing up call-center staffing, as well as more efficiently routing phone calls — something MNsure has begun already.

The fixes won’t be completed before March 31, the last day consumers can buy 2014 coverage and avoid the penalty for not having insurance. But the repairs are doable and substantive improvement realistic.

Optum’s review covered a lot of ground, but it didn’t delve into broader questions about MNsure’s governance structure, funding, accountability and mission.

Legislation authorizing the marketplace was passed on a mostly DFL party-line vote in 2013, just months before the website’s Oct. 1 launch, after a Republican-controlled Legislature stonewalled development during two previous sessions. The toxic politics likely influenced decisions about the MNsure board’s independent structure and future funding from a premium tax instead of state funds. This helped insulate the marketplace from future politically motivated attempts to gut it.

Lower-than-expected enrollment and premiums mean that MNsure could soon face an operating deficit. How will the shortfall be addressed? Questions about MNsure’s governance also raise concerns about the board’s independent structure — who will hold its members accountable for the problematic launch? Should the website scale back its features, adding back functionality as stability improves?

The 2014 legislative session is a short one, with House members and Gov. Mark Dayton looking to exit quickly and painlessly ahead of fall elections. But there’s still critical work to do on MNsure. The topic may be a political hot potato, but a key reason the state built its own exchange was so Minnesotans — not faraway federal officials — would be on the case when problems occurred.

The site can be fixed technically. The question is whether the political will exists in an election year to address the broader questions kicked up by MNsure’s troubled rollout.