MNsure faced a boomerang effect in December when cancellation notices mailed to many people in public health insurance programs were late, resulting in a flood of calls to the state's health insurance exchange.
People trying to sort out public coverage drove up wait times at the MNsure call center, just as the exchange was trying to help thousands of shoppers meet a hard deadline for private coverage.
The links between the public and private insurance sides of MNsure help explain why the exchange's board last week adopted a plan for IT fixes that features significant repairs for managing public health insurance programs.
"Making the core processes work … that's going to help everybody," said Peter Benner, the MNsure board chair, after a meeting Wednesday in St. Paul.
The vote wasn't unanimous, however, with board member Tom Forsythe questioning whether the fixes would spur growth in private plan enrollment. Those customers, Forsythe pointed out, are increasingly important as a source of revenue for the MNsure budget.
"If there's no spending in the IT development line for website enhancement … then that's a concern," he said.
It's a debate that's been common in other states that, like Minnesota, created a health insurance exchange that integrates enrollment in public and private coverage, said Chris Sloan, a manager with Avalere, a Washington, D.C.-based health care consulting group.
"You'd like them to fix everything, but the way they're going about it sounds very similar to how other groups are doing it," Sloan said. "They have finite resources."
Minnesota created the MNsure exchange in 2013 to implement the federal Affordable Care Act, which requires almost all Americans to have health insurance or pay a tax penalty. The exchange has about $33 million to put toward IT improvements this calendar year; after this year, federal grant funding for such fixes won't be available.
Under the federal health law, Minnesota has seen a significant expansion of public programs, which now cover about 1 million Minnesotans. Enrollment in private coverage through MNsure has fallen far short of original projections, although MNsure hit its goal of more than 85,000 enrollees during the most recent sign-up period.
A list of "enrollment tips" on the MNsure website touches on issues that have frustrated some users.
MNsure doesn't work on mobile devices, and users are advised to use just the Chrome and Firefox browsers. Users also are advised to clear their browser histories before applying for coverage. There are tips for how to resize Web pages when users can't see the "Continue" or "Next" buttons.
None of those items is called out on the new "IT road map" that was presented to the MNsure board last Wednesday by a steering committee of state and county officials. The seven-person committee includes two MNsure representatives, two people from the state's IT department, two from the state's Department of Human Services (DHS) and one representative from Minnesota counties.
DHS and the counties jointly administer the public health insurance programs.
"I'm not seeing that many things on the list that are going to drive growth, improve the user interface and add QHP enrollment," Forsythe said, using the abbreviation for "qualified health plans" that are sold by private insurers.
The comments hearkened back to an argument Forsythe made — and won — last spring, when a slim majority of board members voted to change the IT road map for 2015. They added an online tool so shoppers for private coverage could better see the trade-offs between low-premium plans that expose subscribers to a risk of high out-of-pocket costs.
Last week, however, Forsythe was alone in voting against the plan.
Board member Kathryn Duevel said the road map would help both public and private enrollees by improving the notices to enrollees generated by the IT system. In response to concerns from MNsure representatives on the steering committee, Duevel said, the road map was changed to include fixing certain defects, fixes that will help those signing up for private coverage.
"I really felt overall like the goal was to make that consumer experience and the website as a priority, and to me that's our best way of getting QHPs," Duevel said.
Allison O'Toole, the MNsure chief executive, said there will be spending on certain website enhancements beyond expenditures set in motion by the road map.
Late last year, MNsure launched the online tool in conjunction with a Washington D.C.-based nonprofit called Consumers' Checkbook, but didn't include a feature that lets consumers search plan options by which doctors and hospitals are included in the plan's network. Such a tool is increasingly important as more MNsure plans control costs by offering a "narrow" network of providers.
"It is absolutely a priority for us. … Stay tuned on that," O'Toole said of the network search tool in an interview after last Wednesday's vote.
State and county workers have struggled since MNsure was launched to use the system to manage cases in the public programs, and the troubles in December were just the most recent example.
At that time, the state was on the verge of dropping more than 60,000 enrollees, but it decided on New Year's Eve to extend the coverage for a month after hearing complaints that people either were wrongly being cut off or hadn't been properly notified. In January, DHS officials told legislators that the state had failed to give enrollees a required 10-day notice of the cutoffs, partly because of faulty information from a vendor.
MNsure board member Emily Johnson Piper, who is also the state's Human Services commissioner, didn't reference the episode when casting her vote last week. But she voted with the majority to adopt the plan.
"My public program enrollees should receive the benefit of basic IT system functionality when they're enrolling and when they're renewing," Piper said, adding: "Until that happens, I am very, very comfortable with sticking to the basics … which I think is exactly what this road map does."