A new report suggests that about 107,500 Minnesotans last year weren’t tapping federal tax credits to discount health insurance premiums, even though they qualified.

In some cases, people eligible for subsidies might have simply skipped the tax credits, because the dollar value was small.

But there also could be information gaps where people either didn’t realize they were eligible, or didn’t know where to go for subsidies, according to findings presented Wednesday during a MNsure board of directors meeting in St. Paul.

“Affordability continues to be a big concern for people without coverage, and that may be part of the information gap,” said Alisha Simon of the Health Economics Program at the Minnesota Department of Health. Her report added: “Non-group enrollees may be aware of premium subsidies, but many think they are not eligible.”

Allison O’Toole, the MNsure chief executive, said the report will help guide future marketing efforts. This fall, MNsure will present more detailed data that show pockets of potential enrollees on a county-by-county basis.

“Because of the sample size, they can’t be super specific,” O’Toole said of the health department’s report. “But all information helps.”

Minnesota launched the MNsure exchange in 2014 to implement the federal Affordable Care Act, which requires almost all Americans to have health insurance or pay a tax penalty. The health law created exchanges for all states as the way to distribute tax credits to people at certain income levels who buy non-group coverage.

The report presented Wednesday drew on telephone survey data collected by the health department in 2015. It found that only 49 percent of those in the non-group market and only 21 percent of the uninsured were aware that MNsure is the only place in Minnesota to obtain the federal tax credits.

The lack of awareness is “disappointing,” said Stefan Gildemeister, the health economist at the Minnesota Department of Health.

People use MNsure to buy individual and family coverage from private insurers and to enroll in public program coverage. While sign-ups in private plans through MNsure have fallen short of original projections, the exchange this year claims more than 400,000 total enrollments across all groups since Nov. 1, 2015.

O’Toole said the figures show the challenge that’s ahead for MNsure as it tries to connect to the remaining 4 percent of state residents who lack health insurance.

“In two years’ time, we’ve cut the uninsured rate in half,” O’Toole said. “This pool is getting smaller and harder to reach. And so the remaining uninsured, we have more work to do to reach them.”

The estimate for people missing tax credits last year includes a mix of those who bought outside MNsure and those who lacked coverage altogether.

Overall, the report is helpful, O’Toole said, because it points to places where MNsure might target its marketing efforts.

The health department’s numbers, for example, show that a greater share of residents in the northern part of the state are eligible for tax credits, compared with the metro and southern Minnesota.

That helps explain why MNsure is opening a new broker enrollment center in the Bemidji area to improve outreach in the region, O’Toole said.

But the health department’s numbers also point to one of the marketing dilemmas, she added, since the absolute number of people who qualify for tax credits is largest in the Twin Cities.

When it comes to outreach efforts for 2017, the report couldn’t factor what’s emerging as a major issue for MNsure and the entire individual market.

Last month, Blue Cross and Blue Shield of Minnesota announced that it would stop selling certain health plans in the market that currently cover about 100,000 people, including about 20,000 who bought through MNsure.

MNsure will try to inform current Blue Cross customers who bought through the exchange how they can pick new plans that maintain their subsidies, O’Toole said.

“It kind of reshuffles the deck,” O’Toole said.


Twitter: @chrissnowbeck