What's the best way to improve MNsure?

After MNsure's disappointing debut in late 2013, state lawmakers would be remiss if they didn't scrutinize the new health insurance marketplace and find ways to improve it. But convincing arguments have yet to be made for MNsure fixes proposed this year by DFL and Republican lawmakers.

While the state waits for recommendations for improving MNsure from the Office of the Legislative Auditor, both parties ought to be coming up with additional ideas.

The DFL's main initiative calls for getting rid of MNsure's independent governing board and making the marketplace a state agency. In a previous editorial, we said DFL leaders had not fully explained how that would make its operations "more nimble." Despite a high-profile Senate hearing on Wednesday, that explanation remains unclear.

The curious lineup of those urging the bill's passage — representatives from TakeAction Minnesota, Legal Aid and the Service Employees International Union testified — failed to make the case.

The GOP's lesser-known MNsure fix is championed by Rep. Tara Mack, R-Apple Valley. Mack's legislation merits praise for providing a more innovative idea: Eventually allowing consumers who qualify for newly available tax credits to use this assistance to buy directly from insurers instead of going through MNsure, which is still smoothing out website glitches. Currently, the Affordable Care Act's new tax credits are only available to those who qualify and buy their health insurance on marketplaces like MNsure.

Mack's legislation deserves an airing. The debate over MNsure fixes should be a broad, bipartisan discussion with room for new ideas. Proponents of Mack's bill, who include influential co-authors in the Senate, need to answer serious questions. Mainly, is it legal? And would it create more operational problems than it would solve?

To be clear, passage of Mack's legislation would not immediately allow Minnesota consumers to access the tax credits outside MNsure. Instead, the state would seek a waiver from the federal government. The 2010 Affordable Care Act (ACA) allows the assistance to be provided only through new health care marketplaces like MNsure.

The U.S. Department of Health and Human Services, which will consider waiver requests like this in coming years, declined to comment specifically on the likelihood of agency approval. A pending U.S. Supreme Court decision on marketplaces like MNsure adds to the uncertainty.

Other experts were not so reticent, however. Bob Laszewski, a well-known health policy consultant, said that the Obama administration has been "very negative" on this concept, because it could weaken marketplaces like MNsure by diverting business from them. Harvard University Prof. John McDonough, author of a landmark book on the ACA, said the chances for approval of a waiver by the current administration were "pretty close to zero.''

Serious questions also need to be answered about the operational impact of Mack's proposal. A key concern: Who would determine if those seeking assistance meet financial guidelines for tax credits or other public medical programs? If some eligibility would be delegated to insurers, are they ready to handle this technologically challenging process? If MNsure still handled it, how would consumers' experience improve?

Many of the MNsure glitches have been related to this complicated function and the need to update the state's antiquated technology. McDonough also pointed out that moving to this model would undermine one of the key functions of marketplaces like MNsure.

"The exchange structure is meant to provide some security to enrollees that they have an advocate on their side — much like individuals who receive coverage from their employers usually have a human resources department or human resources official who is responsible to help them when the insurer screws up or misbehaves — which happens far more often than [Mack's bill's] proponents would like to admit,'' McDonough said.