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Minnesota 2020 Journal: MNSure is Working!

March 28, 2014 By John Van Hecke, Publisher

Minnesotans are purchasing healthcare insurance through MNsure, the state’s health insurance exchange. The first open enrollment period closes this Monday, March 31. Widely reported, over 136,000 Minnesotans signed up, suggesting that conservative predictions of Obamacare’s failure and demise were greatly exaggerated. Lost in this moment is healthcare reform’s alternative and what we’d be experiencing if the Affordable Care Act hadn’t passed.

Conservative policy advocates really hate Obamacare. At least judging by their rhetoric and repeated political and policy actions working to undermine or eliminate the Affordable Care Act, reasonable people would conclude that conservatives really hate Obamacare. But recall that Obamacare, broadly cast, is an updated version of a Republican policy alternative to the 1993 Clinton healthcare reform initiatives.

Former Massachusetts Governor Mitt Romney, well before he ran for President, championed state healthcare reform. His proposal, “An Act Providing Access to Affordable, Quality, Accountable Health Care,” required every Massachusetts citizen to purchase health insurance. By requiring participation, the plan created a very large risk pool allowing for lower premiums due to the pool’s large size. It further facilitated lower costs through the large pool’s increased purchasing and negotiating power. Central to the entire concept is attempting to bring market competition to a highly regulated and, in many cases, decidedly uncompetitive or at least weirdly, counterintuitively uncompetitive healthcare marketplace.

Romney looked like a hero for his Massachusetts plan until he realized that it was a political liability as a conservative presidential aspirant. Then, he took a different, oppositional tack. But, I’m not interested in Gov. Romney’s rationale for changing policy directions. Rather, I view the Romney reversal as a reflection of larger conservative pressures on policy direction. What was viewed as a conventional conservative policy approach—greater reliance on market mechanisms and competitive structure—has, in the past ten years, been replaced by a new, obstinate conservative policy perspective rooted in opposition without regard to need or even outcome.

In that light, it’s useful to consider the alternative to Obamacare, especially at this moment of its implementation. The short version? We’d still be living with the previous forms of healthcare insurance. Costs would be skyrocketing for both public and private insurance plans. Off-kilter financial incentivization would continue driving care and reimbursement practices. A screwed-up system would continue intensifying the very elements that screwed it up in the first place.

I disagree with much of former Minnesota Governor Tim Pawlenty’s public policy advocacy but he was absolutely correct when he observed that the previous healthcare system was financially unsustainable. Cost growth projections, unless changed, would threaten to collapse the entire healthcare system. In that regard, Pawlenty was right. I opposed his alternative healthcare policy direction then and now which is to essentially do less for people with the hope that somehow they’ll be able to do more on their own.

The Affordable Care Act is not the end-all of being. It’s a start. It already requires improvement but it’s better than the alternative which is returning to an unsustainable healthcare funding system. Or worse, moving forward with a new version of the old plan.

People face considerable obstacles to realizing truly affordable healthcare. There’s the massive weight of insurance companies commanding extraordinary purchasing power and phenomenal informational insight into customer and vendor behavior. Earlier laws prohibiting people from organizing themselves into larger insurance purchasing pools, mitigating individual healthcare risks by spreading risk over a large group, is addressed in ACA by essentially creating a large-if-loose group served by the state insurance exchanges. The key is finding paths forward, toppling barriers by turning liabilities into assets.

Remember the biblical story of David and Goliath. Goliath was a skilled, experienced and physically imposing warrior. Philistine leaders were so confident of Goliath’s prowess that they were willing to stake the conflict’s outcome on a single combat result. David, in contrast, was not conventionally skilled, experienced or strong. However, David won because he changed the fight’s rules. David used technology to keep Goliath beyond Goliath’s arm reach while skillfully projecting force over distance. David used his sling, in effect artillery, to concentrate a projectile’s impact.

Sticking with the previous health insurance system would’ve created a poor outcome. Conservative objection to healthcare reform, including its manifestation through the ACA, courts disaster. Loudly insisting that Obamacare is a failure purposefully misleads people.

Despite the attacks and the implementation glitches, 136,000 Minnesotans individually chose to enroll in a health insurance program through MNsure. By day’s end on March 31, that number will be higher. Every enrollee reminds us that moving forward is a necessary and worthy goal and reinforces a core Minnesota value. We make our lives better by working at it every day. The past guides but doesn’t trap us.

Thanks for participating! Commenting on this conversation is now closed.


  • Steven Hauser says:

    March 28, 2014 at 8:59 am

    David used old tech, a rock (super old) and a piece of string(very old).  Goliath had new tech: swords, metal, armour.  The old fashioned stoning to death still works today.

    The ACA tried to enshrine new fangled high deductible insurance on everyone. Instead, in expanded Medicaid states enrollment is running 70-80%+ SINGLE PAYER.  By 2016 there will be over 30% single payer health care in MN, (Medicare, MNcare, Medicaid), the old fashioned way that old fashioned Europe uses to take care of people since the last millennium. And if the middle class got smart and pushes harder it will move past the tipping point making that old timey health care for all a reality.

    • John Van Hecke says:

      March 28, 2014 at 9:57 am

      Steven, thanks for your response. Strictly speaking, Goliath wasn’t stoned to death, in that “stoning” represents a mob effort. Goliath was felled by a single, powerful, well-placed, amplified blow projected over distance from beyond Goliath’s arm and sword reach. Goliath’s behavior, recounted in Samuel, suggests that Goliath fatally discounted the threat of David’s weaponry, resolve and faith. ACA’s limitations will, as you note, become increasingly apparent with time and experience leading us, I believe, toward single-payer. I still think that we would’ve been better off with the Clinton health reform direction of twenty years ago.

  • Anne Morgan says:

    March 31, 2014 at 7:19 am

    At the end of January, I was called on a Sunday afternoon by a hardworking and competent MNSure employee. We reviewed, and he corrected, my application. He said I would receive a determination letter in approximately three weeks. This letter has not arrived in my mailbox.

  • Mike C says:

    March 31, 2014 at 7:27 am

    For grins and chuckles I decided to go online to check out the web site and compare plans. Since the unaffordable care act was signed into law my private policy that my daughter and I have has more then doubled in price so I wanted to see what options were out there. This us what I found.

    The closest policy that I found was about $100 more per month then my current plan, the deductable would have been $12700 (which maybe 1%of the people have) which makes this unaffordable to let me see, everyone. This was even after the subsidy of $278.00 which taxpayers are paying for.

    Ok so now we have 135000 people signed up in Minnesota with a population of 4.5 million, so about 2% and how many of these people had policies that got canceled.

    On a national level the numbers are worse, but no one us willing to be honest about it. Now they are talking about a cooper plan that has even lower costs but higher deductibles. I applaud people and their ability to save that kind of money, but last year when I took three fingers off in an accident I dropped a $10000 deduct able in less then 5 seconds.

    I had $5000 in my HSA and had to borrow the other $5000 so every month I get reminded of my mistake.

    It is time for some honesty, this us not going to work and the only people making money will be the bankruptsy lawyers so people can get out of paying their deductibles.

    • tony says:

      March 31, 2014 at 9:28 am

      Mike another perosn with high deductibles that dont exist. I am 62, went on MNsure, lowered my payment from $1200/month to $469/month w/same company/same/doctors & lowered deducyible from $2500 to $500. Every sob-story put out by national GOP was followed up by reporters & ALL have been proven to be false. What do expect from Repubs…

      • Mike C says:

        March 31, 2014 at 11:59 am

        Really Tony, ALL are false. Statistically impossible. Just like in Pennsylvania where whole areas had 100% voter support for Obama, again statistically impossible.

        It’s to bad that so many people believed the lies.

        . If you want to keep your doctors, you can. With in MNSure I would have lost my doctors and because I live in rural Minnesota would have had to drive over 50 miles to the closest plan hospital.
        . This will save families $2500 a year in premiums. With MNSure my premiums would have gone up $378.00 a month and would have had higher deductibles.
        . If you want to keep your plan, you can keep your plan. I am keeping my plan because we are grandfathered in, but was told they are not guaranteeing 2015.

        America was founded on freedom and liberty but now we have a government that is mandating something. Who is this government that says I HAVE TO purchase insurance? What’s next? It scares me to think.

        • Tony says:

          March 31, 2014 at 12:36 pm

          Mikey, my numbers are real. Punch in my age(yes some areas of outstate are higher: blame it on the insurance companies) & my zip 55124 & see yourself. I got 39 options, some low as $300/month. Truth hurts dont it…  Thank you Obama, though single payer would be better….

        • Ronald Leurquin says:

          April 1, 2014 at 1:41 pm

          Making claim with abolutes always brings out the opposition with the few examples they can find (both Dems and Repubs do this), and while thier examples may likely be true, it doesnt change the more basic part of the statement that should have sued a most or many rather than an all.

          I’m fortunate to have a fairly good policy thru my employer, but….  This past year our policy was to be cancelled regardless of the ACA, it was ending.  Health insurance companies can call it a cancelation of policy or a renewal, its just symantics much of the time.  Some (SOME) policies this year were canceled due to the ACA, some for other reasons.  The ACA gave insurance companies the chane to blame it on Obama, even though the blame didnt belong there.

          I know several peopel that have used MNSure for a policy.  Most were quite happy with the results.  Most of them had a few problems getting signed up, but just dealt with the technology issues and worked thru them.  Only one person that I know has seen an increase in thier costs, butonce I pressed, found out they bought a better plan than they had before, so the cost increase was at thier choice, not a cause of the ACA.

          I checked out the ACA and MNSure to see if there was something cheaper for me, but found that there wasnt much different for me and stuck with what I had.  I wasnt trying very hard to be honest though, I like my plan for the most part, so see no real reason to change.

          As for keeping yoru doctor and such, its up to the plan you pick.  Ive had my plan thru work change and had to change doctors, not fun, but was the reality at that time.  It happens for all kinds of reasons, so those of you inclined to blame Obama or maybe just the ACA, please get a clue.  The ACA and Obama are not at fault for all the problems with health care in this country.

  • Sheryl Frieman says:

    March 31, 2014 at 8:23 am

    OF Course it is working! What people failed to understand is the concept. The concept would work properly, the problem is IT.  When ever there is new technology there will always be glitches.  The only concept that the designers really did not think of was that ordinary people do not understand insurance. That will remain a problem.  I believe that is so since the designers have no clue on how to make the website flow better and still connect with the National site.
    And the public will always need some one to help them make a choice.  I would like a single payer system, but for now, I am happy to get people on board!

  • Dan says:

    March 31, 2014 at 10:52 am

    The “implementation glitches” still exist.  A friend just tried to sign up today and found the site to be clumsy and unintuitive.  When he called the 800 number for help and was prompted to choose from a menu, (press #1 or press #2), he would get disconnected after doing so.  This happened 3 times before he finally gave up on it.
    I had problems signing up early on.  One day, everything just happened to click and I got signed up and chose a policy.  When I called the insurance company to make sure everything went through, they told me I had gotten lucky.  Luck really shouldn’t have anything to do with the equation when buying health insurance through MNsure.

  • MNsure Fan says:

    March 31, 2014 at 11:18 am

    Attention: Mac users.
    Please spread the word:  MNsure is great, but don’t use a Mac to enroll.  My friend spent the better part of a week fussing with her application.  Finally, a MNsure technician helped her on his computer and told her that Mac’s don’t work!  This information should be posted on the opening page of the website!

  • William Pappas says:

    March 31, 2014 at 6:08 pm

    One of the initial problems with the ACA was technical, on line glitches that were going to be fixed sooner or later.  Some still exist but as predicted many were fixed and the site will be continuously upgraded to provide a more consumer friendly signup.  Not only has the ACA provided insurance for millions who could not previously afford it, the policies meet certain minimum standards that will prevent unintentional bankruptices and gaps in coverage that formerly were a result of the obfuscation health insurance companies used to manipulate consumers and deny coverage at their whim.  Businesses as well benefit from a more regulated health insurance environment that doesn’t chain them to rate raising insurance companies when one of their employees gets very sick.  All of these things are stablizing health insurance and care in this country.