MNsure CEO Discusses Reinsurance

April 06--Half a billion dollars should help.

Allison O'Toole, chief executive officer of MNsure, the Minnesota marketplace of individual, family and small-group insurance, said the just-passed reinsurance law that sets up fund to help insurance companies manage risk in Minnesota should help keep providers in the state and even lure back some, such as Blue Cross-Blue Shield, that left the individual marketplace in Minnesota.

"The Legislature gave (insurance companies) $542 million over two years to help them manage their risk," she said. It is meant to cover high-cost claims.

Part of the problem is that the individual marketplace in Minnesota is small compared to other states, and many enrollees are actually covered by Minnesota Care, she said, meaning the pool covered statewide by private plans through MNsure is relatively small.

In fact, about 121,000 Minnesotans are covered by private plans through MNsure, according to the agency's website. The fund would pay between 50 percent and 80 percent of claims between $50,000 and $250,000 in the individual marketplace.

While Gov. Mark Dayton did not sign the reinsurance bill but simply let it pass into law, O'Toole said she hoped by bringing more insurance companies into the market, prices would go down and choices would go up.

Southeast Minnesota is taking advantage of MNsure. Seventy-eight percent of MNsure's private plan enrollees in the 1st Congressional District receive tax credits. But not every county in the state has a good MNsure experience. For example, five counties in north-central Minnesota have only one provider, Medica, which stayed in those counties because of a deal with the state Department of Commerce.

"I think the efforts to stabilize the market could impact that," O'Toole said. "Consumers want choices and need it."

Even with rising premiums and the high deductibles, MNsure beat its goals for enrollment for 2017 and has balanced its budget. And, absent any major changes on the federal level, will be around for 2018 and beyond.

O'Toole said there are again bills in the Minnesota House and Senate wanting to transfer to Healthcare.gov, the federal portal, but Gov. Dayton has "made it clear that he doesn't have interest in doing that right now."

"There's a lot of confusion in Washington," she said. "But we have Minnesota Care, which has been around 25 years. The federal program doesn't have a way to handle that platform. And if we switched, there'd be thousands of Minnesotans not knowing they are eligible."

In addition to trying to bring back more insurance carriers to the marketplace, O'Toole said MNsure is looking to outsource its beleaguered web portal to try to make signing up simpler.

"We haven't tested the market in a while," she said. "We owe it to the taxpayers to do that."

With 96 percent of Minnesotans now covered with health insurance either through the state or employer health care, O'Toole said repealing the Affordable Care Act -- Obamacare -- would cause ripples throughout the state.

"It could have a huge impact on the state budget," she said.

Furthermore, with MNsure working with so many assistance organizations and navigators to get people signed up, a new health-care paradigm would re-write the rules and undo much of the work MNsure has done to get to the level of coverage the state currently enjoys.

A big part of that was the premium relief bill passed in January that cut premiums by 25 percent. The $326 million bill, though, is probably a one-time thing.

"I don't know if our state could do that a second year," she said.

O'Toole said she hopes more people who have been positively impacted by the ACA come forward to tell their stories. Which all ties back to the reinsurance bill to help keep more insurance companies in the market to, hopefully, keep prices down.

"We shouldn't go backwards," she said. "When (reinsurance) went into effect, that was a move forward."

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