March 10--WILLMAR -- Against a backdrop of turmoil and uncertainty about the future of the Affordable Care Act, Minnesota's health insurance exchange saw record enrollment this year.
That tells Allison O'Toole, chief executive of the MNsure exchange, that Minnesotans see the value of buying an individual health insurance policy through the exchange and obtaining tax credits for doing so.
Scrapping the exchange, as some state legislators have suggested, or repealing the Affordable Care Act at the federal level will have a major impact that won't be for the better, O'Toole said.
"We've made so much progress in the last few years. We can't turn our back on Minnesotans right now," she said. "We need to keep moving forward."
O'Toole was in Willmar this week as part of a series of visits around the state to share enrollment numbers and what may lie ahead for the 4-year-old exchange.
A record 117,654 people purchased individual coverage during MNsure's recent open enrollment period, which ended Jan. 31. Almost half were new to the exchange and about 64 percent are receiving tax credits that average $621 a month.
Public programs also saw record enrollment: 33,369 in MinnesotaCare and 114,511 in Medical Assistance.
Medical Assistance is Minnesota's Medicaid program for low-income people, and MinnesotaCare is a subsidized health insurance program for Minnesotans who cannot afford private insurance.
Improved access to health insurance is credited with helping lower MInnesota's uninsured rate to 4.3 percent, one of the lowest in the U.S.
Amidst these gains, the MNsure exchange is navigating turbulent waters.
The threatened collapse of the state's individual insurance market last fall, which led many of the major insurers to either pull out of the individual market or institute enrollment caps, hit just before the enrollment period opened. Many consumers saw prices go up and choices decrease.
No one was shut out of the market, O'Toole said. "Everyone had at least one choice."
But it created considerable tension, she said. "It was an extra layer of confusion for consumers. It just shifted the cadence entirely."
Jonathan Marchand, a navigator with United Community Action Partnership, said he saw this reflected during enrollment. "The sense of urgency was really prominent in a lot of clients," he said.
He and O'Toole said the potential repeal of the Affordable Care Act will have serious repercussions across the state.
O'Toole worries that progress in lowering the rate of the uninsured will be rolled back and that Minnesotans may become less healthy as a result.
"Minnesota has really led for a number of years. We need to continue that," she said. "We stand to lose a lot with the repeal efforts that are going on."
Marchand's work involves helping low-income families achieve economic self-sufficiency. Access to health insurance is one of the factors that can lift people out of poverty, he said. Coupled with tax credits to offset premium costs, "it can help save a lot of money" for these households, he said.
Tax credits in Kandiyohi County and surrounding counties are averaging around $800 a month -- about $200 higher than the state average, according to MNsure numbers.
MNsure estimates the collective tax credit savings at $370 million, an amount that O'Toole calls "real money."
"That's making a huge difference," she said, adding that medical bills remain the leading cause for bankruptcy filings in the U.S.
Also at stake is a new empowerment among consumers who, for the first time, can shop and compare on the MNsure exchange and make health insurance decisions that fit their priorities and circumstances.
"That did not exist before the ACA," O'Toole said. "That is incredibly important for consumers as they navigate this world. It requires consumers to engage in a different way."
Marchand said he sees this shift in the clients he works with. "The questions have changed from consumers saying, 'Why do I have to have insurance?' to 'What kind of insurance is going to be most cost-effective?'" he said.
Despite the uncertainty, MNsure is moving ahead with plans for the next enrollment period. The exchange is ahead of its revenue and enrollment projections and is meeting budget requirements, O'Toole said.
A preliminary budget for fiscal year 2018 is due to the Legislature next week.
O'Toole said her office will continue to issue information as the situation becomes more clear. "As soon as I know something, I will start to message that, because consumers need to know," she said.
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