MNsure tops last year’s health plan sign-up tally

Star Tribune (Minneapolis, MN)

Jan. 18--More than 116,000 people enrolled in individual coverage via MNsure for 2018, a tally that's about 1 percent ahead of last year's record-setting enrollment at the state insurance exchange.

The uptick came at a time when the federal government website that serves as the health exchange for most states saw a 4 percent decline in sign-ups for 2018 coverage.

MNsure Chief Executive Allison O'Toole said Minnesota bucked the trend because the state had flexibility to run a longer open enrollment period and also maintained marketing efforts as the federal government pulled back on outreach. The marketing was particularly important, O'Toole said, because ongoing efforts by Republicans last year to repeal the federal Affordable Care Act (ACA) caused confusion among shoppers.

"There was constant confusion about whether or not that [law] would be in place, whether or not the mandate would be in place," O'Toole said, referring to the ACA requirement for most people to have coverage or pay a tax penalty. "Our market is stabilizing here in Minnesota because of some bipartisan work. We've got a good story to tell."

Last year, state lawmakers created a "reinsurance" program that's helping keep a lid on premium growth in Minnesota's individual market, which serves about 166,000 people. The market primarily serves people under age 65 who are self-employed or don't get coverage from an employer.

The ACA launched MNsure and other exchanges in 2013, and includes a requirement for most to have health insurance. Last month, Republican-backed legislation signed by President Donald Trump to overhaul the tax code included a provision to eliminate the health insurance coverage mandate in 2019.

"Given the uncertainty in the marketplace, the fact that it actually grew 1 percent is a big positive," said Deep Banerjee, an analyst with S&P Global Ratings.

MNsure's growth rate in sign-ups is smaller than the roughly 4 percent growth in paying customers that's projected in MNsure's budget for 2018. The peak in paid enrollment typically comes in February or March, so it's not yet clear whether the exchange will hit its budget goal.

Even with the record number announced Wednesday, MNsure remains far short of enrollment projections from 2012 and 2013 when lawmakers created the health exchange for Minnesota. A lot of the gap has stemmed from the lack of interest among small businesses in buying coverage through the exchange.

For 2018, insurers are not selling small business coverage via MNsure, whereas last year's final open enrollment tally of 117,654 sign-ups included about 2,800 people in small business plans.

At the end of June, just over half of all individual market shoppers were in health plans purchased via MNsure, whereas roughly 75,000 people in the market bought directly from insurers or through brokers in the "off-exchange" market. It's not yet clear what's happening to off-exchange enrollment for 2018, so the overall trend in the individual market is unclear.

A report last week from the Minnesota Department of Health highlighted promising signs of stability in the market, but noted enrollment declined by about 46 percent from June 2015 to June 2017.

"One of the most pressing concerns has been the rising costs facing individual market consumers," the report stated. "Average individual market premium prices increased by double digits in Minnesota in both 2016 and 2017."

Many buying though MNsure qualify for federal tax credits that effectively cap premium prices, thereby insulating consumers at certain income levels from premium increases. For 2018, the average yearly tax credit amount is $6,912, state officials said Wednesday.

In recent years, MNsure has benefited from an apparent shift of enrollees from the off-exchange market, likely so that shoppers could realize savings via tax credits. In the first year of the exchange in 2014, relatively few Minnesotans signed up via MNsure due to technical problems as well as the relatively low likelihood of subsidies, since the market price of coverage at the time was relatively low.

During open enrollment for 2018 coverage, a total of 116,358 people signed up for coverage via MNsure. The tally is about 1 percent higher than last year's open enrollment count of 114,810 people signing up for individual market health plans.

At the federal government's HealthCare.gov website, about 8.8 million people signed up for 2018 coverage, which was down by about 4 percent from 9.2 million people last year. Thirty-nine states use HealthCare.gov, where open enrollment ended last month.

Minnesota is in the minority of states operating their own health exchanges. Like other state-based exchanges, MNsure opted for a sign-up period that stretched into the new year.

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