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Keep or dump MNsure, or is there an alternative?

MNsure executive Allison O'Toole tells reporters Nov. 3, 2016, that her agency sold more health insurance policies the first two days they were available than it did by Thanksgiving a year earlier. Don Davis / Forum News Service

ST. PAUL — The debate is familiar to Minnesotans: Keep or dump MNsure, the controversial state-run program that sells individual health insurance policies.

Now, Minnesota leaders also are looking at a middle ground that would keep a state insurance sales program, but turn much of the work over to private business.

The proposal by Sen. Scott Jensen, R-Chaska, somewhat resembles a route MNsure itself is considering, but enough questions remained at week's end to make it unclear how much chance it has.

"I think MNsure has been a tool to bring us to a certain point in time," Jensen said, adding that "we can sharpen the pencil and decide where we want to go."

Jensen's bill would seek proposals from businesses to take over the insurance sales program, along with communicating with customers, insurance agents and others involved with individual insurance policies.

Sen. Mary Kiffmeyer, R-Big Lake, said Jensen's bill is "very thoughtful in keeping what works." Change is needed, she said, because "the pain is clear."

MNsure CEO Allison O'Toole told a Senate health committee Thursday, March 23, that the marketplace's rollout three years ago was not smooth, but things have improved since then.

Kiffmeyer and other Republicans say MNsure is a waste of taxpayer money. Many want MNsure to die, leaving Minnesotans to buy individual insurance from a federal-government sales program.

On the other hand, Democratic Gov. Mark Dayton said MNsure works and should remain.

"MNsure is performing very well," Dayton said. "It is not MNsure's fault that rates are going up."

O'Toole said MNsure, and subsidies available through it, are the reason Minnesota's uninsured rate has dropped dramatically in the past three years.

The decision about what to do with MNsure may not be made until May, or even later if lawmakers and Dayton do not agree quickly on a budget for the next two years.

The three options, and any others that arise in the next few weeks, remain possible.

A House committee voted to drop MNsure, requiring Minnesotans to sign up on a federal exchange for individual insurance policies.

MNsure was too big of a project that was rolled out too quickly and doesn't do what it promised, Rep. Matt Dean, R-Dellwood, told the Health and Human Services Finance Committee that he leads.

Dean's legislation would repeal the marketplace and have the state opt into the federal system that currently services many states. The move is intended to save money, Dean said.

Democratic committee members criticized the plan, saying that it is imprudent to direct people toward the federal system while the federal government's position on maintaining it is uncertain, especially in light of MNsure's record enrollment this year.

Several Duluth residents told a Senate committee about their fear of losing MNsure.

"Insurance illiteracy is being replaced by insurance literacy," Karen Walter of Community Action Duluth said. "I see MNsure working for Minnesotans every day."

Megan Halena of the Insure Duluth Coalition said she works with Minnesotans who use MNsure and Wisconsin residents who use the federal sales program. She said Minnesotans "are less likely to fall into a gap" and they get better service through MNsure.

Southwestern Minnesota farmer James Kanne said he knows many people who benefit from the "one-stop shop" MNsure offers.

Many farmers rely on individual health insurance policies such as MNsure sells because they do not have employer-provided insurance.

MNsure vs. insurance

MNsure sells insurance, and pretty much nothing else.

Minnesotans, people who testify at the Legislature and even some lawmakers do not understand what MNsure is. To put it simply, it is a state-run program that sells individual health insurance policies from insurance companies.

MNsure does not write its own policies and has no control over policies it offers.

The 3-year-old MNsure does not set insurance rates, or have anything to do with it. It is the state Commerce Department that does that, and Commerce is a separate agency. Commerce also regulates other aspects of the insurance industry.

People who buy insurance on MNsure are eligible for subsidies. But the subsidies are set by the federal government, not MNsure.

Minnesotans can get state-subsidized insurance on MNsure, such as the free-to-the-customer Medical Assistance (Minnesota's version of Medicaid) for the poor and the inexpensive MinnesotaCare for those who can pay reduced-cost premiums. MNsure only signs people up for the programs, but does not govern them.

MNsure sells policies to small businesses for their employees and to people who need individual policies because they do not have insurance available where they work or via a government program. Both small businesses and those who need individual policies also may buy them from insurance agents, but individual policy subsidies from the federal government would not be available.

In many states, a federal website provides the services Minnesotans get from MNsure.

Don Davis
Don Davis has been the Forum Communications Minnesota Capitol Bureau chief since 2001, covering state government and politics for two dozen newspapers in the state. Don also blogs at Capital Chatter on Areavoices.