The Free Press, Mankato, MN

November 19, 2013

Health care plan implementation gets mixed start

By Mark Fischenich

---- — MANKATO — The initial implementation of the Affordable Care Act has been far from flawless in Blue Earth County, but it's going better than other parts of the country, the Blue Earth County Board learned Tuesday.

The county's Human Services Department is handling the portion of the "Obamacare" enrollment involving government-financed programs — Medical Assistance for low-income residents and MinnesotaCare for certain qualifying middle-income working people.

The national health care reform law, which is under intense criticism in many states that are relying on a dysfunctional federal enrollment website, is working better in states such as Minnesota that agreed to administer the program at the state level. In Minnesota, the computerized insurance exchange where people can enroll is called MnSure.

"MnSure seems to be ahead of the whole United States," said Commissioner Vance Stuehrenherg. "Everybody's looking at Minnesota and saying 'Wow.'"

But that doesn't mean everything is going smoothly.

Human Services Director Phil Claussen said 918 cases have been handled by the county, 573 of them being former MinnesotaCare policies that have been converted to the more sweeping Medical Assistance program available in Minnesota under the ACA. About 300 more new cases are pending through the MnSURE program, and 45 are now active accounts.

Of the 918 total cases, only about 5 percent were completed entirely by the automated sign-up process that was to be at the heart of the exchange-based reform plan. While that's a small percentage, it's a start, Claussen said.

"We'd like to see that number go way up, but it's nice to know there's at least a trickle happening," he said.

And Claussen would like to see the number go up soon rather than trying to handle a flood of new clients when the insurance coverage is supposed to take effect Jan. 1.

"We really are going to hit 'Go' on Jan. 1, and we don't want to have a huge backlog," he said.

Commissioners, like most Americans, appeared to have divergent views about whether the ACA is a looming disaster or a positive development going through a bit of a rough patch.

Commissioner Mark Piepho, a former Republican state lawmaker, said he would have preferred that states be allowed to implement their own strategies for providing medical coverage for the uninsured as Minnesota did with MinnesotaCare decades ago.

"MnSure? We're not so sure," Piepho said. "I'll leave it at that."

Commissioner Kip Bruender also suggested the ACA is causing a lot of disruption while benefiting a quarter or less of the nation's population. And in Minnesota, the percentage of people potentially helped is even lower because MinnesotaCare already was meeting the needs of many of the working poor.

"So we're upsetting the whole apple cart to help those 20 percent," Bruender said.

"The only problem with that, Kip, is if you're one of the 20 percent," Stuehrenberg said, adding that he knows a number of people who couldn't afford insurance even with MinnesotaCare. "I'd like to see some of the politicians going in there ... trying to fix it instead of trying to scrap it."

The one point of agreement is that Minnesota is above average.

"MinnesotaCare gave us a head start," Piepho said.

Claussen said the future of the reform is dependent on the technology getting fixed soon so that people can easily enroll. He also said it's crucial the ACA begin to bend downward the long-term trend of ever-rising health-care costs.