Amid uncertain future, MNsure sign-ups begin

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ST. PAUL—Minnesotans who buy insurance on the individual market could start signing up for plans Wednesday as politicians continued to debate the role government should play in providing citizens health insurance.

Open enrollment for MNsure, the state's Affordable Care Act marketplace, began Wednesday and runs through Jan. 14 for the roughly 4 percent of the state population that purchases individual or small group insurance plans.

Many other Minnesotans who get their insurance through work will also be making health care plan decisions as the end of the year approaches.

Now, 96 percent of residents have health insurance, the most in state history. That's compared to about 91 percent of the U.S. population that is insured.

40,000 visit website

MNsure's fifth open enrollment period began Wednesday with little fanfare. State officials said more than 40,000 people visited mnsure.org. Hold times for the nearly 3,000 callers averaged one second.

That's a big change from the 2013 MNsure launch when users experienced website crashes and long delays for services by phone leading to widespread criticism of the agency.

More than 500,000 Minnesotans get their insurance through MNsure although the majority of them are on publicly funded health care plans. This year, 65 percent of MNsure individual market enrollees qualified for tax credits to keep premiums affordable for their income levels.

The average tax credit is $7,000 a year, and individuals earning up to $48,240 a year or a family of four with an income of $98,400 qualify for assistance.

Politicians seek changes

Minnesota Republicans have spent years trying to kill MNsure, a system they have argued is inefficient and too expensive. They generally want less government involvement and regulation of health insurance.

State Rep. Matt Dean, R-Dellwood, a candidate for governor, marked the first day of open enrollment by renewing his call to dismantle MNsure. Dean wants to transfer MNsure's role determining eligibility for health care assistance to the county level.

"The problem is government has gotten too big and has gotten in between families and their providers," Dean, who chairs the House health and human services committee, said at a Capitol press conference.

Democrats have taken a different approach. They've pushed to cover more people and to try to bring costs down by expanding the reach of government programs.

Earlier this year, Gov. Mark Dayton proposed giving all residents the option of buying plans from MinnesotaCare, which now provides insurance for the working poor. Next week, Lt. Gov. Tina Smith will hold a town hall in St. Cloud to discuss the idea.

"For 25 years, MinnesotaCare has offered a more affordable choice for 100,000 Minnesotans," Smith said in a statement announcing the Nov. 6 meeting. "Gov. Dayton and I strongly believe that all Minnesotans should be able to purchase this high-quality health insurance."

Last month, DFL candidates for governor rallied around the idea of creating a universal, single-payer system that would be publicly financed.

About those rates

After skyrocketing rates a year ago, Minnesotans are seeing anywhere from increases averaging 3 percent to declines of up to 13 percent. That's largely thanks to a reinsurance program approved by the Legislature this spring that will spend $542 million over the next two years to help insurers offset high-cost claims and keeps premiums affordable.

Noting the cost of the legislation, Dayton let the reinsurance program become law without his signature.

The reinsurance plan was approved by federal regulators, but it came at a price. The U.S. Department of Health and Human Services said it would cut federal funding for MinnesotaCare by $369 million.

State and local lawmakers continue to push the Trump administration to restore that funding.

Comparing with other states

The MNsure exchange and the reinsurance program approved by the Legislature may have helped Minnesota avoid some of the health insurance market volatility experienced in other states.

An August analysis by the Kaiser Family Foundation of projected 2018 insurance costs showed premiums on track to rise is much as 50 percent in some states. Others have predicted even larger increases.

Insurers cited rising costs and political uncertainty surrounding health care policy as key factors causing the increases.

Congress unable to agree

So far, Republicans who control Congress have been unable to agree on a path to achieve their longstanding goal of repealing and replacing the Affordable Care Act, often referred to as Obamacare.

In the meantime, President Donald Trump has moved to stop paying health care subsidies that help keep insurance for low-income people affordable. Trump has argued the government cannot pay these subsidies, worth roughly $9 billion in the coming year, without congressional approval.

Insurers and Democrats have said Trump's move could collapse insurance markets, and it is being challenged in court.

A bipartisan bill has emerged in Washington to reinstate the subsidies, but it has yet to come up for a vote.

Gauging impact

It's tough to gauge how costs will change in the private insurance market in 2018 because many businesses have yet to finalize their rates. In September, The Kaiser foundation reported that in 2017 private insurance premiums rose about 4 percent over 2016 costs.

Workers at companies with less than 200 employees tended to have lower premiums compared to workers at larger firms. In 2017, the average cost of individual coverage was $6,690 a year and family coverage cost $18,764.

Since Obamacare was implemented in 2013, the number of U.S. residents who are uninsured dropped from 44 million to about 28 million at the end of 2016. The nonpartisan Congressional Budget Office estimates the reduction of uninsured under the Affordable Care Act cost the federal government $110 billion in 2016.