As Minnesota's legislative auditor announced Wednesday a full evaluation of MNsure, state officials revealed plans to address a key question: Did the federal health law reduce the number of Minnesotans lacking coverage.
MNsure has asked University of Minnesota researchers to work with insurance companies and the state Department of Human Services to provide a preliminary estimate for the impact of the federal Affordable Care Act on the uninsured rate in Minnesota.
The most recent estimate suggests about 445,000 Minnesotans lacked coverage last year. Projections last year suggested the health law would reduce that number to between 159,000 and 201,000 by 2016.
While there has been anecdotal evidence of uninsured finding coverage through MNsure, there hasn't been an assessment.
"Everybody wants to know how many have signed up, and what impact will this have on the rate of the uninsured," said Lynn Blewett, a U health policy researcher who will lead the study.
One of the goals for the Affordable Care Act is to reduce the number of uninsured. Critics have argued that it also threatens to push some from coverage by requiring benefits and thereby increasing the cost of policies.
Word of the study came during a hearing at the Capitol where legislative auditor Jim Nobles said he has received the go-ahead for an evaluation of problems at MNsure.
The legislative auditor typically conducts about six evaluations per year, Nobles said in an interview. The reviews are broad in scope and distinct from his office's routine audits of financial management within state government agencies.
After disclosures in December and January about MNsure's website problems, Nobles said he would seek legislative approval to pursue such an evaluation at MNsure. That approval came Wednesday, he said.
"We're going to be working on this for the next several months, and it won't be completed until the end of the year," Nobles said.
He told the MNsure Legislative Oversight Committee on Wednesday: "The evaluation will be a comprehensive, in-depth evaluation of many issues related to the development of the website, but also many other issues as well."
During the committee hearing, MNsure's interim chief executive Scott Leitz said the best way to show the impact of the Affordable Care Act on the number of uninsured Minnesotans would be a "full-blown population survey" like the one completed every two years by the state Department of Health.
But the department's next such survey isn't scheduled until 2015, Leitz said, adding that no one wants to wait that long for answers.
The U researchers plan to work with the Human Services Department and private health insurers to develop a preliminary look at the issue.
The Human Services Department runs the Medical Assistance and MinnesotaCare public health insurance programs, which provide coverage to the majority of those who have obtained insurance through MNsure.
"We can have a picture of how many folks were in group coverage, how many folks were in individual coverage and how many folks were uninsured prior to the beginning of the open enrollment period, and then a snapshot of that same thing after the end of open enrollment," Leitz told the committee.
The analysis would look at shifts in coverage between last year and the March 31 close of the six-month open enrollment period. Final figures from open enrollment still aren't available, however, because many of those who sought insurance late last month still haven't finalized coverage details.
"We will be working with MNsure and (the U) to determine the process and timeline," said Eileen Smith, a spokeswoman for the Minnesota Council of Health Plans, the trade group for the state's largest health insurers.
During Wednesday's hearing, Republicans revisited questions they have raised repeatedly this week about disclosures that Gov. Mark Dayton was told by MNsure on Sept. 19 that technical problems threatened the exchange's launch Oct. 1.
The website went live on schedule, and Dayton said the briefing wasn't related to problems experienced by users in November and December.
But Republicans on the oversight committee said MNsure staff in late September didn't tell legislators or the exchange's board of directors about potential threats to the launch.
"The board met shortly after (Sept. 19), and the staff did not tell the board what they told the governor," said Sen. Michelle Benson, R-Ham Lake.
Sen. Jeff Hayden, DFL-Minneapolis, said legislators shouldn't jump to conclusions about the sequence of events but should wait for Nobles' evaluation to provide full context about what happened before MNsure's launch.
Leitz said improvements this year to the exchange's website and call center allowed for a strong conclusion to MNsure's open enrollment period.
As of April 7, nearly 180,000 had signed up for coverage through MNsure. While MNsure surged past its goal of 135,000 enrollments, it fell short of original projections for connecting people with private coverage -- a key factor for MNsure's financial stability. Starting in 2015, the exchange will fund its operations by withholding up to 3.5 percent of private plan premiums.
The website remains far from perfect. MNsure has finalized a contract with a primary vendor to lead website repairs, Leitz said Wednesday.
He did not disclose the vendor or price tag for the contract, saying it must first be approved by the federal government.
MNsure will pay for the IT work with federal grants it has already received, Leitz said.
"We still do rely too heavily on manual workarounds," Leitz said, referring to extra steps that state workers and insurance companies must take to make sure people using MNsure actually wind up with coverage.
©2014 the Pioneer Press (St. Paul, Minn.)