The website malfunctioned. The exchange chief was fired. And many people had to sign up the old fashioned way: pen, paper, with a person. So, Minnesota’s launch of the Affordable Care Act was a clear failure, right? Not so much.
A less modest state might call it the Minnesota Miracle: The rate of uninsured people in Minnesota tumbled to less than 5 percent, despite all the problems with its Obamacare website, a new study shows.
How did Minnesota do it? It wasn’t miraculous. The state started out ahead with a rate of uninsurance roughly half the national average. Then it used the health law to strengthen and publicize a health care safety net that was already more complete and generous than most other states.
The number of uninsured Minnesotans fell by nearly 41 percent since September and the rate of uninsurance in the state fell from 8.2 percent to 4.9 percent, according to the study from the University of Minnesota’s State Health Access Data Assistance Center.
The university crunched the numbers at the request of MNsure, the state’s troubled health insurance marketplace. “This is a pretty historic change in insurance coverage in Minnesota,” said Julie Sonier, the report’s lead researcher. “We have never seen anything like the change that we have seen between last fall and May 1st of this year.”
Some 180,500 people gained health insurance, mainly through enrollments in the state’s two government-sponsored programs for the poor: Medical Assistance and MinnesotaCare. Here are the details on those two programs:
— Medical Assistance is the state’s Medicaid program. It covers people who make up to 133 percent of the federal poverty level, or $15,500 for a single person this year.
— MinnesotaCare is a program that predates the health law. It is funded by a state tax on Minnesota hospitals and health care providers, federal Medicaid funds and enrollee premiums. Under the health law, the state adapted MinnesotaCare to be a “basic health plan,” a new category that only Minnesota set up. People qualify if they make up to 200 percent of the federal poverty level, or $22,980 for a single person this year. Congress offered this option to help people who earn too much to qualify for Medicaid, but not enough to afford the out-of-pocket costs of a commercial health plan, even with the benefit of federal subsidies.
Before the health law went into effect, about two-thirds of uninsured Minnesotans qualified for one of these two public health programs but hadn’t signed up. The federal law’s combination of a mandate to buy insurance and funding for outreach and navigators likely boosted enrollment in the two programs.
The study by SHADAC, as the organization is known, goes further than those in other states, other researchers say.
“What’s unique about this Minnesota report is it’s the first I’ve seen that really looks at what’s happening across the whole coverage spectrum. So not just looking at what’s happening with enrollment but also pulling in what that means for the uninsured,” said Rachel Garfield, Senior Researcher at the non-profit Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
Still, the picture of who signed up for private insurance under the ACA in Minnesota is somewhat murkier, critics point out. State Rep. Joe Hoppe, R-Chaska, questioned the report’s findings that tied a big drop in uninsured Minnesotans to the federal health care law. Officials, he said, weren’t initially asking people who were signing up for MNsure if they’d previously had coverage.
Sonier acknowledged that her organization didn’t calculate who was previously insured, but the study did get a measure of increases in the private market by asking the insurance plans themselves for enrollment numbers.
“We don’t know who came in or out during the time, whether they came from group coverage or uninsured, we are still pretty confident that overall shift that we calculated, the 180,000, is in the right ball park,” said Sonier, a former Minnesota state health economist.
The study showed that the number of people buying their own plan jumped about 12 percent, and it also suggests employers didn’t dump their health plans and force workers to buy their own.
Most Minnesotans get their insurance through work. The study found the number of people in employer-sponsored plans went down by about 6,000, a decline of two tenths of 1 percent.
Even as officials applauded the drop in uninsured since September, they wanted to know more about the 4.9 percent of Minnesota’s population that still lacks health coverage.
“That’s something we need more research in — who are we still missing?” state Human Services Commissioner Lucinda Jesson said. “That’s going to be an important thing to find out the future because we need to continue to target our outreach effort.”
The University of Minnesota expects to release further analysis late this fall or in early winter. The study was requested by MNsure and funded by the Robert Wood Johnson Foundation.