Fixing Minnesota's health insurance woes requires firm grasp of facts

It's a question that every Minnesota legislative candidate should be asked between now and Election Day: What can be done to fix Minnesota's haywire individual health insurance market and bring relief to consumers facing staggering coverage costs?

The state Commerce Department recently announced that consumers who buy health insurance on their own will face average rate increases of 50 to 67 percent for 2017. While just 5 percent of Minnesotans buy health insurance on their own instead of getting it through their jobs or public programs such as Medicare, some people simply won't be able to afford health insurance. Financial aid to instantly discount monthly premiums is available through MNsure, but not everyone qualifies.

The Star Tribune Editorial Board has called for a special session to provide immediate relief to people potentially priced out of this market. Officeseekers are also beginning belatedly to detail short- and long-term fixes. Voters wanting to separate candidates offering up real solutions from those trying to score political points should keep in mind these commonly misunderstood health-care realities:

• MNsure is not a health plan or provider. Consumers buy private health insurance, such as from HealthPartners or Medica, on this online marketplace. They can also find out if they qualify for medical assistance programs by using it. But MNsure isn't an insurance company, nor does it operate clinics. It also doesn't set health-insurance rates.

• It's the individual health-insurance market, not MNsure, that's in crisis. The individual market is more than the policies sold through MNsure. Most individual market consumers (73 percent) buy elsewhere, such as directly from an insurer. The rising cost of providing medical care to this relatively small pool of policyholders is driving up premium prices. As state Rep. Tina Liebling, DFL-Rochester, recently put it: Blaming MNsure is about as useful as blaming the pharmacy for EpiPen prices when it's the drug manufacturers hiking costs.

• The state's old high-risk pool was not health-care nirvana. Minnesota long kept individual market plans affordable by allowing insurers to deny coverage to those with expensive medical conditions. These consumers had no choice but to buy their insurance through the Minnesota Comprehensive Health Association (MCHA), also known as the high-risk pool. It served roughly 29,000 people. Its annual budget ($238 million in 2011) was funded by enrollee premiums, health insurance surcharges and, when costs exceeded revenue, other public funds.

Consumers generally paid significantly more than comparable commercial plans. Some also had high deductibles and high out-of-pocket expenses and faced lifetime coverage caps. A 2011 paper reported that 1 in 10 enrollees left the program due to high costs. Politicians who simply want to revive MCHA ought to be asked what would happen to these consumers. And, how might MCHA be modernized to help enrollees pay?

State health officials have also noted that individual market rates are going up across the nation. That's true, but policymakers here made decisions that uniquely pressured the state's individual market. Continuing MinnesotaCare for the working poor reduced the number of people buying private plans. Maintaining MinnesotaCare was the right decision, but the smaller pool makes it harder to spread the cost of individuals with intense medical needs. Real solutions would address this without undoing MinnesotaCare.

Voters ought to support candidates who demonstrate their grasp of these realities. Fixing a problem first requires a firm understanding of the causes.