An editor’s note: Rep. Greg Davids (R-Preston) sent this letter on Dec. 5 to Governor Mark Dayton regarding MNsure’s Consumer and Small Business Advisory Committee’s recommendations that the MNsure Board adopt a robust active purchaser model beginning in 2014.
Yesterday, the MNsure Board of Directors discussed recommendations for its exercise of “active purchaser” authority. The board will vote on whether and how to exercise this authority on Dec. 18. In the strongest possible terms, I urge you to advise MNsure not to adopt or exercise active purchaser authority. Even if we disagree on the merits of active purchaser, it would be completely irresponsible for your hand-picked board to exercise this power next year.
I laud the desire to reduce health disparities and improve access to quality mental health care. However, as the chief executive for the state of Minnesota, the tremendous usurpation of administrative authority inherent in active purchaser should deeply trouble you. For ordinary Minnesotans already struggling with the high cost and reduced options for insurance under MNsure and Obamacare, the concentration of power provided under active purchaser is downright frightening.
As you may know, the MNsure enacting legislation provided the MNsure Board with broad, ambiguous power to limit the number of plans offered on the exchange beginning in 2015. This arbitrary authority is based on innocent-sounding, but subjective and easily manipulated terms, such as “quality and value” and “meaningful choices.” The reality is that active purchaser gives seven unelected, unaccountable board members the power to decide what constitutes a “meaningful choice” for hardworking Minnesotans and small businesses.
Shortly after its botched launch, MNsure revealed their vision for active purchaser in response to questions about the lack of choices in southeastern Minnesota. A MNsure representative told an Owatonna audience that the opportunity to deny carriers from selling on MNsure will result in more competition and reduced costs. In southeastern Minnesota, reducing options to increase choice and competitiveness is a mathematical impossibility. Throughout our region, a family of four has just seven options across two carriers from which to select family coverage on MNsure. It would be unconscionable to limit them to options from one carrier in the name of “quality and value” as seen by a small group of bureaucrats from an office building in St. Paul.
The working group recommendations would entrust the extraordinary powers of creating a new risk adjustment model and determining provider network adequacy for minority communities to a majority of four board members. Further, the recommendations are contradictory, simultaneously advocating for negotiations that result in greater choice and for restricting carriers who cannot meet extraordinary regulatory hurdles from selling on the exchange.
It would be unthinkable to allow a board and executive staff that can barely handle the duties of operating a website to override the extensive rate and form review process conducted by experts at the Department of Commerce and network adequacy review from experts at the Department of Health. Similarly, given the initial failure to develop a racially and culturally inclusive outreach program, MNsure has not demonstrated it has the experience or expertise necessary to determine whether a provider network is culturally appropriate.
In November, MNsure released a laundry list of updates to its website that must be accomplished for the website to be fully functional. Stories about the lack of basic security measures in MNsure continue to underscore the immediate need to upgrade its security procedures to ensure the safety of Minnesotans’ personal information. It would be a much wiser use of MNsure’s time to focus on enhancements to the consumer experience, user security and the still unaccomplished task of electronically transmitting to insurance companies the application and payment information of those attempting to enroll through MNsure. Until MNsure fixes that problem, it has completed zero enrollments and should not even consider something as monumental as active purchaser.
As made clear by the working group’s dissenters, the active purchaser recommendations are driven by the unscientific desire of a few to unleash further uncertainty into the healthcare system for many. These recommendations are not driven by data because, as noted in the minority opinion, “sufficient data does not exist and our committee has not had sufficient time to weigh pros and cons of specific active purchaser approaches.” The dissent responsibly advises that MNsure “wait until there is at least a year’s worth of enrollment data before rushing to introduce new market regulations that could have unintended consequences such as narrowing plan options or increasing costs.”
Active purchaser will undoubtedly result in increased costs, reduced choices, and more confusion for Minnesota consumers. Instead of demeaning the intelligence of Minnesotans and taking a paternalistic approach to helping people choose health coverage, MNsure should empower consumers by improving the functionality of their website and providing user-driven filters to sort through all plans that meet legal requirements for sale in Minnesota.
Representative Greg Davids