Minnesota health insurance
Low uninsurance rate drops even lower after ACA enrollment in 'Land of 10,000 Lakes'
By Carla Anderson
August 12, 2014
The health status of residents and health insurance coverage are important factors to consider when judging overall quality of life. Here is a summary to help you get a handle on the “state of health” in Minnesota.
Minnesota health ratings
Minnesota consistently ranks near the top of health surveys. In fact, the Commonwealth Fund’s Scorecard on State Health System Performance 2014 rated Minnesota #1 among the 50 states and the District of Columbia. Minnesota also claimed the top spot in 2009. Minnesota’s Scorecard explains how the rankings are decided.
The 2013 edition of America’s Health Rankings scores Minnesota third among the 50 states and the District of Columbia. Minnesota ranks high for physical activity, low incidence of diabetes and cardiovascular disease, and high percentage of high school graduates. However, those high marks are tempered by Minnesota’s high rate of binge drinking, low public health spending, and low immunization rates among children.
The 2014 edition of Trust for America’s Health also provides a wealth of public health information; see Key Health Data About Minnesota.
Do you want to learn about a specific area of the state? Get county-by-county health rankings for Minnesota, from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Minnesota and the Affordable Care Act
In the 2010 passage of the Affordable Care Act, Minnesota’s two Democratic senators – Amy Klobuchar and Al Franken – both voted in support of health reform. Franken is credited for the inclusion of a medical loss ratio (MLR) requirement in the reform bill.
One of the early, popular provisions of the ACA, MLR requires insurance companies to issue refunds if they spend more than 20 percent of premiums on administrative items (15 percent for large-group plans). The MLR rule resulted in $1.1 billion in refunds in 2012, though payouts in subsequent years have been much less.
Minnesota’s eight representatives split their votes, with Democrat Collin Peterson joining three Republicans in voting no. However, Peterson has not joined Republicans in their many subsequent votes for full repeal of the ACA. Rep. Michelle Bachman railed against the ACA and made its repeal a key theme of her failed 2012 presidential campaign.
Minnesota Gov. Mark Dayton was a proponent of the Affordable Care Act. After state Democrats gained control of both the state House and Senate in the 2012, legislation was passed to implement a state-run health insurance exchange. Minnesota also expanded Medicaid, which is called Medical Assistance in the state. Medicaid expansion was a key ACA strategy to reduce the uninsured rate.
How did the ACA help Minnesotans?
Minnesota has enjoyed a low uninsured rate for years due to generous Medicaid eligibility standards and MinnesotaCare, a health insurance program for uninsured, working residents. According to a study commissioned by MNsure (the state marketplace) and conducted by the University of Minnesota’s State Health Access Data Assistance Center, Minnesota’s uninsured rate was 8.2 percent just before ACA open enrollment began.
Post open enrollment, the uninsured rate dropped to 4.9 percent. According to another study, Minnesota’s uninsured rate dropped about 3.5 percent to 6.61 percent – ranking Minnesota seventh nationwide.
Minnesotans enrollment in QHPs
During 2014 open enrollment, 48,495 Minnesotans enrolled in qualified health plans (QHPs) through MNsure. While MNsure has far exceeded its goal of 135,000 signups – which was set in October 2013 – for overall enrollment, the mix is much different than expected. Enrollment in Medical Assistance is much higher than expected, while enrollment in private health insurance is much lower.
Five insurers offered individual policies through MNsure for 2014: Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, PreferredOne, and UCare. PreferredOne, which was a small player in Minnesota’s individual insurance market prior to open enrollment, won 59 percent of health plan enrollees through MNsure. Blue Cross Blue Shield of Minnesota won about 24 percent of the market, followed by HealthPartners at 12 percent, Medica at 4 percent, and UCare at 1 percent.
Minnesota offers a variety of subsidized health insurance programs including Medical Assistance (Medicaid), MinnesotaCare, and the Children’s Health Insurance Program (CHIP). Learn about Minnesota Health Care Programs and eligibility criteria.
Minnesota is among the states that expanded Medicaid under the Affordable Care Act. Between October 2013 and June 2014, just more than 137,000 Minnesotans enrolled in Medical Assistance.
Does Minnesota have a high-risk pool?
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Minnesota. As a result, people with pre-existing conditions were often unable to purchase coverage in the private market, or if coverage was available it came with a higher premium or with pre-existing condition exclusion riders.
The Minnesota Comprehensive Health Association (MCHA) was created in 1976 to give people an alternative if they were ineligible to purchase individual health insurance because of their medical history. (Only Connecticut has a risk pool as old as Minnesota.)
Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high risk pools and MCHA stopped enrolling new members as of December 31, 2013. But the plan will remain operational for existing members until the end of 2014.
MCHA membership has dropped considerably since ACA implementation began, but all remaining members will need to transition to an exchange plan during the 2015 open enrollment period. As long as they enroll in a new plan by December 15, 2014, they will have continuous coverage with a new policy effective on January 1, 2014.
State-based health reform legislation
Here’s a summary of recent Minnesota bills related to healthcare reform: