As of November 1st, MNSure and the rest of the nation’s individual health insurance marketplaces are officially open for those who need to buy or renew their insurance policies for 2018.

MNSure staff expect over 100,000 Minnesotans to enroll in a Qualified Health Plan, with an additional 30,000 people enrolling in MinnesotaCare. Additionally, over 100,000 people will qualify for Medical Assistance, Minnesota’s version of Medicaid. The open enrollment period for 2018 lasts from November 1st to January 14th in Minnesota; the deadline for coverage beginning January 1st is December 20th (for readers requiring health insurance, follow this link to shop for plans, this link if you are applying for the first time, or this link if you want to renew your plan.)

This year’s open enrollment period is significantly different than previous years and a number of changes undermine the law’s continued success:

• The federal government spent much of the year waffling on paying cost-sharing reduction (CSR) subsidies to health plans (creating uncertainty that drove up premiums), eventually deciding in October to stop payments and upend the marketplace.
• Possible ending of the individual mandate (which would drive up premiums by 20%) to finance massive corporate tax cuts.
• Cut the open enrollment period from 12 weeks to 6 weeks, as well as shut down the Healthcare.gov website for 12 hours almost every Sunday during open enrollment.

But the biggest move made to undermine the ACA was to cut the budget dedicated to outreach and education efforts around the ACA by 90%, as well as cutting grant funding for navigators by 40%. Navigators are people who are trained to help consumers and businesses to purchase health insurance in the ACA marketplaces. They generally help verify income, fill out eligibility forms, and explain health insurance jargon to help inform consumers on what plan is right for them.

This move furthers the notion that “there is no such thing as Obamacare anymore.” For states that receive federal funding for outreach programs, navigators, and advertising during open enrollment, services were cut that help improve rates of enrollment, particularly in rural areas. In a survey of navigator organizations, most navigator groups said that they would have to lay off staff, reduce advertising, and reduce outreach events. They also cut work on complex cases and reduced or eliminated interpreter services. For a more concrete and local example, the state of Wisconsin lost one of its three main navigator organizations, and the largest navigator service (Covering Wisconsin) lost 42% of its funding and reduced their service area from 23 counties to 11 counties, with the more rural counties getting cut.

These actions at the federal level stand to hinder enrollment results and further damage the individual markets in most of the US. (Paradoxically, enrollment is actually UP nationwide compared to last year, but we won’t know if this is due to a genuine boom in coverage or if people are just enrolling earlier rather than later.)  

Thanks to early dedication to the ACA and efforts by the Minnesota state legislature, the Governor’s office, and MNSure, Minnesota will largely go unaffected by the actions (and inactions) of the federal government. In fact, Minnesota is set to have one of the best open enrollment periods in the country for three main reasons:

Navigators resources already allocated: That is due to a variety of policy stances, proactive market stabilization, and genuine buy-in from state officials. For starters, Minnesota established MNSure very early on, and consequently shifted most of responsibility for advertising and providing grant funding for navigators to the state. This has insulated Minnesota’s navigators, and Minnesotans will see or hear advertisements for open enrollment at roughly the same frequency.

Longer enrollment period: MNSure’s marketplace will close for shorter amounts of time, opening at 6am instead of noon. And since Minnesota’s open enrollment runs later than most states, Minnesota should have significantly lower uninsured rates than our neighbors whose enrollment periods end promptly on December 15th.

Stable pricing: Minnesota also has more affordable insurance options than states like Iowa because we passed a reinsurance bill that capped the rise in premium costs to less than 10%, with many plans actually dropping in price. For example, Minnesota’s individual plans fluctuated between a 3% increase to a 13% decrease in premium costs which would be closer to a 25% increase across the board without reinsurance. In Iowa, with only one participating health plan and no reinsurance, people enrolling for health insurance on the individual marketplace are experiencing a massive 69% increase for silver benchmark plans. For those who have small enough incomes to receive premium subsidies, this isn’t a problem, but those who make a little too much money are experiencing enormous sticker shock.

Minnesota has long been forward-thinking in its approach to innovative and high-quality health care and health insurance. Minnesota has invested in the success of the Affordable Care Act and committed itself to making insurance as affordable as possible (much more so than neighboring states) and these investments have paid dividends this year. It is important that Minnesota health officials and legislators understand that tertiary preventative measures like reinsurance and premium rebates aren’t enough to guarantee lasting affordable healthcare for all Minnesotans, and it is promising that various proposals that address the high costs of commercial health insurance are under consideration. In the coming months, plans that can provide quality, affordable insurance options while circumventing harmful federal actions absolutely must take precedence as we navigate a volatile and uncertain national political landscape.