State Works To Prepare Health Care Exchange By October

More than a fifth of Minnesotans will sit down at a computer, or talk to someone using a computer, a year from now answering a series of questions.

It may look like they are on Travelocity planning a vacation, or maybe searching for the right gift.

Instead, they will be buying health care insurance. And if planners get their wish, they should be getting more choices in an easier-to-understand format than they could today in what will be called a health insurance exchange.

“It really should be a process that takes less than an hour to go through,” said April Todd-Malmlov, executive director for the Minnesota health insurance exchange.

The exchange concept is a key factor in the 2-year-old federal Affordable Care Act, better known as Obamacare, an overhaul of the country’s health-care system shepherded by President Barack Obama. With Obamacare requiring most Americans to carry health insurance, or pay a penalty, insurance exchanges are being established to provide access to policies.

Some states such as Minnesota are building the exchanges to match their residents’ needs, while others are letting the federal government do the work. In either case, federal law requires that they be in operation next October.

A court decision and Obama’s re-election left no doubt the Affordable Care Act will remain on the books, leaving health insurance exchange planners 10 months to implement their ideas.

Todd-Malmlov said 1.2 million of the 5.3 million Minnesotans are expected to use the exchange once it is fully operational. She said that although it must be running by October, all the “bells and whistles” will not be ready for a couple more years.

— Those using the exchange are expected to come from varied backgrounds:

— Those without insurance

— People whose employers opt to give them vouchers to buy their own insurance.

— Working poor on the state-subsidized MinnesotaCare program.

— People who receive Medical Assistance, Minnesota’s Medicaid program.

— Small businesses that decide to use the exchange to cover employees.

Obamacare pushes those without insurance to use exchanges by issuing financial penalties for failure to carry insurance.

A Web site user will be asked what aspect of insurance is most important, things such as deductibles, premium costs and type of coverage. Each answer will narrow the options, and eventually a manageable number of policies will be available for comparison.

Fewer policies will be available when the exchange begins in October because many insurance companies will not have all their plans in place, Todd-Malmlov said. Options will vary across the state, with some insurers selling plans in one part but not another.

Existing insurance companies will offer policies on the exchange, but Todd-Malmlov said some firms not now in Minnesota also are expected to be involved.

The state and federal government will not sell insurance, but will provide a way to buy it.

For those not comfortable with buying insurance via completer, a toll-free telephone number will be available for questions or to set a Minnesotan up with someone who can help make decisions.

State legislators will make decisions next year to answer some of the questions raised in months of planning.

House Majority Leader-elect Erin Murphy, DFL-St. Paul, said she expects action early in the session that begins Jan. 8, so work may be completed in time for the exchange to launch in October.

“In doing that, we will engage Minnesotans in how to best build one best for Minnesota,” said Murphy, one of the Legislature’s top health-care experts. “The benefit of a legislative discussion is what we will hear from those who may not have been participating in the (Dayton) administration’s discussion on the issue.”

An administration task force and several other groups have worked for months planning the exchange.

When the exchange is running, Minnesotans will not be forced to wade through complex spreadsheets or other documents foreign to most people.

“What people should see next October is something that should make health care simpler for them,” Todd-Malmlov said.

Minnesota has received $71 million to launch the exchange and the Legislature is being asked to seek $39 million more. The federal government will pay the first-year’s operating costs, but the state will be responsible for about $50 million a year to keep it running after that.

Murphy said rural Minnesota could especially benefit from the exchange. If good insurance is available at competitive rates, she said, not only will more rural Minnesotans pay for insurance but that should provide stability needed to attract more health-care providers.

Todd-Malmlov said premium costs will vary around the state, and could be lower in rural areas.

Rural Minnesotans tend to be on the state-subsidized MinnesotaCare insurance program in larger numbers than in urban areas, said Professor Lynn Blewett of the University of Minnesota’s School of Public Health, and Obamacare likely will force them into the health care exchange system where they will compare and buy their own insurance at rates based on income.

“I think there will be a lot of people in rural Minnesota who will shift into the exchange,” she said.

The change could be good news because insurance bought on the exchange will offer broader coverage at a reasonable cost, Blewett said. “There is going to be a pretty good premium subsidy.”

Few states are as far along as Minnesota in establishing a state-based health insurance exchange program, and at last report only 17 have decided to set them up.

Six states have opted to work with the federal government to set up exchanges and 16 will leave it up to the federal government. The other 11 states have not announced their plans.

Most Republican governors have said their states will not take part, citing objections to the Affordable Care Act in general.

GOP governors told Democratic President Barack Obama shortly after the election that they wanted to meet with him because Obamacare would be “an enormous strain on state governments and budgets.”

A recent Associated Press poll showed 63 percent of Americans would rather that states run the exchanges.

Republican governors in three states adjoining Minnesota opted against establishing a state-based health exchange.

Kaiser Health News ( follows each state’s efforts:

North Dakota

Republican Gov. Jack Dalrymple announced in November the state will not establish its own exchange. The Legislature earlier had declared the state’s intent to begin an exchange.

South Dakota

Gov. Dennis Daugaard announced in September that the state will not begin an exchange. The decision was based, in part, on the annual operating cost of a state-based insurance buying service.


Terry Bradstad is one of a few Republican governors who plan to proceed with work on an exchange. However, he said, because of lack of federal guidance and time Iowa may rely on a federal exchange at first.


Gov. Scott Walker announced in July that his state would not take part. Wisconsin started work on setting up an exchange in 2011, but that stopped with Walker’s July decision.