The MNsure.org site is known as a website wobbling on the edge of failure. It is not known as a successful state health insurance exchange with its history of enrollment problems, Director resignations, shoddy venal contractors, never tested before opening for business, lack of improvement on the site until March 2014 when they started fixing missing pages and removing broken scripts. A few thousand users overwhelm the site and then users get maintenance screens and unauthorized errors. An outside contractor, Optum, hired to assess the website and software raised the possibility of scrapping the software altogether and starting over calling the software process broken with MNsure unable to make fixes to the site as of January 2014. The website can only run 18 hours per day and has had many outages, some for as long as 5 days. 20% of enrollment is from paper forms that really only got started in January 2014. The backlog of completed applications has been as high as 27,000 in March 2014 and the time interval of the backlog can be measured in months for many.
Maryland’s website software is going to be abandoned and use Kentucky or Connecticut’s version for its exchange. This is notable because it shares contractors and licensed software from IBM Curam and EngagePoint with MNsure. Maryland was able to get an effective paper application process started and enrolled 295,000.
The terrible website has definitely stifled enrollment, the question is how much has it been suppressed? My data is from ACASignups.net, the only blogger tracking national ACA enrollment state by state. I am looking at percent of uninsured enrolled and percent of total population enrolled.
- Kentucky, population 4.4 million, 350,000 people have enrolled by March 27, 18% uninsured about 792,000. 44% enroll/uninsured, 8% enroll/population
- Washington, population. 6.9 million, which has enrolled 500,000 March 28, uninsured is 1/7 or 14% or about 942,000. 53% enroll/uninsured, 5.5% enroll/population
- Connecticut, population 3.6 million, 178,600 enrollments March 27, 337,000 uninsured. 53% enroll/uninsured, 7% enroll/population
- Rhode Island, population 1 million, 69,400 enrollments March 8, 16% uninsured 140,000. 50% enroll/uninsured, 7% enroll/population
- Minnesota, population 5.4 million, 150,000 enrollments March 27, 9.1% uninsured, about 490,000. 31% enroll/uninsured, 3% enroll/population
Enrollment Suppression Numbers at MNsure
Minnesota numbers of enrolled/uninsured and enrolled/population are quite a bit less than the successful states, I am guessing it is the terrible website. Here is what it would be if Minnesota matched the proportions of the successful state exchanges:
At 40% enrolled/uninsured enrollment would be 196,000 or 46,000 suppressed.
At 50% enrolled/uninsured enrollment would be 245,000 or 95,000 suppressed.
At 4% enrolled/population enrollment would be 216,000 or 66,000 suppressed.
At 5% enrolled/population enrollment would be 270,000 or 120,000 suppressed.
At 6% enrolled/population enrollment would be 324,000 or 174,000 suppressed.
At 7% enrolled/population enrollment would be 378,000 or 228,000 suppressed.
So between 46,000 and 228,000 suppressed enrollment from a bad website. These numbers are only estimates but it can be fairly certain that 10’s of thousands did not enroll at the website from the screwups at MNsure. And remember 20% of the finished applications are paper, not on the website, I am not counting that against MNsure.
4 States Auto Enrolled People
See Prescreening People to Enroll in Health Insurance to see how W. Virginia doubled projected enrollment by using data already gathered from food stamp programs and previous Medicaid applications to auto-enroll citizens using HealthCare.gov, the Federal website.
West Virginia, population 1.85 million, 105,000 Medicaid only enrollments, 14% uninsured 259,000, 41% enrolled/uninsured, 6% enrolled/population.
I do not know the other 3 auto enrolling states that used pre-screening processes, let me know if you find out.
MNsure Lags on Processing Paper Applications Too
Maryland’s, population 5.9 million, used 200 additional clerks to process forms and enrolled 295,000, MNsure, with a similar population, only had 50 clerks and 170,000 enrollment. The lack of a robust paper process also suppressed MNsure enrollment. (Minnesota had the fewest additional clerks from April 3, 2014 testimony to Congress Committee chaired by Rep Lankford of exchanges from CA, HI, MN, OR, MD, MA)
Single Payer Health Care Would Be 100% Enrollment
Of course the most obvious improvement to the website would be extending Medicare for all. No complex eligibility rules, no one left out, may not even need a web site to sign up.