Look before you leap?

Yesterday, Governor Dayton chided legislators in the House for passing through committee a bill to eliminate MNsure, saying they should “look before you leap.”

While his long-awaited acknowledgement that MNsure  may be so flawed it can’t be repaired is a welcome sign for Minnesotans who have struggled to work with the long call times, faulty website, and “glitches” that have led to severe consequences, it is a shame he is forgetting the many warnings he was given and the role he himself played in many of the most problematic decisions of Minnesota’s health exchange.

Here’s a helpful reminder of exactly how MNsure came to be and who should be held responsible for the failings – Mark Dayton and the former DFL majority who was so determined to pass the exchange bill they did so without a single Republican vote.  Even worse – when problems came to light, they refused to do anything about it.

A History of MNsure

The Minnesota Legislature And Mark Dayton Created MNsure Without A Single Republican Vote

MNsure Passed Without A Single Republican Vote. “Gov. Mark Dayton Wednesday signed into law historic and controversial legislation enacting the centerpiece of President Barack Obama’s health care overhaul. … The final version of the bill passed without a single GOP vote, capping three years of staunch Republican opposition.” (Elizabeth Stawicki, “Dayton Signs Health Exchange Bill,” MPR News, March 20, 2013)

Republican Legislators Expressed Concern About Many Aspects Of MNsure Legislation

Sole Republican Conferee Tried To Push For More Oversight For Health Exchange. “Rep. Jim Abeler, the lone Republican on the conference committee, pushed for more oversight measures, either by designating the exchange as a state agency or putting it under the governor’s authority. Democrats, however, beat the effort back – at least initially on Wednesday.”  (James Nord, “Three Major Health Exchange Hurdles Remain As Legislators Rush To Meet Deadline,” MinnPost, March 13, 2013)

Sen. Dave Thompson Called It A “Behemoth” “With No Accountability.” “Republicans also criticized the board for having too much authority, and business groups said there wasn’t room for meaningful public input in its decision-making — even after Lourey amended the legislation. ‘It’s just kind of this behemoth out there that can run our health care system with no accountability back to the people,’ (Sen. Dave) Thompson added.” (James Nord, “Minnesota Health-Exchange Bill Clears First of Many Committee Stops,” MinnPost, January 17, 2013)

 

Sen. Michelle Benson Expressed Concern About Limited Oversight And Increased Costs. “The main concerns I have had with this bill, the disregard for data privacy, limited options for selecting insurance plans, and increased insurance rates for everyone, remain in the bill. The appointed board still has a great deal of control and very little oversight.” (Newsletter, Office of Senator Michelle Benson, March 15, 2013)

Rep. Tara Mack: “Rather, the exchange will implement an unelected board of seven people who will impose a gross premiums tax on health care of up to 3.5 percent, manage an annual budget of $60 million to operate the exchange with no legislative oversight and will have the power to arbitrarily decide which health insurance products can be sold.” (Legislative Update, March 22, 2013, Rep. Tara Mack)

Sen. David Hann: The Exchange Is “Not Going To Accomplish What They Say They Were Going To Accomplish.” ’This was ugly politics created by the DFL,’ said Senate Minority Leader David Hann, R-Eden Prairie, whose members staged an almost 12-hour debate on the exchange last week. He predicted the exchange ‘is going to be very, very poorly received by the public. It’s not going to accomplish what they say they were going to accomplish. I think they are going to be in for a big surprise.’” (Jennifer Brooks, “Minnesota Heath Insurance Exchange Becomes Law,” Star Tribune, March 21, 2013)

Senator Julie Rosen: Exchange An “Extremely Expensive” “Super Agency.” “This exchange bill establishes an extremely expensive government infrastructure that guarantees the creation of a super-agency with layers of bureaucracy between Minnesotans and their healthcare.” (Press Release, March 7, 2013)

 Mark Dayton Launched Effort To Develop Health Insurance Exchange In 2011

 Exchange preparation launched long before legislation passed in 2013, putting management directly under Dayton administration prior to exchange legislation

 Gov. Dayton Wrote A Letter To HHS Sec. Sebelius Demonstrating His Commitment To Fully Enacting Obamacare In Minnesota. “I write to reiterate the State of Minnesota’s intention to continue the planning and development of a Minnesota Health Insurance Exchange … Minnesota will proudly work with your Administration to help design and lead the solution.” (Letter from Gov. Mark Dayton to Secretary Kathleen Sebelius, 7/10/2012)

 Gov. Dayton Obtained Federal Grant In 2011 For Exchange Planning And Development. “Dayton, though, thinks the state health insurance exchange is a good thing. … Said Dayton: ‘This funding will help us to provide better health care at lower costs for all Minnesotans. We have already made good progress in designing a health exchange that will put Minnesota in the forefront of health care reform.’” (Joe Kimball, “GOP Leaders Decry Dayton Plan For Health Exchange,” MinnPost, 8/16/2011)

 Prior To Legislation Authorizing MNsure, Staffing Was Run Through Dayton Agencies.  “As commerce commissioner, (Mike)Rothman is the state’s chief insurance regulator. His major project on the health care front is spearheading development of Minnesota’s health insurance exchange.”  (Elizabeth Stawicki, “New Minn. Commerce Chief Takes On Application Of Health Insurance Reform,” MPR News, January 31, 2011)

 Dayton Administration Leaders Assured Technical Development Could Be Done Without Legislation.  “Minnesota Commerce Commissioner Michael Rothman said nothing in the federal health care law requires states to pass legislation to set up their state health insurance exchanges. He said the federal review will be based on other benchmarks. ‘It will look at how far along we’ve built the exchange, the operations, the IT, how far Minnesota is ready and prepared to have its own Minnesota-made exchange, rather than having the federal option imposed on us and certification does not require legislation,’ Rothman said.”  (Elizabeth Stawicki, “Minnesota Plans For Exchange Without New Law,” Kaiser Health News/ MPR, February 7, 2012)

 Before Legislation Set Up Board, Oversight Of MNsure Switched From Department of Commerce To Department of Management and Budget.  “The governor is shifting the project’s oversight from the Department of Commerce to the state Management and Budget office. The move follows complaints that the Commerce Department was too secretive in developing the health insurance marketplace, and questions of possible conflict of interest for the department. The Commerce Department has led the effort to develop an insurance exchange that will help more than a million Minnesota consumers find and buy a health plan, starting in 2014. In a letter to state lawmakers, the governor said the Commerce Department has done an excellent job of launching the design and developing the exchange. But MMB is now taking over.”  (Elizabeth Stawicki, “Citing Potential Conflict Of Interest, Dayton Moves Insurance Exchange To Budget Office,” MPR News, September 19, 2012)

Top Commissioners Worked With Dayton And April Todd-Malmlov To Develop Exchange. “Governor Dayton has been working closely with Commissioner Rothman, Human Services Commissioner Lucinda Jesson, and Health Commissioner Dr. Edward Ehlinger on preliminary plans for the Exchange. In the coming weeks, the Dayton Administration will offer an Exchange proposal that brings greater health care value to Minnesota consumers in a convenient, user-friendly format. Health Insurance Exchange Director April Todd-Malmlov compares the Exchange to a website much-like Travelocity or Expedia.com.” (Press Release, “State Receives $1 Million Federal Grant To Plan Health Insurance Exchange,” Office Of Governor Mark Dayton, February 25, 2011)

Board Authority For MNsure Transitioned From Department of Management And Budget To MNsure Board At End Of Summer 2013.  “Minnesota Management and Budget Commissioner Jim Schowalter, who will turn over formal authority to the board at the end of the summer, said he expects the transition to go smoothly. ‘It’s a great set of issues,’ Schowalter said, reflecting on the transition. ‘I cannot think of a bigger set of challenges that have come across state government.’”  (James Nord, “Minnesota Health Exchange, As Expected, Encounters A Few Hiccups,” MinnPost, June 25, 2013)

Gov. Dayton Called Obamacare A “Big Gamble” In Minnesota. This is a big gamble. I can’t say [if] it’s going to succeed or not,”… “It’s a huge undertaking. It’s a gargantuan software issue to try to put all this information about all these providers … and have it be current and accessible, and understandable. It’s staggering.” (Catharine Richert, “Affordable Care Act Has Unique Proving Ground In Minnesota,” Minnesota Public Radio, 7/9/2013)

As MNsure Launched, Dayton And Top Legislators Publicly Expressed Confidence In MNsure

Routinely Derided Any Questions As Political

Gov. Dayton Was Pleased With The First Weeks Of MNsure. “Gov. Mark Dayton says hes pleased with the performance of Minnesotas health insurance exchange so far but that it’ll be at least a year before it can be judged a success or failure.” (Associated Press, “Dayton: MNsure Off to Good Start,” WJON, 10/22/2013)

Gov. Dayton Criticized Those Asking For Accountability With Obamacare. “As for critics of the new health care law, Dayton said they are only out to ‘disrupt and destroyit. ‘Every slight misstep or glitch is jumped upon and they want 400 questions answered,’ Dayton said. ‘Anything goes positive … they have no interest in whatsoever.’” (Catharine Richert, “Gov. Dayton Defends MNsure From Critics, Potential Challengers,” Minnesota Public Radio, 10/25/2013)

Gov. Dayton Thought MNsure Was Going “Phenomenally Well”. “I think the MNsure beginning has been not perfect. But given the complexity and scope of the project, I think it’s performed phenomenally well.” (Catharine Richert, “Gov. Dayton Defends MNsure From Critics, Potential Challengers,” Minnesota Public Radio, 10/25/2013)

When Asked About Accurate Concerns Regarding Enrollment Data Transfer, Gov. Daytons Office Blew Them Off. “Bob Hume, a spokesman for Dayton, wrote in an email that the Republicans who sent the letter ‘have done everything they can to exaggerate and distort the facts on MNsure for as long as it’s existed.’” (Christopher Snowbeck, “MNsure Enrollment Processing Concerns GOP,” Pioneer Press, 11/22/2013)

Pressed Against A Year-End Deadline And Facing Numerous Technical Issues, Gov. Dayton Finally Expressed Some Concerns About MNsure. “The ongoing technological problems that continue to plague the state’s online health insurance marketplace should have been resolved by now, Gov. Mark Dayton said today. ‘There continue to be problems that are operational problems and it’s two and half months now since it got started,’ Dayton said. ‘In my mind we’re at the point where these kinds of snags should have been resolved.’” (Elizabeth Stawicki, “Dayton: MNsure Issues Need To Be Fixed,” Minnesota Public Radio, 12/11/201)

When Forced To Accept MNsure Problems, Dayton And Legislative Democrats Pointed Blame At Staff

Gov. Dayton Claimed MNsure Has Not Kept His Office Apprised Of Problems. “MNsure officials have not been keeping Dayton’s staff aware of current and looming problems, or up-to-date on the scope of problems, the governor added during a Thursday news conference at the Capitol.” (Christopher Snowbeck, “Dayton Calls MNsure Issues Unacceptable,” Pioneer Press, 12/12/2013)

In Weeks Before Launch, Gov. Dayton Received Daily Updates On MNsure’s Status. “‘The impetus for the meeting was that the Curam software was taking too long to get in, and it was holding other things up,’ Todd-Malmlov recalled. Of the governor, she noted, ‘He was extremely frustrated.’ Afterward, she said, she provided updates to Dayton on a daily basis.” (James Nord, “MNsure: Anatomy Of A Breakdown,” Politics In Minnesota, 4/11/2014)

Gov. Dayton Claimed The Decision To Launch Was MNsure’s, But The Former Executive Director And Dayton’s HHS Commissioner Dispute That. “Dayton said he was reassured in the days that followed that MNsure’s website would be ‘good enough to go,’ but he left the final call to Todd-Malmlov, a health care policy specialist who served as MNsure’s executive director. Todd-Malmlov, in her first interview since resigning under pressure in December, said the decision to launch was made jointly with Lucinda Jesson, commissioner of the Minnesota Department of Human Services. Todd-Malmlov said she also consulted with the governors office and top officials at MN-IT, Minnesota’s technology department. ‘It was definitely a shared decision,’ Todd-Malmlov said. Jesson said she regularly consulted with Todd-Malmlov and agreed to go live with online enrollment.” (Jeffrey Meitrodt, “MNsure Defects Were No Surprise,” Star Tribune, 3/7/2014)

Gov. Dayton Doesn’t Think He Would Change How MNsure’s Launch Was Handled. “Dayton insisted that the Sept. 19 meeting was the first time he learned that problems with the website were serious enough to call into question whether MNsure could proceed with the launch on the same day open enrollment began across the country under the Obama administration’s health care overhaul. But he said his office kept in close contact with MNsure officials throughout the process and he thought enough problems would be resolved in time. Even in hindsight, Dayton said, he still believes the decision not to delay was correct. He said he thought the system was operating ‘very well’ at first and that its glitches were due mostly to problems with the federal system. He said he ‘didn’t have any inkling of persisting problems until the middle of November’ when he said new problems kept cropping up every time old issues got resolved. He also said he never tried to mislead Minnesotans on MNsure’s condition. (Steve Karnowski, “Dayton: MNsure’s Critics Are Waging Campaign To Destroy It,” Star Tribune, 3/8/2014)

One MNsure Board Member Did Not Inform The Rest Of The Board About The Extent Of MNsure’s Problems. Jesson was the only MNsure board member who knew the depth of the problems. ‘I remember talking to MNsure staff at some point in September and saying, ‘You need to make sure other board members know what I know.” (Jeffrey Meitrodt, “MNsure Defects Were No Surprise,” Star Tribune, 4/7/2014)

Amid Growing Frustration With MNsure, Its Executive Director Resigned Just 2.5 Months After Launching. “The embattled director of the state’s fledgling health insurance exchange resigned Tuesday amid mounting criticism of her leadership and the troubled rollout of the new health care program. MNsure executive director April Todd-Malmlov announced she would step down from her $136,000-a-year post during a closed-door meeting with the program’s executive committee.” (Baird Helgeson, “MNsure Director Steps Down; Interim CEO Is Selected,” Star Tribune, 12/17/2013)

An Independent Report Blasted MNsures Leadership Structure. The Optum report, however, was strongly critical of MNsure leadership, saying, ‘Current Program Management structure and process is nonexistent, and management/leadership/decision making is occurring via crisis mode.’” (James Nord, “MNsure Leaders Face Big Decisions, Bleak Projections,” MinnPost 1/23/2014)

Thanks To Legislation Passed By 2013 Legislature And Signed By Governor Dayton – MNsure Passed out Performance Bonuses To Top Executives 

While MNsure Was Failing, It Was Handing Out Performance Bonuses To Its Executives. “Fourteen MNsure managers were paid bonuses totalling more than $26,000 in November as Minnesota launched its troubled online health insurance exchange, state officials said Wednesday. After MNsure went online Oct. 1, software problems bogged down website users and led to long delays for callers to its overwhelmed call center in St. Paul” (Christopher Snowbeck, “MNsure Awarded $26,000 In Manager Bonuses Before Troubled Web Site’s Launch,” Pioneer Press, 1/30/2014) 

MNsure Has No Plans To Recover Their Bonuses Paid To Executives. “Republican U.S. Rep. Paul Gosar shot his first question to MNsure interim CEO Scott Leitz, asking why the state would pay nearly $27,000 in bonuses to people responsible ‘for a blotched Website?’ ‘Those bonuses were approved by the previous director,’ Leitz replied. ‘Have you done anything to claw back those bonuses?’ Gosar fired back, wondering if the former staff members were required to pay back any of the money. ‘Not to this point, no, sir,’ Leitz said. Gosar responded: ‘Interesting.’” (Don Davis, “GOP Congressman Grills MNsure Leader,” Capitol Chatter, 3/3/2014)

MNsure Bonuses Were More Expensive Than Previously Thought. “An audit released Tuesday includes new details about performance incentives and awards for MNsure employees before the troubled launch of the health exchange in 2013. In January, MNsure disclosed that 14 managers collectively received more than $26,000 in bonuses for the quarter ending Sept. 30, 2013 — the period preceding the Oct. 1 start for the exchange’s balky website. The new report from the Office of the Legislative Auditor shows total MNsure payroll spending of $32,191 connected with the bonuses. The extra money reflects employer-paid costs related to the bonuses, including federal taxes, said MNsure spokesman Joe Campbell. In addition, the audit showed $6,271 in what state officials called ‘achievement awards’ at MNsure during the 12-month period ending June 2013.” (Christopher Snowbeck, “Audit Reveals The Full Costs Of MNsure’s Prelaunch Bonuses,” Star Tribune, 10/28/2014)

 Legislators Approved Compensation Plan The Led To Bonuses For Top MNsure officials.  (HF 1069, May 2013)

 Minnesota’s Legislative Auditor Began Sounded Alarm in Early 2014, Governor and Legislature Did Nothing

Minnesotas Legislative Auditor: “State is Not Supposed To Be A Passive Observer In Managing A Contract.” “Nobles said Dayton’s letter provides his office with a starting point to examine the problems with the site, which have infuriated users, prevented people from getting insurance, and kept MNsure from meeting a critical deadline related to determining an individual’s eligibility for Medicaid. Nobles also said his team may learn a lot more once they start sifting through the details. ‘Once we are in there, we may see a lot of other issues we may pursue.’ Nobles said he’s particularly concerned that the state apparently never verified or tested the software before buying it. He’s concerned that the state didn’t learn any lessons from the failed HealthMatch project, a massive computer systems overhaul that was also meant to determine eligibility for public insurance programs. ‘Even the governor reveals in his letter that the state seemed to not know a lot of things, and that concerns me a great deal,’ Nobles said. ‘The state is not supposed to be a passive observer in managing a contract of this importance and this size. So why the state was coming so late to understanding what was going on is of great concern.’” (Catharine Richert, “Minn. Legislative Auditor Investigating MNsure Contracts,” Minnesota Public Radio, 1/26/2014)

Gov. Dayton Didn’t Think There Is Anything He Or The Legislature Should Do To Fix MNsure. “At least one high-profile issue — the state’s troubled MNsure — will be outside the purview of the governor and legislators this year, Dayton said. The exchange’s website has been troubled with glitches since its rollout on Oct. 1. ‘I would certainly do it differently,’ Dayton said of MNsure, which was passed into law last session. I don’t think theres anything that the Legislature needs to do or can do really thats going to affect these problems. These are operational problems and they are being corrected, and the system is working a lot better now. It’s not perfect yet, and that’s where it needs to be, and we are working toward that.’” (Brianna Bierschbach, “Dayton Expects Lots Of GOP ‘Rock Throwing,’ Even With Limited Legislative Agenda,” MinnPost, 2/25/2014)

The Legislators Who Passed MNsure Don’t Want To Do Anything To Fix It. Key DFL lawmakers dont want to act on legislative changes to MNsure this session, making it very unlikely that the health exchange will be substantially transformed through political action. Republicans have introduced a bunch of bills – many of them amendments they proposed to the initial MNsure legislation last year – to reshape its governing board authority, legislative oversight and budgeting process. With the passing of the first legislative policy deadline last week, those bills appear to be going nowhere. … House Commerce Committee Chairman Joe Atkins, who sponsored the MNsure legislation last year, said he didnt want to spend too much time on the exchange this session.” (James Nord, “MNsure: Legislators Likely To Keep Hands Off Health Exchange This Session,” MinnPost, 3/24/2014)