MELISSA BLOCK, HOST:
More than 180,000 Minnesotans, who didn't have health coverage a year ago, now do. That means the state has an insured rate of almost 95 percent. This all happened even though the state's health exchange website never worked very well - a website which, by the way, cost some $100 million. And now as the state is spending more money on it. Some people wonder whether it's worth it. Elizabeth Stawicki reports.
ELIZABETH STAWICKI, BYLINE: Even before the Affordable Care Act's major changes took effect, 92 percent of Minnesota residents had health insurance. Of those remaining without coverage, researchers estimated about two-thirds were already eligible for government programs. They just didn't know it or how to sign up. Enter the healthcare law, which gave most Americans a financial incentive to find coverage - sign up or pay a penalty - and accompanying ad campaigns, like this one with Paul Bunyan, to raise public awareness.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED MAN: Oh, no - woah, woah. Oh, ow, ow.
UNIDENTIFIED WOMAN: Minnesota, land of 10,000 reasons...
UNIDENTIFIED WOMAN: To get health insurance.
STAWICKI: At the same time, Minnesota expanded Medicaid. The government also spent many millions of dollars paying so-called navigators to fan out to churches, schools and other communities to provide one-on-one help. Minnesota's rate of insured jumped to more than 95 percent. But its insurance marketplace, MNsure, stumbled from the beginning. This has left some Minnesotans questioning whether the state needed an insurance website if the goal is solely to get more people covered. Dannette Coleman who works for a health insurer, Medica, says maybe not.
DANNETTE COLEMAN: I think we still would have achieved that. In fact, you could look at it to say if the exchanges worked better out of the gate, would it be even higher?
STAWICKI: Others agree, like Steve Parente who teaches health finance at the University of Minnesota. He says, at the very least, Minnesota could have just gone with the federal exchange.
STEVE PARENTE: The one advantage of having it be federally controlled was that, you know, when it really became problem, there was a lot of resources that went to it very quickly. And whether you like the changes or not, it did turn around rather quickly.
STAWICKI: Parente acknowledges it's easy to say that now, knowing that while the federal exchange was able to write itself, MNsure still has a lot of problems and may not be ready for the next open enrollment, which begins mid-November. MNsure CEO Scott Leitz says the Affordable Care Act is bigger than a website. He agrees the many efforts brought down the state's uninsured rate, including the work of counties and navigators to help people get into coverage. But he says those actions were intertwined with the publicity surrounding MNsure. And he says MNsure's presence played an important role on its own.
SCOTT LEITZ: Actually having transparent information available led the competition among health insurers, which was exactly what marketplaces and exchanges were intended to, which was to create the competition. It very clearly did that in Minnesota.
STAWICKI: A consultant Joel Ario, who formerly headed the U.S. Department of Health and Human Services, Office of Health Insurance Exchanges, is not worried. He says with any new technology, it takes time to work out the kinks.
JOEL ARIO: I'm as confident of this as I would be that when the first car didn't work well, it wasn't time to return to horses and buggies. It was time to improve the cars.
STAWICKI: But for some Minnesotans, the insurance enrollment process is still in the horses-and-buggies stage. The big question is how much time and money it will take to get MNsure road-ready. For NPR News, I'm Elizabeth Stawick in St. Paul.
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