Political reality: DFLers own a MNsure program that fails

MPR News reporter Elizabeth Stawicki’s story today on a consultant’s opinion that the state’s health insurance exchange program “won’t be fixed quickly and the state should consider the option of scrapping the system altogether and starting over,” brings us back to a question that’s lingering: Is anybody in charge listening?

As I wrote in December, so many politicians — starting with Gov. Mark Dayton — have their careers tied to MNsure that the order of the day has been denial for months. The risk of facing the problems head on is political suicide for the leaders — the state is full of “I told you so” opponents who would be happy to take their jobs.

Instead, we’ve been led to believe a little tweak here or a little tweak there and things will be fine. This line of thinking manifests itself in the cliche, “you don’t think Amazon had the same problems when it started?”

Of course, people weren’t required to shop Amazon, and their health doesn’t depend on it even if they did. Also, Jeff Bezos is a pretty good leader and isn’t up for re-election.

It’s understandable that people want MNsure to succeed (some politicians claim to want the site to work, but they’re more interested in simply killing availability of health care to other people), but today’s report isn’t the first wake-up call that it’s not going to, and won’t if someone doesn’t step up and lead.

In fact, one of the recommendations of Optum, the firm that produced today’s assessment, is to identify and define an “accountable program leader.” It took a consultant to come up with that?

The report describes a horribly inefficient system, but then delivers the really bad news: There’s no choice but to stick with it, at least through the first quarter of 2014. It identified three options for getting the system fixed in time for next year’s enrollment, all of which require spending more money and one of which essentially calls for blowing MNsure up and starting again, which happens to be the position of one of the Republican candidates for governor.

How did this mess happen?

Writing in MinnPost, Mark Haveman of the Minnesota Center for Fiscal Fitness, said there are almost two dozen open information technology positions with the state, many of them for MNsure. The advertising for the positions indicates salaries of about $55,000-$65,000 for some top positions:

To investigate whether the state can compete for this talent and fill these needs, we copied these position descriptions verbatim and sent them to some IT professionals and consultants to get an estimate of what private sector firms in the Twin Cities area might be expected to pay to obtain someone with such capabilities and experience.

Our respondents were quick to note they could only generate ballpark estimates. But the consensus was all four positions could easily fetch $100,000 and more in annual salary in the private sector based on the skill requirements and responsibilities described, the extreme tightness of the IT labor market, and the fact that these openings are in the healthcare area. The possible exception was the programmer position, but with four years of professional experience, it was believed that position too could demand a nearly six-figure salary.

“You get what you pay for,” Haveman concludes. And sometimes, you get virtually nothing for what you pay for.

In the meantime, predictably, Republicans are preparing to gang up on Gov. Dayton, the Star Tribune reported this week. It’s already started:

Democrats, in response, say when the system is functioning and thousands of people are getting health insurance, the success stories will overwhelm the Republican efforts.

Today’s report suggests that will come after Election Day, if at all.

  • Kassie

    Optum stopped just short of offering their own services for the total redo of the system, right? Because that is what they are going for. I’m not going to deny that MNsure is likely a mess, but I’m not going to take the word for a company that is in the business of building health care technology and could potentially make millions if they were chosen to fix it.

    As for state IT employees not making enough money, right on! We don’t. But we do have lots and lots of talented people. We find talented people by offering something most companies can’t: 40 hours a week, not more, not less. Add in good health benefits and vacation time and we have a pretty good package if you don’t mind making $30-$50+k below your peers.

    • No, they didn’t stop short. They actually *did* offer their services. But whose word ARE you going to take? Just go back to the thing I wrote last December, check the PiPress, check the Strib editorial. It’s impossible to find anyone who says this thing isn’t a steaming pile.

      MNsure hired these guys and that’s what they got. But we can wait another few months until the legislative auditor comes out with its report. That should be a good one, be pretty much infallible in terms of connections, and likely lead to some bureaucratic saying, “I wish I’d known.”

      • theinnerring

        then i’ll wait. optum has a dog in this “fight” as it stands now.

        • That’s one way to look at it. The other way is that someone with some talent and expertise finally got a look under the hood.


          • Dave

            They aren’t an independent (i.e., neutral) party by any stretch of the imagination. Their opinion on MNsure has to be taken in that context. Not that the Star Tribune will make any attempt to do so.

          • If only we had a consultant with a team of 15 that drops in on the operations at MNsure, that puts out a report that says “this is going great; a couple of dings that will buff right out.”

      • Kassie

        I would have liked to see a company without an interest in getting a follow up contract do an audit. You pay a company to do one and write into the contract that they cannot bid on any work on the product in the future. This is something I’ve seen the State do in the past and I’m unsure why they didn’t do it this time.

        And they didn’t hire these guys. It was free. It was just United Health drumming up work.

      • Andy

        Two rhetorical questions:

        1. When you consider that the ENTIRE health insurance industry is a “steaming pile”, how can we reasonably expect any program that simply tinkers around the edges to be any different?

        2. How often in our country or culture do we have examples of leaders standing up and admitting to mistakes? Especially on such a politically divisive issue?

        • 1. I don’t 2. Never The irony is the politics of this will eventually push everyone to single-payer. Maybe that was the diabolical plan from the start. :*)

          • reggie

            We should have a single-payer system, and if this is what it takes to get there, full speed ahead.

          • Thorley Winston

            I doubt it, when supporters of the Democrats are referring to ObamaCare as “big steaming pile,” it’s unlikely they’d ever be trusted with something like single payer.

          • tedb

            We already have Medicare, which is single-payer. Change the eligibility age, and we are done.

  • Optum isn’t exactly an “independent” consultant.

  • John Peschken

    Despite months of “tweaking”, it’s STILL a steaming pile. I am considering possibly retiring a little early, and wanted to see what I can get for insurance through MNsure. No joy. “System Error” I’m just lucky I’m not uninsured.

    It’s a fiasco, but not bad enough to make me vote Republican, unless some more moderate Republicans show their faces.

  • Dave

    “which happens to be the position of one of the Republican candidates for governor.”

    You don’t say.

    • Dave

      And who the hell is Jeff Bakken and why does his opinion matter?

      • Why don’t you click the link and find out.

        • Dave

          He says they should all resign. Is that a reasonable thing to say? Would I trust his insight into the matter after he says that?

          • He’s a pol who’s used MnSure as a weapon. That’s the point. “A reasonable thing to say”. It doesn’t matter. The campaign is underway.

  • Is it too glib to suggest the quickest way to fix our state’s healthcare problems would be to make MNSure mandatory for all state politicians? This is fixed in a month if their family’s health is at stake.

  • There’s no denying that MNSure has it’s problems and that the board has been less than forthcoming about the extent of those problems. But before everyone goes jumping on the “let’s just scrap it” train, please ask yourself how many of these problems could have been avoided had implementation not been delayed for two
    years by a hostile Legislature? It’s hard enough to bring a massive project like this to fruition on time and on budget without being actively undermined in the process.

    • kevinfromminneapolis

      The DFL, particularly Governor Dayton, embraced this with open arms. It’s theirs, all theirs and they don’t get to point fingers. They get no excuses.

      • The ACA was passed in 2010. The DFL did not take over control of the state Legislature until the 2013 session. A simple Google search will show plenty of examples of where David Hann and other Republican legislators tried to muck up the works.during those two years in between.

        • kevinfromminneapolis

          Cry me a river.

        • Keep in mind, Gov. Dayton claimed earlier this month that he didn’t learn of the contract changes in MnSure until SIX MONTHS after they were made. He said he didn’t know about the technical problems until AFTER the October 1 launch.

          Well, someone did. Who? And where were the Board of Directors in all of this, who were appointed by…. wait for it… Gov. Dayton? And one of those members is his own cabinet member.

          Were they out of the loop? Or were they trying to smother news about the problems?

          • Those are great questions that will hopefully be answered by the Legislative Auditor’s report. Having gone through that experience myself several years ago with my agency, they don’t pull punches when they find problems.

          • Sean Olsen

            The Board didn’t assume any formal responsibility until August. We can only blame them for mistakes made since then.

    • That’s true and there’ll be plenty of time for parceling out blame. And, perhaps, the bunker mentality of MNsure’s allies is a direct result of that assault. But that doesn’t change the reality of where we are now.

    • Thorley Winston

      When your Big New Program relies on getting the people who you locked out of the room while you were drafting the bill to help you implement it, you pretty much screwed yourself.

      • Who was locked out of any rooms? Gov. Dayton invited Republican legislators to participate in developing the health care exchanges numerous times. They refused because they didn’t want to look like they were supporting it.

  • Dave

    It would be interesting to know if any of the Republicans currently bellyaching about MNSure are even in need of its services. They don’t like government-funded healthcare. They outwardly hate and heap scorn upon the people who seek and support it. They offer no alternative because the current system is “working,” in their view.

    So yes, Bob, I’m delighted to know that Republicans suddenly and vigorously want MNSure to succeed. Good for them.

    • Well, golly, that didn’t take long at all to devolve into Republicans v. Democrats, which provides the perfect example of why MNsure got to where it is. Democrats slapped lipstick on a pig. Republicans killed it — as I said earlier — with a thousand paper cuts.

      Well, swell for both of them and wonderful for the people who get up in the morning to have just one… more… day… of the political argument that never ends.

      So, you’ve got this thing that doesn’t work. It hasn’t worked for months and now we’re months further down the road.

      The leaders of the state have wrangled themselves into this position: They can either sugarcoat the problems and get re-elected and be insulated by the luxury of two or four more years before they have to stand for election again, by which time — maybe the thing will work.


      They can acknowledge what everyone not dependent on the next election has pointed out, acknowledged the true nature of the problem and rebuild it, likely losing an election in the process because the opposition is going to make them wear it.

      What a fine example of good government.

      • Dave

        To be fair, you are the one who included the tweets of three Republicans, telling us they’ll gang up on Dayton. Also, I didn’t say anything about Democrats.

        “So, you’ve got this thing that doesn’t work.”

        I’ll have to take your word for it. I honestly have no earthly idea how well or poorly MNsure is working. I will not be using the service; I have not needed to enroll. So the only perspective I have is based on what I hear in the media. I’ve heard that there are long waits on the phone. I’ve also heard that thousands of people have enrolled.

        This is playing out exactly as the Obamacare fiasco did. A bunch of negative media coverage (deservedly or not, that’s beside the point), Republicans get angry gleeful, etc. Problem for them is, by the time the election rolls around and new legislators are sworn in, both programs will have been in place for more than a year. That’s a lot of enrollees who will have been using the service for a long time. Good luck undoing that. The Republicans are going to have to work within the confines of both systems whether they like it or not.

        • Right. i did so to point out that it’s past the tipping point of getting it properly fixed without casualty.

        • Let’s also keep in mind that this “thing that doesn’t work” has managed to enroll 80,000 Minnesotans in health care coverage that they didn’t have previously, including several friends of mine. Not trying to sugarcoat the problems, but it’s also not the flaming bag of poop that the critics like Jeff Bakken would like us all to believe.

          • There’s two things here. There’s the program of health insurance and then there’s the infrastructure. For purposes of this we’re talking infrastructure — really the automated infrastructure — and not the system of navigators and paper that has been relatively effective in signing people up.

            As far as the mandate to have health insurance, that’s no longer a debate.

          • Correct. I will be watching for what Bakken and other MNSure critics offer for alternatives. Doing away with the exchange is not an acceptable alternative.

          • dpsours

            Wait. I’m confused. Is it a steaming pile or a flaming bag?

  • mark gettner

    Everyone who voted for MNsure, didn’t vote for the IT rollout. The wrong people were hired. Leadership lacked. Affordable health insurance is a must. So, those voting against MNsure, what alternative did they offer? They offered the status quo: Ubber profits for the insurance industry, no affordable health care for small business owners. Our country has the most expensive insurance in the world with some of the worst outcomes. Most small business owners can’t offer insurance benefits.

  • Uncle Geo

    Websites a mess? Absolutely. New people needed at MN Sure -yep, but since Republicans get all crabby when you talk about paying them competitive wages we’ll get someone’s nephew just out of tech school.

    And where is the reporting that informs people they can simply call an insurance agent and have them do it for you? I friend of mine is super busy writing new Obamacare policies.

    The bottom line is that no matter what a mess the web experience is, people will eventually get coverage that they can’t under our current truly stupid system. Children will get health care whether their parents currently hold a job or not. People who have a pre-existing condition won’t be charged more for it or be denied. Lose your job, you still get covered. Lives will be saved.

    Republicans should be wanting this to succeed for everyone’s health but they want it to fail not simply because Obama wants it to succeed (though that’s a sure bet) but also because they were never serious about it in the first place; after all it was their idea to have exchanges where you compare plans from insurance companies. And that was to distract everyone from single payer. Knowing he’d never get single payer, Obama basically called their bluff and now they’re freakin’.

  • KTFoley

    I wonder if it’s possible to talk about this as an IT problem, on its own? Because I’m pretty sure that there’s still going to be a need for an IT solution.

    As much as I enjoy my own IT job, one of the least enjoyable parts is witnessing the human affinity for turf. Case in point: Optum is not distanced enough to offer a credible evaluation, even as a starting point? Whatever. Doesn’t make the chart of open defects any less damning.

    From reading their presentation, the scope of their assessment went well beyond an audit. They were asked to determine not only what’s wrong, but what would be necessary to fix it, how long would it take, and how much would it cost. Those last two are impossible to deliver if the company providing the info can’t use the measuring stick of time & cost for THEM to fix it.

  • MrE85

    It should be noted that any “political reality” occurs in November, and not before. Until then, it’s political speculation/opinion.

  • Iceman

    Everything that any form of government attempts to provide as opposed to the free market system, it is revealed that they cannot do anything adequately. We need LESS government – fewer government workers and fewer non producers feeding off of our fragile society. We are near the tipping point folks so don’t fall asleep and think things are just gonna be ok because the nanny state say’s so. Very soon there will be more tax consumers than tax producers.