Health care reform still alive

ST. PAUL - Minnesota lawmakers say they scaled back their expectations for health care reform this year, but the Legislature still should make sweeping changes to the state's health care system.

Lawmakers behind a comprehensive health care reform package nearing votes in the Senate and House say changes are needed this year to prevent steep increases in health care costs.

Citizens who are insured and who don't have health insurance would be affected by the proposed reforms - as would hospitals, employers, physicians, insurance providers and even obese children.

The leading legislative Democrats working on health care reform - Sen. Linda Berglin of Minneapolis and Tom Huntley of Duluth - say there are many areas of agreement with GOP Gov. Tim Pawlenty.

The reforms emphasize preventative health care, and focus particularly on improving routine health treatments for people with chronic diseases, such as heart conditions, diabetes and asthma. The assumption from reform supporters is that working with doctors and other medical professionals to limit serious health issues linked to those conditions will reduce the need for costly hospital visits.

An estimated 75 percent of health care spending is for chronic disease sufferers.

"If we could do something to cut that down, we could save a lot of money as well as improve health," Huntley said.

The reform package would establish a process in which physicians would seek certification to work closely with chronic disease sufferers. In exchange, they would be paid an additional fee.

The bill's effects could be seen across Minnesota. It would create a statewide public health plan targeting obesity, chemical dependency and tobacco use, with the belief that those issues lead to costly health problems in later years. Cities, counties or community groups could seek state grants.

Funded by a surcharge on nonprofit hospitals and health plans, the program's goal is to reduce the number of Minnesotans who are overweight or smoke.

As part of the reforms, lawmakers considered requiring that all Minnesotans must have health insurance - as a Massachusetts health care reform plan required -- but legislators predict a mandate will not be part of a final package.

An estimated 93 percent of Minnesotans are insured. Huntley said the reform package will make it possible to reach 97 percent without a mandate.

However, Berglin said that while they have agreed there is a need to increase the number of insured Minnesotans, her plan to expand a state-subsidized program using a dedicated health care account does not have Pawlenty's approval.

Berglin said her bill would tap the Health Care Access Fund to increase eligibility for the state-supported MinnesotaCare program, increasing the number of insured by 27,000.

That is the same fund that Pawlenty has proposed using to help balance the state budget deficit, meaning the two proposals are competing for the same dollars.

"I believe that the Health Care Access Fund should be used primarily to provide coverage to uninsured people," Berglin said.

Pawlenty said he has had "good discussions" with legislators on the reform proposals, but that "there's still significant sticking points."

The governor said while DFL lawmakers tend to emphasize expanding services to uninsured, containing costs for those already carrying insurance is his priority.

"As time and circumstances and money allows, expanding access to the uninsured is important as well," Pawlenty said. "But we can't lose sight of the fact that the main problem is cost escalation for the 93 percent who are insured."

Rep. Matt Dean of Dellwood, the lead Republican on a House health care committee, said there is agreement behind the bill's intent - to reward preventative health care rather than responsive, curb costly treatments and to expand the number of people insured.

However, Dean said there remain concerns about what some consider taxes included in the bill, as well as unknown costs in future years.

"It's a little loosey," he said. "How much are we really saying?"

The bill also creates a health insurance exchange, where individuals and small employers could get information about insurance options and purchase plans. A similarly controversial provision calls for health care providers to post their rates, which reform supporters say will make it easier for patients to shop for treatments.

Leading business groups, some medical providers and insurance agents oppose parts of the bill, and lawmakers have many questions about the reform package.

To be sure, health care spending would not decrease if the reform package was put into law. Roughly $30 billion is spent every two years on health care in Minnesota, but that is expected to jump to $42 billion by 2011 if no changes are made. That projected increase is the result of an aging population and rising costs.

The reforms could result in health care costs 20 percent lower what they would be without any changes to the system, Huntley said.

Confusion over the bill and lawmakers' many unanswered questions delayed a Senate floor vote Wednesday. It is expected after the Legislature returns from an Easter recess. Huntley, whose bill continues to move through House committees, said he does not want to pass a bill Pawlenty will veto.

"This is too important," he said.

Huntley said the state's economy would benefit if health care spending increases were tamped down.

Rep. Mary Ellen Otremba, DFL-Long Prairie, typified some lawmakers' feelings toward the bill. A member of two health care committees, Otremba studied the package and had concerns. One part of the bill could hurt rural areas, she said. Another, however, would benefit the same people.

"I know we have to do something," she said. "It's a broken system."

Sen. Julie Rosen, R-Fairmont, who has worked with Berglin on the Senate bill, said the package could undergo changes and still pass this year. However, she said the bill cannot lose major provisions and still be effective.

"The way it's set up, you can't take a leg out and expect it to work," she said.

Rosen agrees with others that the Legislature and Pawlenty must come together on a package, even if the potential health care savings are unknown.

"It's still a gamble, but I don't think we have a choice anymore," she said.

Scott Wente works for Forum Communications Co., which owns the Bemidji Pioneer.