If there's any state that should be heard and heeded during the complicated rollout of federal health reform, it's Minnesota.
Again and again in the battle over health care legislation, Minnesota was singled out for its high-quality care, low uninsured rates and innovative programs. Now that the Affordable Care Act is the law of the land, it just makes sense for the state's providers and insurers to guide federal efforts to make the bill's key provisions a reality.
And that's why it was utterly illogical for Gov. Tim Pawlenty to decide against sending an important letter outlining Minnesota's official response to the construction of one of the pillars for the 2010 law: health care exchanges. Intended to unleash the power of competition in health care, the state-based exchanges are expected to be online marketplaces (operational in 2014) where consumers can comparison-shop for health insurance. Exchanges are hardly a radical idea. Pawlenty, in fact, called for establishing the "Minnesota Health Insurance Exchange" in his January 2007 budget proposal. The program even had its own acronym: MnHIE.
The state's official response letter was drafted after the U.S. Department of Health and Human Services (HHS) sought state input as it builds exchanges' framework. Minnesota's nationally respected providers and insurers generously shared their expertise when state officials sought their input.
Their hard work can be seen in the 11-page letter dated Oct. 4 that was signed but never sent to HHS by three high-ranking state officials. The letter gets technical, but it's clear that providers and insurers wants flexibility foremost, especially in allowing exchange consumers to base their purchasing decisions on information generated by Minnesota's pioneering efforts to measure providers' quality and value. There's also a plea that federal officials not dictate provider network requirements; overly inclusive requirements could undermine efforts to improve quality and cut costs.
This is valuable feedback. Whether it will be considered by HHS remains a question. Last week, three leading health care groups found out inadvertently that the letter hadn't been sent. To their credit, the groups -- the Minnesota Council of Health Plans, the Minnesota Hospital Association and the Minnesota Medical Association -- obtained a copy of the letter through the state Data Practices Act and defiantly sent it on their own. But the letter missed the deadline.
It's hard not to cynically see the unsent letter as the latest prop in Pawlenty's bid to become the most anti-health-reform GOP presidential candidate. He's declined to apply for money to set up a state exchange and has dictated that state agencies clear many "Obamacare" efforts through his office. Most recently, the Department of Commerce (which answers to the governor) has failed to issue a ruling that insurers say they desperately need to sell plans for children with preexisting conditions.
In fairness, there is a growing divide between Democrats and Republicans over the exchanges. The GOP sees them as a way to reduce regulation. Democrats see them as a consumer-protection mechanism to ensure that plans cover essential care. Supporting exchanges doesn't mean supporting the opposition's version.
The governor's office also said Monday that the letter didn't reflect Pawlenty's views on exchanges' cost-control limits and that the administration was told by the Minnesota Department of Health that there wasn't time to redraft the letter.
Careful, quick editing and common-sense communication could have resolved concerns. The letter should have been sent. Now is the time to amplify Minnesota's health care expertise -- not mute it.