Hoping to persuade Minnesota's new Republican legislative leaders to cut the $6 billion budget deficit with a scalpel instead of a hacksaw, a coalition of hospitals, doctors and other medical providers may offer a plan to restructure the state's large and costly health insurance programs.

"I don't think we have any choice," said Michael Scandrett, a Minneapolis health care consultant who has been active in the coalition. "We're going to have new leaders who are not as familiar with health issues as the DFL leaders were, and we have an opportunity to help them find solutions while minimizing the damage to people in need."

Coalition members, who met the day before voters turned the Legislature over to Republican control, are mindful that Medicaid, MinnesotaCare and the other big health programs consume roughly one-fifth of state spending and frequently have been targets of budget-cutting efforts.

Though still hazy, their proposal might build on current efforts to create "health care home'' programs that offer efficient, coordinated care to patients with chronic or complex ailments, perhaps with a fixed payment covering a patient's total medical care.

Ultimately, any proposal from the group may test whether the next Legislature, which convenes Jan. 4, will be an arena for compromise or a battleground for the 2012 elections.

One top Republican was receptive on Thursday. "We'll listen to anything they have to say," said Rep. Jim Abeler of Anoka, who expects to head the House Health Care and Human Services Finance Division. "We all need to work smarter, and we all need to work together. I want to consider keeping our spending flat for the next biennium. I'm ready to listen."

Seeking common ground

First, the coalition representing doctors, hospitals, health plans and others must find its own common ground.

"We're two months from a new session and we don't know who will be on what committees, who will lead them, even who the governor will be for sure," said Julie Brunner, executive director of the Minnesota Council of Health Plans.

Still, the work must start quickly, said Lawrence Massa, president of the Minnesota Hospital Association. "We know we can't sustain the current health care system," he said. "But with a huge budget deficit, we can help the legislators and our patients with an agreement on better ways to provide care."

Dr. Patty Lindholm of Fergus Falls, the new president of the Minnesota Medical Association, said that she personally supports the coalition's work but that she needs to consult fellow physicians before proceeding.

The alliance coalesced last year as the GAMC Stakeholders Coalition, in an attempt to find innovative ways to finance General Assistance Medical Care, which covers very poor childless adults, after Gov. Tim Pawlenty vetoed funding for the program.

In the end, legislative DFLers and Pawlenty saved the program, but with a compromise that attracted only four hospitals, all in the Twin Cities, offering coordinated care to 32,000 poor, childless adults statewide.

It won't be easy

Some DFL leaders, though still smarting from bruising encounters with Pawlenty, say they're ready to work with Republicans on new health care models. "My compromise skills certainly have not gotten rusty. Sometimes that feels like all I've done the past eight years," said 30-year Senate veteran Linda Berglin, DFL-Minneapolis, who will surrender leadership of the Health and Human Services Budget Division.

Even with a proposal from the health groups, reaching legislative agreement won't be easy. "We're going to have to focus on helping the people who need help the most," Abeler said. "If one family is starving and another is just hungry, you help the starving people first. We have to continue doing the things that are essential, not just things that would be nice."

Warren Wolfe • 612-673-7253