A key reason it takes time to get new medical treatments on the market is that even the most promising may have harmful unintended consequences. A new drug, for example, may damage the liver, a risk that negates its benefits. Another may increase heart attack risk.

Regulators err on the side of caution, generally requiring extensive study before widespread use. That prudent approach has served the nation well. A recent development in Minnesota suggests a cautious approach is also warranted in fixing the costly, ailing American health care system. In particular, a sweeping reform that delivers substantial savings to state taxpayers but that unexpectedly shuts UCare out of Minnesota's public health program contracting merits a prudent pause to ensure that pluses outweigh minuses.

Minnesota was among the first states to privatize its public medical assistance programs and is commendably at the forefront of reforming the contracting process. Reforms here likely will be the model as other states turn to managed care to administer expanded public health insurance programs, underscoring the need to get it right. The value of these contracts in Minnesota alone is projected at about $5 billion next year.

Gov. Mark Dayton and Department of Human Services Commissioner Lucinda Jesson have done exceptional work in driving a better bargain with the state's big health plans: Blue Cross, Medica, HealthPartners and UCare. A previous administration put the contracting process on autopilot, allowing plans to often exceed profit margin targets, a problem pointed out in Star Tribune editorials. Dayton and Jesson not only negotiated a $73 million giveback from the plans in 2012, but launched competitive bidding pilot projects in a limited number of counties.

This year, the competitive bid system was logically expanded to all counties. But it yielded an outcome that shocked Minnesota health care experts: UCare failed to win even a single county after being a top plan in previous bidding. It currently administers medical assistance in 64 counties. This outcome is especially devastating to UCare, which until recently had only served public health programs and relies on them for much of its income. UCare officials say it will survive. But it's clear it will be a far weaker competitor in future years.

That's an important reason why questions about the process should be taken seriously, not dismissed merely as UCare defending its turf. Yes, expanding the competitive bid to all counties is projected to yielded around $450 million in savings next year. But is the state gaining these savings in the short-term while giving up longer-term value? A marketplace with weaker or fewer competitors may well decrease the state's negotiating leverage in future years. Blue Cross, a big winner in this go-round, has excessively padded its financial reserves (unlike UCare) and can endure thinner margins for a time.

In addition, little information has been released about the criteria for winning bids, but cost wasn't the only consideration. Forty-five points were awarded for price, while 55 were given to technical considerations such as counties' input, network adequacy and health care reform/innovation, a category that would be difficult to score objectively. That a number of Minnesota counties are now advocating for UCare's continued participation suggests a disconnect somewhere in this process. Counties are also raising concerns about the resources needed to transfer UCare's 360,000-plus state program enrollees to another health plan, which is complicated by its historic emphasis on serving culturally diverse populations. County staffs are already stretched due to other health reforms underway.

Dayton and Jesson stand out for their cost-conscious approach to managing these programs. Assuming UCare can match the other plans on price, extending it a lifeline to ensure the new bidding process doesn't cost more in the long run is not a departure from that strategy.