Gubernatorial candidates agree health care is a top priority, but they differ on how to provide care while facing a $6 billion budget deficit.
Six leading candidates for governor say a top priority next year will be wrestling with the cost and shape of health care in Minnesota. No wonder: Medical spending accounts for roughly one-fifth of the state budget -- a share that is growing and is sure to be battered by a $6 billion projected deficit, just as state and federal laws start shifting health care into uncharted waters.
"If there's one good thing about a $6 billion deficit," said Rob Hahn, an Independence Party candidate, "it forces us to look at things differently."
As they prepare for Tuesday's primary, the candidates' health care ideas run a wide gamut -- from blocking President Obama's ambitious new health care law to starting a string of state hospitals and clinics with cheaper care than is now available.
All six want to ease the burden of rising health care costs, which are projected to top $41 billion this year in Minnesota for government, business and individuals, though none has a comprehensive plan to do that. Here's what they say.
All three DFLers would immediately seek federal expansion of Medicaid, as allowed under the new federal health care law, to cover about 30,000 poor, childless adults now on General Assistance Medical Care (GAMC), bringing the state $1.4 billion in federal funding. Gov. Tim Pawlenty refused to do that, saying the state cost of $188 million (DFL figures) or $430 million (Pawlenty's estimate) is too high.
All endorse a state reform effort passed by the Legislature in 2008 to improve quality and control costs. It will measure and report clinic and hospital costs and quality, encourage clinics to become "health care homes" with coordinated care for people with chronic conditions, and take steps toward paying for results.
Margaret Anderson Kelliher (endorsed): Having pledged earlier to seek a state-funded, single-payer system, Kelliher now says the state must study the cost first. She would accelerate the creation of health care homes for those on Medicaid and a system of paying providers for comprehensive care instead of volume of care.
She also would set up a human services inspector general to crack down on waste and fraud and consider converting the MinnesotaCare insurance program for low-income working people into a state-subsidized health plan offered through a new state "insurance exchange" under the new federal health law.
Mark Dayton: He favors a national single-payer health system and would start working for one in Minnesota, primarily by expanding MinnesotaCare eligibility and further subsidizing its premiums.
Reducing health care costs will "require eliminating profiteering" by health insurers, drug companies and others in health care, he said, though he did not say how.
Matt Entenza: He would name a health advisory panel after the primary to advise him on how to best use the new federal health care legislation.
The state should continue shifting money into programs that help older people stay at home, delaying moves to more expensive nursing homes or assisted living, he said.
MinnesotaCare might become a public option for health insurance, but if it no longer is needed, he might scale back the 2 percent tax on health care providers that funds it.
Tom Horner (endorsed): He proposes raising the state tobacco tax to help fund health and other programs, and he would name a task force to help integrate federal health changes with state changes.
Horner would also seek incentives encouraging people to take more responsibility for their health and health care choices, expecting improved health and lower medical costs. Horner advocates more innovation in paying for care, such as a federal pilot program for which the state has applied that would allow new ways to pay for care in Medicare or Medicaid.
Rob Hahn: He says he's still working to understand the innate complexities of health care, but he favors opening Minnesota to for-profit hospital and health insurance companies and allowing Minnesotans to buy insurance from other states, even if the sellers are not vetted by state regulators -- all ways to cut costs, he said.
He also said setting up state-owned hospitals and clinics might cut costs. "That doesn't fit in with my general view that less government is good government, and some people at first think it's a crazy idea. But it's worth a look," he said.
Tom Emmer (endorsed): Emmer, who faces token primary opposition, would replace MinnesotaCare with vouchers to help individuals pay for private insurance and would cut health care and other state programs, but he has not offered details.
He would try to block a federal requirement that everyone obtain health insurance starting in 2014, and like Pawlenty, he'd reject expanded Medicaid to cover those on GAMC.
Emmer opposes state and federal health-system overhaul laws that he says are "artificial cost reductions, restricted access and government-dictated standards [that] will destroy the greatest heath care services in the world," and he favors tax incentives instead of mandates to influence health care choices.
Warren Wolfe • 612-673-7253