Influential leaders, frustrated by the governor's inaction, submitted health reform letter on their own.
Frustrated by what they see as stonewalling by Gov. Tim Pawlenty's office over preparations for federal health reform, three of Minnesota's most influential medical groups took matters into their own hands Thursday.
After Pawlenty declined to send Washington a letter with several state agencies' recommendations for a key piece of the reform package, the medical groups got hold of a copy and sent it themselves.
The letter to the U.S. Department of Health and Human Services contained comments and recommendations on health insurance exchanges, where people could shop for policies, in response to a request sent to all states.
But the letter from Minnesota, dated Oct. 4, the deadline for comments, didn't go out because Pawlenty didn't like it.
"We believed the State of Minnesota would submit comments on behalf of all residents and stakeholders in Minnesota," the groups wrote. "Because the enclosed letter was not sent, we respectfully request that you review and consider the comments contained in this document even if you cannot accord it the deference of an official, timely, state-sponsored letter."
The package was signed by Julie Brunner of the Minnesota Council of Health Plans, Lawrence Massa of the Minnesota Hospital Association and Dr. Robert Meiches of the Minnesota Medical Association.
The council of health plans and the hospital association were among about a dozen groups and individuals that had submitted detailed comments on health insurance exchanges.
The comments were compiled by the Minnesota Department of Health, the Minnesota Department of Commerce and the Minnesota Department of Human Services.
The exchanges are a pillar of the new health law. By 2014, most Americans will be required to have insurance and insurance companies will be required to take all comers. Those who can't afford to buy insurance will get government subsidies to buy it. The health exchanges are the mechanism to make all that happen.
Among other things, the 11-page letter asks the federal government to allow some flexibility in how the exchanges are set up and run. At the same time, it requests clear and early guidance on certain issues -- such as what constitutes an essential benefit set -- to help states evaluate options and costs and the impact on existing state programs such as MinnesotaCare.
In Minnesota, a final draft was ready by Monday, the deadline.
On Tuesday, Brunner, who is executive director of the Minnesota Council of Health Plans, said she called Deputy Commerce Commissioner Manny Munson-Regala, one of the three signatories of the original letter, to ask for a copy of what was sent. "I was told nothing was sent," Brunner said.
Asked Thursday why the letter wasn't sent, Commerce Department spokeswoman Nicole Garrison-Sprenger referred the question to Pawlenty's office.
Said Pawlenty spokesman Bruce Gordon: "The Health Department's initial draft letter did not reflect the governor's position on health exchanges."
Gordon said the letter also did not include information from a 2008 study by the Minnesota Department of Health on health exchanges which stated that "the operation of the exchange would likely have only a minimal impact on the cost of health insurance coverage." He added: "Any analysis of exchanges that does not include this report and this finding is seriously flawed."
He did not mention that the 2008 report also stated: "In combination with other reforms, however, there could be significant impacts on the cost of coverage."
Pawlenty, a Republican who is considering a run for president, has made no secret of his opposition to federal health reform.
In late August, he announced an executive order designed to keep "Obamacare" out of Minnesota.
He told all state agencies to funnel their federal grant requests through his office to "stop Minnesota's participation in projects that are laying the groundwork for a federally controlled health care system" -- unless they are required by law or approved by his office. Minnesota and Alaska are the only two states that have refused to apply for federal money to set up the exchanges.
For the groups that toiled on the exchange recommendations, it felt like they had been robbed of their say in a national-scale project.
By Wednesday, Brunner had obtained the unsent letter by requesting it under Minnesota's Data Practices Act.
"We worked really hard on this," she said. "In some ways, it feels like it's cumulative frustration. This exchange is going to happen and the federal agency has a lot of discretion in designing it. To not have Minnesota's voice and comments, it was just too much."
Chen May Yee • 612-673-7434