The GOP governor embraces an issue that was central for DFLers in the recent campaign.
In a sweeping policy departure that aligns with a top agenda item of the newly elected DFL legislative majorities, Gov. Tim Pawlenty called Tuesday for extending health care access to up to 90,000 uninsured children as a step toward coverage for all Minnesotans.
"We all, I think, can chart a path toward universal coverage," he said in a luncheon speech to a health reform conference in Minneapolis. "We're going to have to move in stages. ... We should start with covering all kids."
Pawlenty also peppered his remarks with broad criticism of the nation's current "tattered, outdated, inefficient" health care system and hard shots at health maintenance organizations (HMOs), prescription drug advertising and political meddling in health policy.
But the Republican governor's change of course on universal coverage was particularly hailed by DFL legislators who fought his cuts in state-subsidized health care during a budget crisis in 2003.
"We are thrilled that the governor is agreeing with us on this issue that is so important to Minnesotans," said Rep. Paul Thissen of Minneapolis, the leading House DFLer on health care costs. "It was a central part of our agenda. It's amazing how an election can make such a big difference in health care policy."
Pawlenty was a rare GOP survivor of last week's elections, which unseated a Republican House majority that had been entrenched for eight years and gave DFLers near veto- proof control of both legislative chambers.
Senate Health and Family Security Committee Chairwoman Becky Lourey, DFL-Kerrick, who is retiring from the Legislature after an unsuccessful run for governor and what she said was 20 years of advocacy for universal health care, praised Pawlenty's shift.
"It's very exciting to hear the governor talk like this," she said. "If he wants to be a leader, Minnesota is the state to move forward with universal health coverage. And this coming year will be the year to do it."
Pawlenty offered no specific route to the goals he outlined, and his office gave no cost estimates.
House DFLers said two weeks ago that all Minnesotans younger than 18 could be covered at an added annual cost of $46 million.
They said that and other initiatives to help small businesses, uninsured prescription drug buyers and long-term caregivers could be financed by ongoing surpluses in the state health care access fund, which is fed by a 2 percent medical tax.
Some of these moves toward universal health care have advanced in the DFL-controlled Senate in the past two years but not in the Republican- controlled House.
Taking cues from his foes
Pawlenty said his administration is studying health care reforms in Massachusetts, Utah and elsewhere for guidance on how to proceed in Minnesota. But he emphasized that "giving more access to a broken system does not ultimately fix the problem."
In addition to stepping onto a key DFL legislative campaign plank on children's coverage, he also adopted stands of the two major-party candidates he defeated to win reelection -- DFLer Mike Hatch's attacks on HMOs and Independence Party nominee Peter Hutchinson's call for modernizing and standardizing medical recordkeeping.
On HMOs, Pawlenty suggested that the giant third-party payers and treatment managers have fallen short in containing runaway costs and improving people's health.
"Are they just banks?" he wondered aloud. "Are they just underwriters of risk? Or are they true partners in health improvement?" Those questions must be answered, he added, by assessing progress -- or lack of it -- in combating obesity, diabetes, heart disease, cancer and mental illness.
And, in a nod to Hutchinson, Pawlenty urged the adoption of universal treatment and billing computer codes to bring an "enormously inefficient" health industry up to speed with other businesses.
Broad health agenda
Other points made by the governor before the Midwest States Health Reform Summit, a conference of health professionals and policymakers:
Repeating an earlier statement, Pawlenty said prescription drug ads should be limited or temporarily suspended because they only "create consumer-driven appetites for prescription medicines that do not yield wise decisions."
Congress' ban on negotiating bulk discounts for prescription drugs under Medicare Part D is "unconscionable" and should be repealed.
Most health care consumers should be able to learn the prices and quality of various treatments. Only such transparency will improve the rate of optimal care for conditions such as diabetes from a current 6 percent to a goal of at least 80 percent, Pawlenty said.
His recent executive order moving health providers in state-subsidized programs toward "performance pay" incentives based on quality benchmarks that are "largely indisputable" will lead Minnesota to better and more affordable health outcomes, he said.
The medical establishment will be a welcome partner in bringing such reforms, he said, because "you don't want politicians making these decisions."
He also warned that the greatest challenge of establishing universal health coverage will be managing "a modest and affordable benefit set" in a political environment.