politics

Fifteen months in the making, a bill changing how health care in Minnesota is provided and paid for was approved late Monday by the Legislature, a measure one sponsor said "is at least the first stage on the road to health-care reform."

However, the bill faces a possible veto when it reaches Gov. Tim Pawlenty, who has expressed misgivings, and the 83-50 vote by which it cleared the House was short of the margin needed for an override. The Senate approved the measure 53-13.

Although significant, the changes provided by the bill are far less dramatic than those recommended at the start of the session by separate panels appointed by the governor and the Legislature.

The bill would start a statewide campaign to reduce smoking and obesity and offer public data on the quality and costs of doctor and hospital services.

The bill would also certify doctors and clinics that provide "medical homes" with comprehensive and coordinated care, and expand eligibility to add about 40,000 people to MinnesotaCare, the insurance program for lower-income working poor.

Even that scaled-back version still may be vetoed, however. Pawlenty has proposed using some of the Health Care Access Fund reserves to balance the state budget, leaving less for the health-care bill.

At a news briefing earlier Monday, he complained that the bill would spend most of the reserves without resolving budget issues. "We're having a hard time paying for the [budget items] we have, much less adding the new ones," he said.

Pawlenty also has taken issue with the expansion of the MinnesotaCare program at a time when medical care is consuming an ever-greater portion of government budgets.

During House debate Monday night, Rep. Laura Brod, R-New Prague, said: "Throwing more people into a public system is not reform. It's more of the same."

Rep. Paul Thissen, DFL-Minneapolis, said covering more people would cut down on uncompensated care that now shifts costs to people with private insurance. "We save money when we have people insured and not uninsured or underinsured," he said.

Before Monday's floor sessions, the bill's chief Senate sponsor, Linda Berglin, said: "This bill is a start, but not what I wanted or what I think we need."

"It seems the governor doesn't want to spend the Health Care Access Fund on health care access," said Berglin, DFL-Minneapolis. "We lost a lot [in negotiations with the governor]. We don't project as much cost savings, and we no longer have language so the state can recapture some of those savings. And now the governor might not sign it anyway."

If the bill is enacted, about $67 million would be spent over three years to improve the health of Minnesotans and slow the growth of health-care costs to consumers, employers and the state. Health care in Minnesota will cost about $30 billion this year and could soar to $57 billion by 2015.

Proponents said earlier forms of the bill would have cut spending by 20 percent. Now, Berglin said, it may cut costs by 10 percent by 2015.

During floor debate in the House, Republicans expressed skepticism that such savings would be achieved.

'First stage of reform'

"What we've accomplished is the first stage on the road to health care reform," Berglin said. "We wanted to get farther, but at least we'd get a start."

Dropped earlier were raising the cigarette tax; requiring small employers to offer so-called "125" health insurance plans where employees use pretax dollars to pay premiums, and allowing the state to collect part of the savings generated by the system changes.

Here are some provisions:

• Reporting quality: The state would gather and make public data about the costs and quality of health care. Patients would see an overall ranking or tier of quality in which a provider falls. Part of physicians' pay would be based on their quality of care instead of the number of services they give.

• Medical homes: Participating doctors, groups of doctors and clinics would provide comprehensive, coordinated care. It would focus first on patients with chronic conditions such as diabetes to keep them healthier and reduce care costs. Providers could offer one-price "baskets" of care for specific chronic conditions.

• Statewide health improvement program: To lower rates of obesity and smoking, communities would receive state grants totaling $20 million in 2010 and $27 million in 2011.

• Who's in charge: Instead of a new appointed Health Care Transformation Commission, commissioners of health and human services would develop and supervise changes in the health care system.

Still no budget deal

"The question is whether the governor signs it," said Rep. Tom Huntley, DFL-Duluth, the House sponsor. "Health care reform is important to him, but we still don't have a budget deal yet."

Nearly all of the money for the bill would come from the Health Care Access Fund that collects a tax from health care providers and insurers.

Pawlenty first proposed taking $250 million from the fund to help balance the budget, then $125 million and most recently $48 million annually for three years.

The Associated Press contributed to this report.

Warren Wolfe • 612-673-7253