politics

More than 120,000 uninsured Minnesotans would gain health coverage under the bill headed for a climactic vote in the U.S. House this weekend, according to congressional Democrats, while another 1 million Minnesota consumers would get tax credits and other subsidies to help defray the cost of health insurance.

"It's going to mean increasing access, controlling costs and protecting patients from insurance company abuses," said U.S. Rep. Betty McCollum, D-Minn.

The Democrats' report, one of the most detailed yet in the fractious congressional debate, was based on rough state-by-state estimates but appeared to reflect findings by the nonpartisan Congressional Budget Office that the bill would expand coverage while cutting the federal budget deficit.

Republicans were quick to express skepticism.

"The source, timing and premise of these numbers make it clear they should be taken with a grain of salt,'' said Rep. Erik Paulsen, R-Minn. "What we do know is that this bill will cost close to $1 trillion [and] cut nearly $500 billion from Medicare.''

In Minnesota, too, reaction to the landmark legislation split along partisan lines.

Rep. Tom Huntley of Duluth, senior House DFLer on health care issues, introduced legislation Thursday to start taking advantage of the $2.8 billion in money and savings that he says would come to Minnesota by 2014. Huntley said expanded coverage under the federal bill could allow Minnesota to sunset two big, costly state health care programs, General Assistance Medical Care (GAMC) and MinnesotaCare.

"I want Minnesotans to understand how much they have at stake,'' Huntley said this week. "It's huge.''

Gov. Tim Pawlenty, however, fired off a letter to the state's congressional delegation Thursday urging them to vote against the measure.

"We are in agreement that health care reform is desperately needed," he wrote. But the bill before the House "would do little to improve overall health care quality and hold down explosive cost growth," the governor wrote.

Republican state legislators have offered a resolution opposing the federal measure but on Thursday failed to convince the Senate to bypass normal committee hearings and vote on the measure before this weekend.

"There are many reasons to oppose [the federal bill]," Senate sponsor Julianne Ortman, R-Chanhassen, said at a news conference Wednesday. "But the two primary reasons" are that it would violate the 10th Amendment by imposing an unequal tax and requiring citizens to buy health insurance.

In releasing their estimates of the bill's impact, Democrats said consumers are likely to notice three core effects:

•People with insurance will see better coverage because the bill prohibits a variety of insurance company practices, such as caps on lifetime insurance benefits. The report estimates that 56,000 Minnesotans could benefit from a provision that bans denial of coverage based on pre-existing health conditions.

•Moderate-income consumers, facing a mandate to obtain coverage, would get federal subsidies to buy insurance.

•The poor uninsured could gain coverage from a major expansion of the state-federal Medicaid program.

Federal help by April 1?

Huntley, a veteran legislator and a member of President Obama's health care advisory group, said he wants Minnesota to be prepared for the provisions. Quick action could allow the state to start collecting roughly $250 million as soon as April 1 if Congress expands Medicaid to cover very low-income childless adults now in GAMC. That program was to end April 1 after Pawlenty twice vetoed it, but he and DFLers in the Legislature negotiated a new version. The Senate approved it Thursday night and send it to the House.

MinnesotaCare would not end for several years, when federal subsidies would take effect for people earning up to 400 percent of poverty, but if that happened, Minnesota could phase out the provider tax that provides MinnesotaCare's funding, cutting state taxes by hundreds of millions of dollars, Huntley said.

Some DFLers differ with Huntley on that point. Even his counterpart in the Senate, Linda Berglin, DFL-Minneapolis, a strong supporter of the federal bill, favors an option that lets the state keep the federal money to subsidize health insurance and use it to support and expand MinnesotaCare. "Rep. Huntley has been counting his chickens for some time,'' Berglin said. "I'm really focused on this session, not the future.''

While the federal bill contains only modest provisions for cost containment, Huntley said Minnesota is ready to proceed with reforms. His bill would authorize payment reforms using fixed monthly fees to "accountable care organizations" designed to encourage high-quality, low-cost care.

Separately, a pilot project with Medicare soon may give Minnesota a chance to expand the accountable-care approach, Huntley said. Minnesota's commissioners of Health and Human Services already "are hard at work getting ready" for the Medicare pilot, he said.

In case Congress fails to act, Huntley's bill also would launch parts of the federal plan at the state level, such as requiring everyone to buy health insurance and establishing an insurance exchange similar to one in Massachusetts offering private insurance to individuals and small businesses.

Huntley, a retired professor of chemistry and molecular biology at the University of Minnesota-Duluth, said the struggle in Congress resembles the passionate debate that led to passage of Medicare in 1965.

"This will be the most important change in health care since Medicare," he said. "A lot of people were frightened then, too."

Staff writer Baird Helgeson contributed to this report. wolfe@startribune.com • 612-673-7253 kdiaz@startribune.com • 202-408-2753