Different motivation, same end result: Nation's first such plan.
Amid the politics of doom and confrontation in St. Paul, some key legislators are considering compromise over a potentially explosive Republican proposal to partly privatize Minnesota's public health care programs and require some low-income residents to buy their own insurance.
If they can find common ground, it would create the nation's first such privatized state health care plan.
The House and Senate have approved their own versions of the idea -- both contained in budget bills likely to be vetoed by Gov. Mark Dayton.
But several DFL and GOP leaders say there may be room for agreement over one plan, which would introduce vouchers into MinnesotaCare, a form of subsidized insurance for the working poor.
Republicans hope the experiment will lead to greater privatization of government health programs; DFLers see it as a path to faster implementation of health care ''exchanges,'' a hallmark of President Obama's Affordable Care Act.
Both believe that if properly structured, the model could improve medical care for low-income Minnesotans while containing the state's exploding health care costs.
"Look, I know some people have dug in their heels, but this doesn't need to be a big partisan issue," said Rep. Steve Gottwalt, R-St. Cloud, chairman of the House Health and Human Services Policy Committee, who has championed the measure for three years.
"I think if we change MinnesotaCare from a defined benefit to a defined-contribution program, we actually can improve care, improve payments to doctors and hospitals and save the state money."
Rep. Paul Thissen, a Minneapolis DFLer who is House minority leader, said he's keeping an open mind.
"This bill really is a heath insurance exchange -- an important part of federal health care reform. This is one thing we might actually find agreement on, even it we're doing it with different expectations."
Under the federal law, by 2014 states must establish insurance exchanges, online marketplaces where small firms and individuals can buy health insurance, with vouchers for low-income residents.
Starting with MinnesotaCare "actually might be a good idea if we can work out the details," said Thissen, who chaired Gottwalt's committee until Republicans took control of the Legislature this year. Thissen said he considers the current version "too harsh,'' but said there might be ground for compromise.
A competing version of the plan, in the Senate health and human services budget bill, would include Medicaid and very poor people -- something DFLers and some House Republicans consider unworkable. But its author, Sen. David Hann, R-Eden Prairie, chairman of the Health and Human Services Committee, said "the details are not set in stone."
DFLers say they would consider negotiating on the House version, which gives vouchers to people on MinnesotaCare with incomes somewhat above the poverty level, who might find vouchers more workable.
Room to negotiate?
Dayton is not saying whether he would seek a compromise on vouchers, but Gottwalt is optimistic. "All I know is I've brought up the idea with three of [Dayton's] commissioners, and they have concerns, but they haven't said it's a deal-breaker," he said.
Under the House plan, the state would pay premiums to insurers for health plans selected by MinnesotaCare patients. Clients would be responsible for any co-pays and deductibles set by the insurers; deductibles might run $1,000 per year or higher.
"It's those deductibles, especially, that could really kill this idea," said Rep. Tom Huntley, DFL-Duluth, a health care expert in the House who last year was chair of the Health and Human Services Finance Committee.
"Poor people can't afford deductibles. ... Can we work something out? Well, maybe."
Top Republicans acknowledge there are kinks. "It may be that some who are very poor would have more trouble using vouchers,'' said Hann. "Frankly, we'd like the governor to come to the table now so we can work these things out."
If Dayton and Republicans can reach a compromise on this piece of the budget puzzle, Hann said, "Who knows? Maybe that will start to unlock things" in the larger fiscal standoff that looms in the Legislature's final weeks.
Warren Wolfe • 612-673-7253