How much federal money will Minnesota lose to other states because Gov. Tim Pawlenty dislikes the new federal health care reform law?

The ticker clicked another $1 million on Wednesday, the deadline for Minnesota's application for a grant to help fund the establishment of an exchange at which people can shop for affordable health insurance.

That's chump change compared with the money he has already turned down, to the detriment of sick and needy Minnesotans and the professionals who treat them. The Republican governor has already spurned early enrollment of the state's poorest adults in the state-federal Medicaid program. DFL legislators say it would bring an additional $1.4 billion to the state's health care industry through 2013 and fund an estimated 22,000 private-sector health care jobs.

Also on Pawlenty's rejection list: $68 million to bring a federal high-risk insurance pool to Minnesota (a justifiable choice, since Minnesota's own pool is less expensive for most people than the federal one); $1 million for premium rate reviews, and $850,000 for teen-pregnancy prevention -- though Pawlenty did apply for a $500,000 abstinence-only sex ed grant. The latter program will cost the state an additional $350,000 and offers weaker evidence of effectiveness. Pawlenty must have been persuaded by something other than cost and results.

The lost-opportunity tally is bound to grow -- and with it, the negative impact on Minnesota lives. Pawlenty assured as much Tuesday by turning what had already become an executive branch pattern into formal policy. He issued an executive order prohibiting agencies from seeking federal health care grants without his express permission, "unless otherwise required by law." (See box, above right.)

The amount of money that's at stake is not known, but it could be substantial. A tally by the Minnesota Council of Health Plans lists 72 possible grants for which Minnesota might apply. Which of those the state is legally compelled to seek is also unclear -- and may become the subject of a court test. The 2010 special-session budget bill that Pawlenty signed into law on May 21 appears to require application for the $1 million insurance exchange planning money. Yet that statute did not persuade Pawlenty to apply.

Neither did his professed distaste for the apparent consequences of his inaction. Pawlenty's failure to meet Wednesday's application deadline won't deny Minnesotans access to a health insurance purchasing exchange -- something that, ironically, Pawlenty himself proposed in 2007. Rather, if Minnesota declines to set up its own exchange, the federal government will do it. The federal "intrusion ... into personal health care matters" that Pawlenty decried Tuesday will deepen, not ease, as a result.

That inconsistency makes it hard for Minnesotans to believe that Pawlenty's executive order is grounded in policy principles. Presidential politics is the more plausible explanation.

Pawlenty's executive order sets him apart from other GOP governors, including those who are suing the federal government to stop health care reform but are also applying for the money it makes available to states. It flirts with a dubious notion that GOP gubernatorial candidate Tom Emmer has advanced, that state governments should be able to block federal actions from going into effect within their borders.

Pawlenty's move also inoculates him from the partisan sniping he endured last year when he accepted federal economic stimulus money on the state's behalf while castigating President Obama and Congress for enacting it. But if it's a shield from partisan arrows that Pawlenty is seeking, he has latched onto one that comes with a high price for the state that he has sworn to serve through the end of this year.

Even before this week's executive order, more than half of Minnesotans as measured in the Aug. 25-29 MPR News-Humphrey Institute poll said they disapprove of the frequent out-of-state campaigning Pawlenty has done this year. This week's gubernatorial move is bound to meet with more Minnesota disfavor. Seeing Wall Street Journal coverage of Minnesota's governor flipping pork chops at the Iowa State Fair is one thing. Watching badly needed federal money that should flow to Minnesota head elsewhere is another, and is much harder to take.