Huge health care bill spikes a nasty fever

The huge state health care reform bill, the product of two bipartisan panels that spent months creating an elaborate framework for change, hit a major and potentially fatal roadblock Tuesday.

DFL leaders said that Gov. Tim Pawlenty had abruptly withdrawn his support for the bill because, they were told, it lacked support from Republican House members.

"It's very disappointing," said Sen. Linda Berglin, DFL-Minneapolis. "This is exactly the framework we negotiated, and now he's backing out."

Pawlenty spokesman Brian McClung said that Pawlenty, in fact, "never supported this bill," because it expanded health care rolls without offsetting savings. McClung warned that if legislators proceeded, "they know that a veto is among the options."

The bill is projected to slice health care spending nearly 20 percent by 2015 while extending coverage to 47,000 more Minnesotans. Proposed long-term savings could add up to $12 billion, through efforts such as obesity and smoking reduction, and reductions in the uninsured. But it would cost money up front -- $49 million in 2009 alone, under one proposal.

The stakes on both sides are high. Hospitals, insurers, unions, physician groups and patient organizations have worked to craft major changes in how health care is financed and delivered in Minnesota.

Pawlenty is scheduled to meet with House Speaker Margaret Anderson Kelliher, DFL-Minneapolis, and House Minority Leader Marty Seifert, R-Marshall, on the bill's fate and overall budget talks.

Passage of the bill could set up another confrontation between the DFL-controlled Legislature and the Republican governor.

"We believe with a little bit of work and compromise, we could still achieve significant health reforms this year," McClung said Tuesday night.

DFLer criticizes Pawlenty

But Rep. Tom Huntley of Duluth, the lead House DFLer on health care, said Pawlenty had done an about-face on a bill that incorporated many of his ideas on reform.

"This is exactly what he did with the Durenberger report," Huntley said, referring to a previous health care effort that had, among other things, recommended a cigarette tax increase to pay for reforms. "He can't deliver, so he's just going to put it on a shelf."

McClung confirmed that Ludeman did call House and Senate leaders to tell them of the governor's opposition to the bill "in its current form."

Legislative sponsors said they will try to pass the bill in the Senate on Thursday and the House on Friday.

Veto specter

Last month the Legislature succeeded for the first time in overturning a Pawlenty veto, passing a $6.6 billion transportation bill that included an increase in the gasoline tax.

Seifert said there would be no repeat on a health care bill.

The bill, the product of a panel appointed by Pawlenty and a legislative committee, champions many of the governor's proposals.

The proposed savings would come through measuring and publicizing how well doctors and hospitals perform and what they charge, as well as the other efforts. About $20 million of the 2009 costs would be paid by health insurers and providers to fund community grants to communities to tackle obesity and smoking, and $29 million would come from the state's Health Care Access Fund.

That pot of money now is used to finance MinnesotaCare, the state-sponsored health plan for lower-income people, and other health initiatives. Pawlenty has proposed tapping it to reduce a $935 million projected state budget deficit.

Berglin said that she was aware of the differences on using the access fund but that "it was never seen as a deal-breaker."

Pawlenty has long advocated for changing the health care system and attacking rising costs.

To win Pawlenty's support, DFLers had already dropped an attempt to increase the state's cigarette health-impact fee.

In a meeting last week, Berglin had assured health care committee members that Pawlenty supported "the general outline" of her bill and would sign it if the Legislature passed it.

Billions in savings sought

The 50-page bill delves into many areas of health care in Minnesota.

It aims to trim up to $12 billion in health care costs that otherwise were projected to soar to $57.4 billion by 2015.

Through a system to be developed by an appointed commission, the state would provide incentive payments to providers to improve quality and trim prices -- then publish that information to help patients choose the best care.

The bill would encourage doctors and clinics to become "health care homes" offering comprehensive and coordinated care to patients, especially those with chronic conditions such as heart disease or diabetes -- intended to improve overall health of Minnesotans.