“Let Minnesota do its own health care thing. We’ll do it right.” During the run-up to enactment of the Affordable Care Act, I heard that so often from so many health care stakeholders that I mistook the meaning of a comment last week from Allina Health System CEO Penny Wheeler.
“Maybe we can get to some bipartisanship here that puts people before politics,” Wheeler said to a Strib scribe as the GOP Obamacare replacement effort collapsed in the U.S. Senate. “I think this gives us a chance to do that.”
“Here” as in Minnesota? I asked her spokesman to be sure I understood her point. No, said David Kanihan, “here” as in “now.”
That’s not to say, Kanihan added, that Wheeler doesn’t still look hopefully toward the Minnesota Capitol for smart bipartisan steps that would better deliver on the promises of the still-in-force Affordable Care Act — access, affordability and adequacy of insurance coverage.
But if she’s like most of us State Capitol watchers, her glances lately have been more wistful than hopeful. The last decade saw a deterioration in the Legislature’s capacity to function in bipartisan fashion on a variety of topics. But polarization over health care policy — previously the purview of wonkish bipartisan task forces and study commissions — has been a particularly visible and worrisome change.
Call it a local manifestation of eight years of national R-vs.-D warfare over Obamacare, and you’d be more than half right. Minnesota politicians seem less willing than they once were to keep some daylight between themselves and their national counterparts on lots of matters. Health care is a leading case in point.
Local players have also helped polarize state health care policy. For example: The process that produced MNsure’s enabling legislation was as one-sided politically as was Obamacare’s birth in Washington. Republicans weren’t in charge at the Capitol when MNsure’s DFL steamroller went through in 2013. They are now — and they talk about MNsure as if it were something smelly the previous tenants left in the refrigerator.
Another homegrown health care venture, MinnesotaCare, has also taken on a partisan tint. The state’s publicly subsidized health insurance program for the working poor had bipartisan parentage 25 years ago. One wouldn’t have guessed as much last session, as Republicans rebuffed DFL Gov. Mark Dayton’s proposal to make more Minnesotans eligible for what Republicans now scornfully describe as undesirable government insurance.
But last session also showed that Minnesota hasn’t completely forsaken the bipartisan health policy habit it once had. In January, a decent compromise was struck to provide rebates to the MNsure buyers hardest hit by rising premiums. Compromise was less evident two months later when Republicans provided taxpayer-financed reinsurance to health care plans, but Dayton gave the measure a bipartisan fig leaf by allowing it to become law without his signature.
Something encouraging is in the works now in the Senate. That’s where one of the Capitol’s most consistently bipartisan lawmakers, Jim Abeler, R-Anoka, chairs the Human Services Reform Finance and Policy Committee. (His call for a bipartisan fix for Obamacare appeared in this newspaper Monday.) And where, at the instigation of rookie Senate Majority Leader Paul Gazelka, a bipartisan select committee has been empaneled to come up with health care cost-containment ideas that can be forwarded to the 2018 Legislature.
I’m not surprised that it’s the Senate — not the House — in which such an effort has taken root. Partisan warfare has long been more intense in Minnesota’s large lower chamber. With two-year terms, it’s always near an election. The Senate’s longer terms and culture of comity — and its current 34-33 Republican-DFL split — make it more fertile ground for bipartisanship.
What’s more, this year the Senate has something the Legislature hasn’t had for a long time, if ever: two physicians among its members. Both first-term Republican Sen. Scott Jensen of Chaska and DFL Sen. Matt Klein of Mendota Heights serve on the new select committee; Jensen is its chair.
Jensen said all the right words last week about the select committee’s mission. Containing health care costs “isn’t a partisan issue. It’s a Minnesota issue. I really think we have a reasonable chance to put together a bipartisan proposal that we can put into law next year,” Jensen said.
With a focus on questions such as “Should Minnesota invite more direct marketing of pharmaceuticals to consumers?” the Senate committee won’t go straight to the heart of the question that has stymied the U.S. Senate: How can all Americans get the health care they need? But if it finds ways to reduce the cost of that care, it should keep Minnesota scoring high among the states in health care value — and that could be an increasingly valuable competitive plum.
“If you don’t focus on costs, all you are doing is playing a shell game,” Jensen said.
If Congress and the Trump administration stay stumped on health care, there’s a decent chance that states will find themselves with more freedom to innovate. A policy punt to the states looks increasingly plausible. Jensen is angling for as much.
“The implosion of the various forces in control at the federal level is almost giving us more traction,” he said. “We want to do everything from a state level that we can to get the federal level to let us lead, as we did in the past. If we put this together in a bipartisan way, we can lead again. We can be a beacon state.”
Those steeped in the last decade of Minnesota politics will dismiss Jensen’s talk about health care bipartisanship as a naive throwback to an earlier, less-polarized time. I prefer to think of it as a new legislator’s clear-eyed assessment of the limits of one-party policymaking. The bad health care show this summer in Washington is making those limits more evident by the day.
Lori Sturdevant, an editorial writer and columnist, is at firstname.lastname@example.org.