House passes narrower version of health care bill

04/11/2008

Major differences with the Senate or opposition from the governor could derail it.


By WARREN WOLFE,
Star Tribune
April 10, 2008


On the heels of Senate approval last week of a health care overhaul plan that Gov. Tim Pawlenty threatened to veto, the House Thursday voted 83-50 for a narrower version.

The bill aims to improve quality and cut health care costs by billions of dollars by changing how care is financed and delivered, and launching a statewide campaign to reduce obesity and smoking.

Some Republicans fought to scale back and delay portions of the bill that they said would harm doctors and hospitals by pushing change too far and too fast. That could drive up insurance premiums, they warned.

"I can tell you the bill in its current form will not be signed," House Minority Leader Marty Seifert, R-Marshall, said shortly before the final vote was taken. Earlier in the evening Democrats dropped a measure that would require Minnesotans to buy health insurance if the rate of uninsured people in the state doesn't drop from the current 7.2 percent -- lowest in the nation -- to 6 percent by 2011.

Even with changes made during eight hours of sometimes contentious debate Thursday, the legislation will face stiff negotiations in a conference committee, along with a critical look from Pawlenty.

The Senate bill goes into far more detail than the House version and would assess insurers and care providers to pay for some of its costs.

"This bill is very controversial. The whole health care industry is nervous about it," admitted Rep. Tom Huntley, DFL-Duluth, the chief sponsor. But he showed letters of support from Mayo Clinic, the Minnesota Medical Association and other groups.

Questions on cost

The proposal would cost $400 million over the next four years, including $100 million in grants to communities to fight obesity and smoking.

The money would come from the state's Health Care Access Fund, which is financed by a tax on providers and helps pay for MinnesotaCare, the state-sponsored health plan for low-income people.

"The fund will go broke after 2012, and what do you do then? You start dis-enrolling people from MinnesotaCare," said Rep. Mark Olson, IR-Big Lake. "This is extremely risky policy. This will disintegrate the bill."

Huntley acknowledged that the bill would deplete the fund by 2013 "if you don't count on the very big savings in health-care costs that the governor's own Department of Health says we will achieve."

Pawlenty has proposed taking $250 million from the access fund to make up part of the state's nearly $1 billion projected budget deficit.

Democrats turned back most Republican amendments, including one by Rep. Steve Gottwalt, R-St. Cloud, to allow for-profit insurance companies to sell health policies in Minnesota.

The bill also would subsidize premiums to help lower-income people buy health insurance through employers.

For instance, people earning less than 300 percent of the federal poverty level -- $41,000 for a family of two -- would pay no more than 6 percent of their income for health care. People earning up to 400 percent of the limit -- about $55,000 for a family of two -- would pay no more than 8 percent of income, with state subsidies making up the rest.

Republicans challenged the wisdom of subsidizing insurance for people with incomes that high, and chided Huntley for not including in the bill the estimated $55 million the subsidies would cost over the next two years.

The bill also would launch a system to measure the cost and quality of care provided by clinics and hospitals, then publish the results. The system would increase payments to providers with better results.