At Issue: Health reform still in play

After nearly a year of task force and commission meetings on health reform proposals, a bill was finally presented to the governor, but was quickly met with a veto.

Sponsored by Rep. Thomas Huntley (DFL-Duluth) and Sen. Linda Berglin (DFL-Mpls), HF3391*/SF3099, would have created a statewide health improvement program, established criteria for health care homes and care coordination fees, allowed providers to offer one-price “baskets of care” for chronic diseases in hopes of saving money and raised the percentage of federal poverty guidelines for some services to qualify an additional 39,000 people for state-assisted medical care. The changes were projected to cost $11.9 million in Health Care Access Fund money this biennium, increasing to $180.7 million in the 2010-11 biennium.

The House passed the measure 83-50 on May 12, and the Senate passed it 53-13 the same evening.

It was vetoed by Gov. Tim Pawlenty the following day.

“A tremendous amount of work went into this with a whole lot of people, we need to get it done,” Huntley said.

He is working on a compromise and is optimistic that some form of health reform will happen yet this session, calling it a “70-30” chance. “It will involve some expansion of MinnesotaCare and it will involve some payment reform that will result in lower premiums for everybody that has insurance,” he said.

Pawlenty believes the poverty guideline set in the bill is too high. “A family of four with income up to $84,800 would be eligible under this legislation. This is above the Minnesota median family income for a family of four of $81,477,” he wrote.

Rather than adding more money to the mix, the governor said in his veto message that fundamental changes were needed and the “goal should be to encourage more individuals to participate in the private sector, not make it easier for those currently in private coverage to transfer to public coverage.”

As far as raising the federal poverty guidelines, Huntley said, “We need some expansion and I think he’ll end up going for that, particularly for adults without children, because the standard is way too low.”

Health care homes would have been a centerpiece in the bill to guide patients through the decision-making process of medical needs by providing comprehensive, coordinated care by physicians, advanced practice nurses, physician assistants as personal clinicians and specialists.

Huntley said 80 percent of health care costs are for people with chronic illnesses. The point of health care homes is to keep people out of hospitals by maintaining their health through continuous care, he said.

The medical homes would be paid to focus on delivering high-quality, efficient and effective health care services, while enhancing the experience of continuous care for patients by providing ongoing contact with a personal clinician.

The health commissioner would develop definitions for “baskets of care” and consider specifically, “coronary artery and heart disease, diabetes, asthma, and depression.” Health care providers could then establish package pricing for baskets of care, and the commissioner would publish comparative prices and information on those “in a manner that is easily accessible and understandable to the public.”

While the governor agreed the concept of medical homes were progress, he questioned the additional duties that would be assigned to the health commissioner. “The bill allocates less than half the needed funding to implement these responsibilities,” Pawlenty wrote.

The bill called for a 10-member Health Care Reform Review Council to develop and implement the certification, process and quality standards for health care homes, the implementation of payment reform and develop a plan and recommendation for providing subsides to qualifying employees of employer-subsidized health coverage.

The bill also called for a statewide health improvement program, whereby grants would have been made available to communities for strategies to reduce the number who are obese or use tobacco.

The health commissioner would have had to develop measures to access quality care resulting in the monetary reward, and consider risk adjustments to reflect the differences in the health and demographics of patient populations, as well as the types of services needed. The commissioner would annually publish the information on providers’ cost and quality.