When a major health-care reform bill was introduced at the start of the legislative session in February, policy advocates heralded it as a bold, landmark effort. But by the time the gavel fell for good Sunday night, the reaction was far more subdued, with many calling the drastically pared-back final version only a good first step.

"We hoped when we began that over time we'd come close to universal coverage," conceded the bill's chief author, Sen. Linda Berglin, DFL-Minneapolis. "That's something we fell far short of. ... Of course, getting 12,000 more people [on state health care rolls] is a step in the right direction."

A baby step, agreed sleep-deprived lobbyists and Capitol-watchers who were still parsing the fine print on Monday — and a glacially slow one at that. Adding further disappointment, they said, the drama surrounding the reform's passage, veto, and rebirth all but overshadowed massive cuts to other state health care programs.

The basic idea driving the reform: That paying doctors and clinics to prevent illness would improve care and generate savings, which could in turn be used to beef up enrollment in MinnesotaCare (PDF), the state program for the working uninsured. The measure, which enjoyed broad support from lawmakers of both parties, as well as employers and health care providers, went from insuring 40,000 additional people when it left the Senate floor to 12,000 in the final version.

And there are caveats: No new enrollment will take place for a year, and some provisions will not go into effect until the next biennium. State health programs can't enroll anyone until July 2009 and can accept only 7,000 new members through 2011. Tax incentives should help persaude employers to insure the other 5,000 people lawmakers said the measure would help.

Berglin pleased key provisions survived
Berglin is pleased that several of the reform's key provisions are intact, especially efforts to make medical pricing transparent and to reward preventive care. "We will begin to pay physicians differently, especially for treating people with chronic conditions," she said. "We'll see better accountability, and better outcomes."

Even though the reform effort was partly the brainchild of a panel of luminaries he appointed, Gov. Tim Pawlenty said early in the session that he had designs on its funding source. Reversing a pledge he made before the Legislature convened, the governor said he wanted to move $270 million from Minnesota's Health Care Access Fund into the general fund to help fill the state's nearly $1 billion deficit.

Since 1992, Minnesota hospitals and health care providers have paid a 2 percent tax into the Health Care Access Fund to pay for extending care to more of the working poor, principally via MinnesotaCare. Because lawmakers have tightened eligibility requirements, even as the number of uninsured Minnesotans has skyrocketed, the number of people who qualify for state help has gone down and the fund's surplus up. Pawlenty tapped the account to deal with deficits in 2004 and 2005.

Under the final, compromise version of the reform, the governor will "borrow" $50 million from the fund; the money will be repaid from savings the reform is supposed to generate. Originally, the bill proposed using the savings to pay to enroll more people in state health care programs.

Some dismal over program cuts
Public health and social service sector lobbyists were still examining the compromises forged over the weekend and asked not to be quoted by name. But they were feeling even more dismal about cuts to health care programming hammered out during the last week's marathon budget negotiations. Nearly across the board, it appears that grants made by both the departments of Health and Human Services will be reduced by 1.8 percent. Funding to hospitals also will be cut.

Many of the reductions were made to state services designed to keep people in their homes and out of pricey institutions, services that were curtailed during the last round of dramatic health care cuts in '03. And because many of the grants were matched by federal Medicaid dollars, the pinch will be even greater than it would first appear, one said.

On another health front, Pawlenty vetoed a measure that would have allowed government agencies to extend benefits to domestic partners of gays, lesbians, and other unmarried employees.

Just one group that has long tried to get lawmakers' attention went home with everything it wanted: Thanks to $5 million in new funding, Iron Range residents may finally learn whether there is a link between taconite mining and elevated levels of deadly lung diseases among miners.