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Bipartisanship in the 1990s delivered health-care reform in Minnesota

The stage had been set for enactment of MinnesotaCare when Gov. Arne Carlson vetoed a more extensive reform bill a year earlier. Carlson signaled that he was willing to work with the Legislature on a more targeted plan.

This summer, as national health-care reform is embroiled in a fierce partisan debate, Minnesotans can look back to the early 1990s when a remarkable era of bipartisanship enabled this state to move ahead with its own health-care overhaul plan.

Initially dubbed HealthRight when its authorizing legislation was adopted in April 1992, the plan become MinnesotaCare three months later when a California agency notified state officials that it held the federal trademark for the Minnesota program’s original name.

The stage had been set for enactment of this ambitious new initiative when Gov. Arne Carlson vetoed a more extensive health-care reform bill a year earlier. In his veto message, Carlson signaled that he was willing to work with the Legislature on a more targeted plan.

The ‘Gang of Seven’
Over the next nine months, Carlson’s staff worked with legislative leaders to come up with a proposal that preserved many of the features of the earlier measure. Spearheading this legislative effort was a bipartisan legislative group that came to be known as the “Gang of Seven.” The group included State Sen. Linda Berglin and Rep. Paul Ogren, two DFL legislators who had championed the early health plan vetoed by Carlson. Berglin and Ogren were joined by Republicans Duane Benson, the legislative leader for his caucus in the Senate; Dave Gruenes, a health-care expert in House; and a second House Republican, Brad Stanius, who ended up withdrawing his support for the health plan before its final passage. Rounding out the Gang of Seven were Rep. Lee Greenfield and Sen. Pat Piper, both DFLers.

In the early 1990s, as they developed the plan that became MinnesotaCare, these state leaders grappled with the same issues that are confronting legislative architects today: how to expand the system to provide health care for the uninsured while controlling costs and streamlining the health-care delivery system.

In its final compromised form, MinnesotaCare provided subsidized health insurance for thousands of low and moderate income Minnesotans who were unable to access affordable insurance on their own. The plan also imposed new regulations on private insurers and created a commission to set targets for reducing health-care expenditures by eliminating unnecessary and ineffective medical procedures.

Fierce opposition
As the plan moved toward final action in the House and Senate, it aroused fierce opposition from the Minnesota Medical Association and the Minnesota Hospital Association, both of which objected to the proposed 2 percent tax on health-care services, intended to finance the new system of subsidized health insurance.

But the two powerful trade associations were ultimately unsuccessful in eliminating the 2 percent tax, which became a permanent feature of the new state health-care system.

Roadblocks in the House
While the HealthRight legislation easily passed the Senate, the bill encountered more roadblocks in the House where some out-state legislators were concerned about the plan’s impact on rural hospitals.

As House Speaker Dee Long prepared to close off House voting on April 16, the bill had only generated 62 yes votes,  six fewer than were needed for final passage. But a concerted lobbying effort by Gov. Carlson and his legislative agents delivered some additional Republican votes, and the bill finally passed the House with 17 Republicans and 53 DFLers voting for the landmark legislation.

At a signing ceremony later that month, Carlson declared that the new law “significantly redefines and broadens the definition of the quality of life in Minnesota.”
 
While  MinnesotaCare may not have reformed the delivery of health care in this state, as its architects might have hoped,  the statewide program has made health insurance available to thousands of the Minnesota families who had been priced out of the private insurance market.

In the final analysis, the 1992 legislation may be significant mainly in terms of political history. It demonstrated that bipartisanship was able to help this state overcome the swirl of competing pressures that impede any effort to move beyond the status quo.

As Congress heads toward its August recess in this politically polarized era, it remains to be seen whether bipartisanship can help propel health care reform forward on a national level.