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Balking GOP legislators want to be ‘partners’ in shaping state’s health exchange

Minnesota Republican legislators won’t even accept $4.2 million from the federal government without putting up a squawk.

The funds arrived to help the state create the infrastructure that would be needed to create a health insurance exchange. This exchange, which is to be functioning by 2014, would become a one-stop shopping place for people or businesses — especially small businesses — seeking private health insurance as federal health care reforms unfold.

The idea of an exchange receives applause from the business community, which usually has the ear of the GOP.

So are Republicans protesting what many of their own supporters endorse simply because it’s included in “Obamacare”? In the name of politics, is the GOP going to reject anything that comes from the Obama administration, even if it means saying “no” to policies that the party typically would embrace?

Rep. Steve Gottwalt, R-St. Cloud, is among those protesting the Dayton administration’s acceptance of the federal money. There are some members of his party, he admits, who would reject any idea that might be associated with the president.

Rep. Gottwalt worries about new ‘bureacuracy’
But, he said, his concern is that legislative leaders weren’t consulted about moving forward with a plan that he believes could dramatically change health care in the state. He’s also believes that a government-run exchange will only create another bureaucracy that “will hurt a robust, private market.”

Rep. Steve Gottwalt
Rep. Steve Gottwalt

Gottwalt and Sens. David Hann and Chris Gerlach were among Republican leaders talking tough about holding hearings on the health care exchange, perhaps even going to court to block it.

“We [legislators] need to be partners in what this will look like,” said Gottwalt, who is chairman of the House Health and Human Services Reform Committee. “We can’t let this simply happen behind closed doors.”

Hann, chairman of the Senate Health and Human Services Committee, says this reflects the fundamental differences between Republicans, who believe in the sanctity and efficiency of the private market, and those who believe that government does a better job.

In his world view, “red flags” fly over this exchange plan.

“I’ve talked to people in the [health insurance] industry,” Hann said. “They don’t see this as necessary. That raises red flags to me.”

Commerce commissioner surprised by objections
Mike Rothman, the Dayton administration’s commissioner of Commerce, says he is surprised by the Republican complaints.

The idea of Minnesota setting up its own exchange not only is applauded by the business community but also will help the state maintain control of its own destiny regarding health care. That, too, usually is a Republican goal.

Hann, though, believes business really isn’t all that excited about any sort of government exchange program.

Sen. David Hann
Sen. David Hann

“I think the chamber and some in the health care industry have been supportive out of fear that if something isn’t done, something worse will happen,” said Hann. “I think it’s the like the question: Would you rather be executed by the guillotine or by strangulation.’ I think they’re saying ‘strangulation’ because it might give us time to get out of it.”

The $4.2 million, coupled with $1 million the Legislature already had provided, is to be used to create the exchange structure. By government standards, the timeline is tight.

The plan must be in place by Jan. 1, 2013, and, assuming it’s approved by the feds, ready for public use by Jan. 1, 2014.

If the feds don’t approve of the Minnesota plan, the state would be lumped into a federal exchange.

Republicans and Rothman seem to agree that’s not the desirable way to go.

Differing views on state’s leadership role
“Minnesota already has a unique, nonprofit system,” Rothman said. “We’re ahead of the nation, and we want to stay that way.”

Gottwalt echoes Rothman in singing praises to Minnesota’s leadership role in health care.

“We ought to preserve our leadership,” he said, but in his view that means more private, less government.

The exchange is only a small portion of the federal health care reform package. In theory, it’s designed to inform consumers and create cost controls by creating competition through direct comparisons of health insurance options.

“It’s a Travelocity or Expedia for the health care market,” Rothman says.

This exchange site would be available to all — a place to turn to compare costs and benefits of health insurance plans. The exchange will include all types of insurance programs for all sorts of users, including individuals, those who can’t afford private plans, and programs for small and large businesses.

Gottwalt argues that the private sector already offers such websites. He said he’s got a constituent in his St. Cloud district eager to sell the state a system that he’s already devised.

Among the dangers Gottwalt sees in a state exchange is that “the government will end up dictating everything. It will dictate benefits, costs. You’re now putting government pretty much in charge.”

Rothman, however, says that a state-controlled exchange does exactly the opposite. It puts Minnesotans, through the legislative process, in charge of what the fundamentals of responsible health care coverage includes.

If Minnesota ends up in the federal system, the fundamentals of what should be contained in a health insurance program suddenly would be controlled by the feds. Assuming that Minnesota currently has more coverage requirements than many states, it’s reasonable to assume that if the state ended up lumped into the federal system, a Minnesota health insurance policy might have fewer benefits in the future.

There are Republican politicians at both the state and federal level who believe the Supreme Court will reject all — or most — of the federal government’s health care requirements.

Gottwalt believes the court will reject a crucial portion of the federal reforms, the mandate that requires individuals to purchase health insurance, but likely will allow the exchange portion of reforms to go forward.

Health exchange key part of reforms
Of course, if the federal reforms, including mandates to purchase, do pass muster with the Supremes, an exchange system would play an important role in leading individuals to insurance plans.

But Rothman emphasizes that mandates are “a separate issues, completely out of state plans.”

So back to that basic question: Are Republican legislators complaining only because they’re so accustomed to saying “no” that they can’t say “yes”?

“My hope is that politics is not the issue,” said Rothman, without laughing.

The administration will go forward, quickly, he said. A task force, made up of various “stakeholders” will be formed to help create the plan for a Minnesota exchange.

The stakeholders include the commissioners of the departments of Health and Human Services, leaders of the health insurance industry, health care providers — and legislators.

“In preparing for an exchange, we will actively seek constructive public input from all parties,” Rothman said Wednesday in a statement. “We need all hands on deck — consumers, employers, legislators, insurers, agents, navigators, and health care providers — to help design an exchange that supports Minnesota’s unique health care system and demonstrates again why Minnesota leads the nation in health care innovation.”

Hann says that if the exchange idea was so good, the Dayton administration would have brought it forward in the form of proposal for the Legislature to vote up or down.

“We [the legislators] represent people from every corner of the state,” he said. “By them [the administration] not coming to the legislature, it leads me to believe they’re not too interested in what we have to say.”

Gottwalt also says a “consultative role” is not enough for the Republican majority.

“We want a partnership,” he said.

That partnership concept didn’t seem to work so well during the legislative session.

Doug Grow writes about public affairs, state politics and other topics. He can be reached at dgrow [at] minnpost [dot] com.

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Comments (15)

  1. Submitted by Eric Ferguson on 08/18/2011 - 11:01 am.

    Some fiscal responsibility. It’s a federal grant. It’s free money to do something that has to be done at some point anyway, and they want to throw it away.

  2. Submitted by Jeff Wilfahrt on 08/18/2011 - 11:08 am.

    Gottwalt is NOT good for Minnesota as a society. He has no respect for the MN Constitution and open disregard for the disadvantaged among us.

    I say he stands in open violation of his election certificate for his attempt to subvert the MN Bill of Rights on the issue of equality under the law.

    Jeff Wilfahrt, Rosemount, MN

  3. Submitted by Mark Snyder on 08/18/2011 - 11:18 am.

    “Gottwalt also says a “consultative role” is not enough for the Republican majority.

    “We want a partnership,” he said.”

    Note to Rep. Gottwalt: to be considered for a partnership, one has to be willing to actually contribute towards reaching the desired outcome. In other words, if your intention is simply to say “no” to what is being proposed, there’s no point in you getting involved.

  4. Submitted by David LaPorte on 08/18/2011 - 11:20 am.

    Why would Dayton trust the Republicans after partisan bickering over their No-New-Taxes stance forced a government shutdown? Dayton gave in because the government shutdown was bad for Minnesota, something that he cared about. But there are consequences to the Republican “victory”, and a loss of trust is one of them.

  5. Submitted by Jim Bernstein on 08/18/2011 - 11:21 am.

    Republican legislators spend the entire 2011 session (and then some) refusing to be “partners” with the Governor or their DFL legislative colleagues on major policy and budget bills. They passed bills they knew were certain to be vetoed by the Governor and declined to negotiate compromises to please their Tea Party supporters. Now, they insist on being “partners” to implement a process that nearly all of them strongly oppose? Their chutzpah is truly astonishing!

  6. Submitted by Bill Coleman on 08/18/2011 - 12:22 pm.

    Geez, maybe the GOP should have been more worried about this during the legislative session, instead of pushing through prospective constitutional amendments or failing to devise a budget.

  7. Submitted by Tom Christensen on 08/18/2011 - 12:39 pm.

    Republicans need to get off their “No” campaign and start working for the country as well as Minnesota. Republicans can’t be against everything that they were once for with any sort of sensibility or rationality. Politics has turned into electing someone and then immediately the opposing party spends the rest of the winners elected term undercutting the him or her. That is not democracy that it is just mean spirited politicians who egos have blocked any common sense.

  8. Submitted by L.A. Krahn on 08/18/2011 - 12:49 pm.

    English translation of the R guys whine:

    “But the Minnesota Council of Health plans and their Italian-suited lobbyists with only have a few SEATS at the Exchange planning table and not the ENTIRE table?”

    Commissioner Rothman is good on his word for enlarging the table — he met with a delegation of residents of Greater Minnesota yesterday. Thank you for the audience, and the good reporting, Mr. Grow.

  9. Submitted by James Hamilton on 08/18/2011 - 01:05 pm.

    To the extent that Minnesota law has not been pre-empted by federal law on this point, then it makes sense to me for the governor to have initiated this process now in that it seems to be a primarily administrative function.

    If only those insurers licensed to do business in Minnesota are to be included in the exchange and the products they offer are required to comply with Minnesota policy standards, then it would seem that the state already has much of the information that I would expect to find on the exchange. That wheel’s already been invented.

    Of course, some legislators may have an ax or two to grind when it comes to whether the exchange should exist and whether or not it should address such things as the availability of coverage for controversial medical procedures. (E.g. abortion.)

    It is ironic to hear any Republican legislator argue that the exchange shouldn’t go forward because the viability of the entire program is in doubt. I can’t count the number of times I’ve heard legislators say that they couldn’t be concerned with the constitutional validity of a bill in deciding whether to vote for it. Then, too, there’s the enormous amount of money wasted by state government in preparing for and recovering from the recent shutdown, not to mention the money lost during the shutdown. Efficiency, it seems, is only a virtue when it involves an effort one favors.

  10. Submitted by Tim Walker on 08/18/2011 - 01:52 pm.

    “I’ve talked to people in the [health insurance] industry,” Hann said. “They don’t see this as necessary. That raises red flags to me.”

    I’m so glad that Rep. Hann has consulted with the for-profit health-care companies and their executives with multi-million-dollar salaries.

    And he’s apparently heard loud and clear that these companies feel that a state-run health exchange is “not necessary.”

    By a weird coincidence, just this morning I chatted with the CEOs of Williams Pipeline, Koch Industries, British Petroleum, and Excel Energy. To a man, they each told me that the environmental regulations imposed on them by the state are also “not necessary.”

    Now, I’m sure Rep. Hann’s next step is to consult with an uninsured mother of three who cannot afford to take her children to see a doctor for preventive health care.

    Or does Rep. Hann feel that hearing from such people is also “not necessary”?

  11. Submitted by Richard Schulze on 08/18/2011 - 07:36 pm.

    I think the best option is probably to put the onus on doctors’ groups to reduce costs by offering them a set annual fee per patient based on that patient’s age and any chronic ailments. There will still be problems, and the correct level of regulation will be hard to judge. But medicine will never be a perfect market, and market solutions alone will never produce a workable and humane system.

  12. Submitted by will lynott on 08/18/2011 - 10:01 pm.

    “”the government will end up dictating everything. It will dictate benefits, costs. You’re now putting government pretty much in charge.”

    Oh, God forbid, Gottwalt! While we’re at it, why don’t we do away with the VA and Medicare, government programs that deliver excellent health care (don’t believe it? Ask a sign waving teabagger)for about $0.04 on the dollar?

    Your precious private sector has brought us nothing but spiraling costs, impenetrable bureaucracy, denial specialists, health care rationing, and shedding of the highest risks to fend for themselves, all in the name of maximizing profits. I still wonder how those people sleep at night. The private market cannot cope with an industry whose primary goal is not to maximize use of its product but to minimize it.

    Not that you give a damn. I get it; ideology trumps everything. My fervent hope and expectation is that the voters, having seen your true stripes, will eject you and your ilk from any position from which you can do any more damage.

    “Vibrant private sector” my rosy red a$$.

  13. Submitted by Ray Schoch on 08/19/2011 - 08:15 am.

    I lived for a dozen years without health coverage. I paid for office visits to the doctor out-of-pocket. I paid for my own skin cancer surgery in 2008, the only year of my life in which my medical expenses were so large that they actually passed the threshold required by the IRS for some of them to be tax-deductible.

    If you’re wealthy, or have a generous employer, the United States has a satisfactory health care system. Not great, but satisfactory. If you are not wealthy, or your employer, like many private individuals, cannot afford health care coverage for you, this country’s health care system is an embarrassment.

    Republicans worried about government control of health care don’t seem to mind the greed-driven private sector alternative: health care controlled by equally faceless bureaucrats, based not on your desired health outcome, but on ROI (return on investment) to shareholders, who’d prefer not to spend any money at all on benefits. After all, they’re already paying their CEOs millions of dollars annually, why would they want to lower shareholder return further by paying for your health care?

    We ration health care in the United States on the basis of affluence. It’s not only unfair, it’s immoral. Republican legislators touting the Minnesota health care system need to try using that system sometime. Speaking as a relative newbie to the state, I’m totally unaware that such a statewide system exists, or how it works. Fortunately, I turned 65 shortly after moving here, and qualified for Medicare – an efficient, cost-effective government health care program that’s relatively inexpensive to me as a consumer. It doesn’t pay for everything, but as anyone with private health insurance can tell you, private sector health coverage doesn’t pay for everything, either, and it’s uniformly more expensive.

    When Stephen Hemsley at UnitedHealth is being paid the salary of a fireman or teacher instead of the $48+ million he was paid in 2010, then the public can begin to put some very minimal faith in the notion that private health insurance might have the public’s best interests at heart. Until then, however – and I’m not going to hold my breath waiting for it – we can safely assume the the goal of private health insurance is to make money, not provide health care.

  14. Submitted by Bernice Vetsch on 08/19/2011 - 10:53 am.

    Messrs. Gottwalt and Hann want to be sure that the Exchange includes their Health Minnesota Contribution Plan (See HF 8) in which the state’s “contribution” would be to pay 80% of the cost of premiums. Period.

    Patients would have to pay the other 20% of a separate policy for each family member plus various co-pays and deductibles until reaching a minimum of $3,000 in out-of-pocket spending for each person before their insurers would cover any expense in full for that person. Extra charges for name-brand drugs or out-of-network provider use would not be included in the $3,000.

    Governor Dayton was successful in blocking this injurious plan for MinnCare and MA families with children, but NOT for some 7,200 childless adults. These generally very-low income adults will probably not be able to afford insurance at all and will have hospital emergency rooms as their only alternative unless they can find free clinics.

    “Partners” like these Minnesota does not need.

  15. Submitted by Bernice Vetsch on 08/19/2011 - 10:58 am.

    Additional warning: Minnesota has stronger protections for patients than many other states.

    The Right wants insurers to be able to sell policies across state lines without regard for state laws against exploitation of their customers.

    Minnesota must tell insurers that they either obey our laws or forget about selling policies in our state.

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