Former Minnesota Governor Tim Pawlenty has stood strongly against both Barack Obama and fellow presidential candidate Mitt Romney for what he calls ‘Obamneycare.’ Pawlenty believes his state’s health care plan implemented in 2008 provides a paradigm for the nation’s health care coverage should he successfully take office, arguing he “passed health care reform the right way. No mandates. No takeovers. If I could do it in Minnesota, we could do it in Washington.”
Certain sources including health care experts and former advisors who counseled Pawlenty on the matter during his governorship have testified to the man they once called Governor Tim Pawlenty, the man that embraced universal healthcare. Pawlenty’s 2004 Citizens Forum on Health Care Costs chairman and former U.S. Senator David Durenberger disclosed a Pawlenty who allowed institution of low-cost insurance and new quality regulations for hospitals and doctors as consumer health incentives, some of the very same ideas contained in President Obama’s Affordable Care Act. In Durenberger’s opinion, Tim Pawlenty’s new talking points are ”unworthy of a governor of a state that has been working hard to create many of the care system and access innovations that the Affordable Care Act will help to fund with federal dollars as an example to the rest of the country.”
Using the ‘Obamneycare’ label to beat out competitor Mitt Romney, Pawlenty may be guilty of a similar flip-flop. Speaking highly of Romney’s attack on health care costs in 2006, Pawlenty said he was ”open to” a comparable insurance mandate, claiming that ”everybody should be in a health plan of some sort.” In fact, he worked to implement steps toward becoming a universally-covered state by proposing that same year to extend health care access to 90,000 uninsured children. ”We all, I think, can chart a path toward universal coverage. We’re going to have to move in stages. … We should start with covering all kids,” he said at a Minneapolis health reform conference. ” In 2007, he urged the Legislature to pass a state-regulated insurance exchange for individuals not covered by company coverage. Falling short of the individual insurance mandate, the plan did require purchasing all individual insurance policies through the exchange, a feature that serves as Obamacare’s focal point. The proposal failed, but Pawlenty appears to have changed his mind soon enough. Once the current federal health care reform took effect, Pawlenty joined 26 other state governors to challenge it’s constitutionality.
While Romney and Obama were adding millions of uninsured people to a broken health care system, Pawlenty says, he was getting to the root of the biggest problem: costs.
Critics, though, argue that it's too early to know whether the Minnesota law will lower costs and noted that it does little to expand insurance coverage. Others complain that while Pawlenty signed the law, he didn't show much leadership in getting it passed.
Former Sen. Dave Durenberger, R-Minn., who first got to know Pawlenty when he was Durenberger's driver, said it was Democratic legislators - not Pawlenty - who led the charge on the state law. "You have to put a priority on changing things," he said. "You've got to provide leadership. He never did that."
Some of the changes the Minnesota law made also can be found in the later federal overhaul. The state changed the way that physicians, hospitals and other medical providers are paid, rewarding them for high-quality care and for coordinating care for chronic conditions such as diabetes through health care "homes."
For some conditions, medical providers are paid one fee to cover all the costs of related services. One pot of money, for example, pays for a patient's knee replacement, from preoperative services to anesthesia and rehabilitation. The federal law also contains provisions to pay providers more for high-quality care and to test similar payment restructuring.
The state law created a tool to compare costs and quality information and a program to encourage Minnesotans to stop smoking and to lose weight to prevent conditions such as cancer, heart disease and diabetes. In 2009, about 63 percent of Minnesotans were overweight or obese, and 17 percent used tobacco. The state estimates that the program could bring 10 percent of overweight adults back to the normal range and get 6 percent of smokers to stub out their tobacco. The result could be $1.9 billion less in total health care spending by 2015.
As Pawlenty seeks to gain momentum in the race for the GOP nomination, he's continuing his focus on costs and spending. He says the government must put an end to runaway expenditures on entitlement programs such as Medicare and Medicaid. He also says he supports high-deductible health savings accounts in which consumers pay a large portion of their initial health costs but can put aside pretax income to cover those expenses.
Pawlenty has said he supports the Medicare plan that House Budget Committee Chairman Paul Ryan, R-Wis., proposed, which would raise the eligibility age from 65 to 67 and change the program so that seniors get help with paying the premiums for private insurance plans. Currently, Medicare pays whatever is necessary to provide a set of specified benefits.
Unlike most states, Minnesota traditionally has enjoyed a high rate of insurance among residents, so Pawlenty was under little pressure to expand coverage. For low-income residents who didn't qualify for Medicaid - mainly childless adults - the state offered two additional subsidized health insurance plans.
Still, consumer advocates say, it was a constant battle to maintain the state's coverage levels. "The first place Governor Pawlenty looked when there was budget trouble was cutting people off of health care," said Liz Doyle, the policy director of the consumer group TakeAction Minnesota.
By the end of Pawlenty's second term, Minnesota still ranked high in coverage but had lost some ground. Uninsured people accounted for 6.1 percent of the state's population in 2001 and 9 percent in 2009, according to Minnesota government figures; that's half the national average.
As he was positioning himself for a presidential campaign, Pawlenty was the subject of intense criticism in 2009, when he used his line-item veto authority to try to end the state's General Assistance Medical Care program, which then was serving about 33,000 low-income adults. State expenditures were growing by about 30 percent every two years, according to McClung, who said that was because it was a fee-for-service-style program.
Pawlenty wanted to shift participants to MinnesotaCare, another state program for people without insurance. Consumer advocates and Democrats in the legislature fought the change because they feared that administrative requirements would make it more difficult for some people to remain covered. In the end, Pawlenty and the Democratic-controlled legislature agreed to change the program so that the state would give hospitals a set amount of money to care for eligible people in their areas.
But that was unrealistic for thousands of people, Doyle said, because only a handful of hospitals chose to participate, shutting off access for those in other areas.
Durenberger calls Pawlenty a moderate in many areas and praises him for establishing a health care commission to study the issue soon after he became governor. But he's critical of aspects of Pawlenty's approach to health care.
"Once he found that solution, he was like most Republicans," the former senator says. "Arm everyone with a high-deductible option and give them skin in the game and you have the answer.
No comments:
Post a Comment