Governor Tim Pawlenty and House and Senate leaders have not resolved their differences on a sweeping health care reform initiative.
They met Wednesday and Pawlenty restated his objection to the cost of the legislation. The stalemate reduces the chances that any sort of health care reform will pass the Legislature this session.
The dispute stems in large part from the state's projected nearly $1 billion budget shortfall. To plug that deficit, the Governor wants to take surplus money from a special health care fund intended to help insure poor Minnesotans. DFL leaders strongly disagree with the idea.
The health care reform bills moving through the House and Senate have a goal that's easy for any lawmaker, Republican or Democrat, to embrace in theory. The legislation would change the state's payment system to reward doctors for preventing illness, rather than paying them just for treating sick patients.
But like most health care proposals, this one needs some up-front money to get it rolling. And that has complicated discussions at the Capitol, as lawmakers struggle to close the state's projected $935 million dollar budget deficit.
Governor Pawlenty proposes scaling back expectations until the state's budget situation is more stable. And he recommends tapping $250 million dollars in surplus money from the state's Health Care Access Fund to plug the deficit.
Representative Marsha Swails, DFL-Woodbury, described the Governor's idea as a raid on the fund.
"I'm very disappointed that this is the tact that the Governor has chosen, and it's not the first time. He did this before. He raided this fund, and I think that we need to honor those who are putting this money to good work," Swails said.
The Health Care Access Fund was created in 1992 with a tax on health care providers. The fund helps pay for the state-subsidized MinnesotaCare insurance program. The money is earmarked for health care, but the fund was tapped in 2003 to help close an even larger state deficit.
DFLers aren't the only ones who object to using the fund for anything but health care.
"Physicians in general have been quiet for too long with regards to the use of the provider tax for non-intended purposes," said Dr. Dan Hoeffel, an orthopedic surgeon from St. Paul.
Hoeffel said the provider tax essentially gets passed on to sick people through their medical bills.
He said it's already an unfair burden to expect those people to subsidize MinnesotaCare. But he thinks it's even more onerous to use their tax money to pay for pot holes and other state expenses.
"To take those monies that are considered excess, which is the fund for those patients to receive medical care, and to use it for non-medical purposes, in my opinion, is just frankly not ethical," Hoeffel said.
Minnesota hospitals also oppose using the Health Care Access Fund to close the budget deficit. But Minnesota Hospital Association President Bruce Rueben said in a way it's the lesser of several evils. He said hospitals would rather see surplus money tapped than endure any more reimbursement cuts.
"When the state uses the Health Care Access Fund it's obviously a violation of the purpose of the fund and the policy that the fund finances. But you only lose that one payment. In other words, it isn't perpetuated," Rueben said.
A spokesman for Governor Pawlenty said that's the idea behind the Governor's budget proposal.
Brian McClung said while the Governor understands the desire to use the Health Care Access Fund only for health care, he said it's more important to protect health care programs that already exist. "It should be noted that under the Governor's budget plan that resolves the deficit, we do not change eligibility levels or benefit programs for anyone who is on MinnesotaCare or any government-subsidized health care program," McClung said. "So we're using that Health Care Access money to be able to avoid cuts."
While it's not clear if lawmakers will be able to reach agreement on health reform this session, some providers said they see the writing on the wall, and they will begin putting together their own reform plan to cut costs and improve the quality of care.