Minnesota's next governor will play a major role in setting the shape of federal health care reform in the state.
Gov. Tim Pawlenty has ordered state agencies to decline all "discretionary" involvement in the federal law, including rejecting millions of dollars in grant money.
While none of the three candidates is calling for the across-the-board rejection of federal health care funding that has drawn a lot of flack for Pawlenty. But none of them says the state should accept any and all federal funding either.
Republican candidate Rep. Tom Emmer sides with Pawlenty in opposing health reform, especially when it comes to the provision that requires all Americans obtain health insurance in 2014 or face penalties. He even proposed a state constitutional amendment to block such mandates.
Emmer worries too that the law won't make health insurance affordable, but will degrade Minnesota's quality of health care.
"We don't want to affect the quality of care that's provided. But we must work on reducing costs, so it improves access," Emmer said. "And what the federal government has provided is not going to help either of those two."
But Emmer's opposition to health reform is not as categorical as Pawlenty's.
The health care law will allow states to obtain millions of dollars in grants. Emmer says the governor and legislature should evaluate each grant on its own merits.
"There are so many unintended consequences sometimes that look good when they first come to us and then they obligate us for a long time and then don't achieve the outcomes that we expect," he said.
That language is similar to some of Pawlenty's but Emmer says the state should not give up control of new programs.
In some cases, the law says that if states don't implement its programs, the federal government will do it for them. Emmer says if Minnesota has an option to manage a program itself, it should do so rather than the federal government.
Democratic candidate former U.S. Sen. Mark Dayton agrees. But unlike Emmer, Dayton likes the health care law and most of its programs.
"The immediate benefits which are often overlooked. It prohibits the exclusion for pre-exsiting conditions and that's huge especially with an aging population, you're looking for new policies, because if they change jobs, or find a better opportunity," Dayton said.
Dayton opposes a tax on medical device companies, but says he'll work with the state's congressional delegation to see if it can be modified.
On the issue of grants, Dayton says he'd rely on consultation and the health experts he'd appoint to his administration.
He wouldn't rubber stamp every grant proposal but he'd support those that would create a better public health system in the state.
Independence Party candidate Tom Horner calls federal health care reform a good first step. Like Emmer, Horner said he doesn't think the law does enough to control costs. The law's details still need to be worked out and those details present an opportunity for Minnesota, Horner said.
"In being a model and saying let us show how, let us take the lead and really putting together the kind of program that can make a differenc -- that can deliver the quality of care," he said.
Horner says he hopes that reform will bring more data on what's driving the cost of health care and hold health care plans, providers, and consumers more accountable. On the issue of grants, Horner says he wouldn't rubber stamp them either but would seriously consider them.
In the wake of the backlash against Pawlenty's stance, that was the position that all three candidates could agree on, despite their many other differences.