Health care reform -- what a difference an election makes

Dayton and Pawlenty
Gov. Mark Dayton, left, met with outgoing Gov. Tim Pawlenty in December 2010 to discuss the transition between their administrations. The changeover in the governor's office brought a sweeping change in Minnesota's approach to health care reform.
MPR file photo/Tim Pugmire

Recent polls show Americans are deeply divided on the federal health care law, which was signed by President Barack Obama one year ago today. Support for the overhaul continues to be divided sharply along political party lines.

A new poll by the Kaiser Family Foundation says about 70 percent of Democrats favor the overhaul legislation while about 80 percent of Republicans oppose it.

When it comes to carrying out the law's policies in Minnesota, that party divide has also had an obvious impact.

Consider Republican Tim Pawlenty, an opponent of the health care reform law, who was still Minnesota's governor last August when he made this statement.

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"Obamacare is a misguided piece of legislation. It puts Minnesota and other states on the wrong path towards health care reform," Pawlenty said at the time. "So anything I can do to slow down, limit or negate Obamacare, I'm going to do it within reason."

Pawlenty barred executive branch departments and state agencies from applying for millions of dollars in discretionary grants under the federal health care law. That included a $1 million grant to plan for a key part of the law, a health insurance exchange -- a kind of online marketplace where consumers will be able to compare and buy policies online in 2014.

Obama signs bill
President Barack Obama signs the heath care reform bill on March 23, 2010, in the East Room of the White House.
J. Scott Applewhite/ASSOCIATED PRESS

In addition, Pawlenty rejected an option under the federal health care law to expand Medicaid in Minnesota.

Contrast that with Democrat Mark Dayton, whose first official act after he became governor in January was to expand the Medicaid program with the help of those federal dollars.

"It is such an obvious decision that I'm astounded that anybody other than the political attack squads even think this is something to be debated or considered," Dayton said at the time.

Dayton created a health reform sub-cabinet that includes the state commissioners for health, human services and commerce all working together to implement the law here. Those commissioners will apply for as many grants as possible -- including some Pawlenty passed up.

The federal health care law led to a number of changes this past year in Minnesota, including:

• Allowing young adults to stay on their parents' health insurance coverage until age 26;

• Providing $250 rebates for some seniors on Medicare's prescription drug program;

• Prohibiting insurers from denying coverage to children based on pre-existing conditions;

• Creating a temporary reinsurance program that reimburses employers for some of their costs in insuring early retirees.

Minnesota is not the only state whose vision of health care reform was dramatically changed by a new governor.

"The [partisan] fight over health care reform ... carries over into the states with one difference -- the offer of money."

Consider Wisconsin, which was one of the nation's leaders in health care reform under Democratic Gov. Jim Doyle. Doyle set up a state office to carry out federal health care reform in Wisconsin, which included an Internet model of a health insurance exchange.

But after Doyle left the governor's office and Republican Scott Walker took over in January 2011, Wisconsin reversed course on health care reform.

Walker created a "Free Market Health Care" office. He also joined 20 other governors in sending a letter to Health and Human Services Secretary Kathleen Sibelius, saying the reform law would destroy state budgets, among other things.

"We believe the system proposed by the [federal overhaul law] is seriously flawed, favors dependency over personal responsibility, and will ultimately destroy the private insurance market," the letter stated in part.

But in other areas of the country, the change in governors and their approaches to federal health care reform is not as clear cut. Ted Marmor, emeritus professor of political science at Yale University, says tight state budgets may mean that governors of all political stripes will find the federal dollars available under the health care law attractive.

"The fight over health care reform, which is fundamentally a partisan divide in American politics, carries over into the states with one difference -- the offer of money," said Marmor.

Former U.S. Sen. Dave Durenberger of Minnesota agrees. Durenberger, a Republican, supports the health care overhaul. But he's particularly critical of Democrats for not doing a good job of explaining the law's benefits.

"Democrats are simply debating, 'When do I get my million dollars to start my health insurance exchange? When do I get my million dollars to do my Medicaid expansion?'" Durenberger said. "Nobody is communicating adequately in ways that are understandable with the American public."

Minnesota's Human Services Commissioner Lucinda Jesson says the state will ramp up efforts to explain health care reform in the months to come.

"We're setting up a speakers' bureau so that we can have folks from the state go out and explain what federal and state health reform means for people," said Jesson. "We also have in the works a new web page focused on health care reform. So we do see going forward a great need to engage the community about what federal and state reform means."

And what that reform means will continue to change in the years to come. While supporters might be celebrating the law's anniversary today, the overhaul has only begun. All phases of the law won't be complete for at least seven more years.

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