IN THE STATES: Minnesota Gov. Vetoes Health Coverage Expansion Bill

Joanne Kenen — Wed, 14 May 2008 19:58:00 -0400

Minnesota Gov. Tim Pawlenty has vetoed a health care bill, saying it would expand coverage without doing anything to restrain costs or improve quality, the Star-Tribune reports.The bill had passed the state Senate with a veto-proof margin, but the vote was closer in the House.

The bill would have made more people eligible for MinnesotaCare, the state's subsidized health insurance program for the working poor. It would have covered an estimated 40,000 people.

"The state cannot afford to further expand subsidized health programs without certainty of reform that will control costs," Pawlenty wrote.

Pawlenty noted that the bill would subsidize households with incomes of up to 400 percent of federal poverty guidelines, making eligible a family of four with an income of $84,800. "This is simply too high," he wrote.

The governor said there were parts of the bill that he liked, including promotion of electronic health records, development of medical homes and payment reform for doctors.

The paper had also recently reported that the bill would have started a statewide campaign to reduce smoking and obesity, and would have offered the public data on the quality and costs of doctor and hospital services. The bill was not as far-reaching as measures recommended by advisory panels appointed by Pawlenty and the legislature.

IN THE STATES: Health Reform Wrap-Up

Joanne Kenen — Thu, 08 May 2008 20:16:00 -0400

Lots of health reform activity recently in states. Here's some help in catching up:

Connecticut. The state legislature has approved a Democratic bill permitting municipalities, nonprofits, and small businesses to join the state employee health insurance pool. Unclear whether Gov. Jodi Rell will support it. Some leading Republicans object to a "government-run" health system, while Democrats and labor backers say the greater buying power of the pool will save municipalities money. Not a comprehensive solution but we'll be interested in watching how this plays out.

Alabama. We posted a few weeks ago about Birmingham's plan to cover children—which we confess was a pleasant surprise to us given the state's history, poverty, and health status. Now we see the state has a new $3 million, five-year grant for the University of Alabama's initiative to reduce health disparities among older blacks.

"It's a huge agenda...There's lots of work to be done," said Dr. Richard Allman, who will head the new Deep South Resource Center for Minority Aging Research, noting that the elderly black rural population is growing fast. The program will start with a focus on three areas—how to help families make decisions about nursing home services, social support for patients with chronic heart failure, and cytomegalovirus infections in older blacks.

Minnesota. The legislature has approved a bill that would stop a hospital from using a patient's medical debt history to decide whether to treat the patient. The governor is expected to sign it.

"It hasn't been a problem here yet, but we do know that some companies were working on gathering that information to sell to health care providers," state Sen. Linda Scheid told the Star Tribune.

Under the bill, a health care provider can't share or obtain medical debt information about a patient seeking care until after the care is delivered.

Florida. This is the biggie, and the devil is in the details, which have yet to be figured out.

With nearly 4 million uninsured, Florida has one of the highest rates of uninsured in the nation, a bit more than 20 percent. Republican Governor Charlie Crist pushed hard this year for an affordable alternative health plan that people can purchase in the individual market, and state legislators gave him much of what he wanted.

The plans will be free of most state coverage mandates and regulations, and will be "no frills." And that's what we worry about. We appreciate Crist's effort to act—and the financial limits his state faces. And he's said the plan will cover prescription drugs, screening, even mental health. But for $150 a month,we're not yet sure how comprehensive these benefits can be. Will the young and healthy go for bare bones plans, making prices of more traditional insurance plans even more costly for the older and sicker? The details are going to be decided by the insurers, who will negotiate with the state. Still, we're sympathetic to states who are trying to help people even in economic tough times -- and one reason we're pushing a national comprehensive solution is that we recognize the states can't do it all on their own.

We've read several state newspaper accounts, (Here, among others) and called on an expert who tracks Florida but if our readers have any insights into where the Florida program is likely to go, please free to comment.