Health reform still possible? - Talks continue as session wanes

With a May 19 end-of-session deadline looming, key lawmakers and Pawlenty administration officials continue to press for a solution that would improve Minnesota’s health care system.

The House and Senate have passed different versions of what an improved health system would look like for both the commercial and public sectors. Pawlenty favors the House’s approach over the Senate’s, and in recent days has floated his own solution. As this article went to press, all parties involved in negotiations believe final passage is possible.

The current debate is a culmination of many years of task forces, advisory panels and work groups that have wrestled with how to better the system and control the cost projections that all agree are unsustainable. Health costs now consume more than 25 percent of the annual state budget.

The main sticking point in the current negotiations is how to pay for fixing the current system and expand coverage to more uninsured Minnesotans. Specifically, there is disagreement on how much should be drained from the Health Care Access Fund, which was created by the 1992 Legislature to pay for the MinnesotaCare program. Legislators say the funds should only be used to pay for health care. Pawlenty wants to use some of it to plug the current $935 million budget hole.

People with disabilities stand to gain from elements contained in all the proposals now being debated. Recognizing that our current health system is fractured, confusing, and tough to navigate, the concept of a ‘health care home’ has been proposed. This would link an individual to a particular clinic or provider who would agree to help coordinate all of a person’s health needs. In return, the service provider would receive a financial benefit for doing so. Advocates have sought to ensure that individuals with complex needs who may already have a health care home, (such as children with disabilities in the TEFRA program, or those in the Minnesota Disability Health Options program) would not have their current arrangements disrupted. Also important will be the ability to designate a mental health professional or specialist as a ‘health care home,’ not just a primary care doctor. Currently, no one is assisting many of the enrollees in the fee-for-service Medical Assistance program to ensure their health needs are being addressed and coordinated.

Additionally, the legislature wants to expand the Min-nesotaCare program, which would give more individuals and working families access to affordable health care. Many current enrollees have complex medical issues or conditions, but they may not be ‘disabled enough’ to qualify for Medical Assistance. For individuals in this situation, their pre-existing conditions may price them out of the private insurance market, so MinnesotaCare may be the only option they can afford. The governor’s most recent proposal would include no expansion of the program.

How we pay for health services—and determining what the real price is for certain services—would also be addressed in the reform package. The buzz word is ‘transparency,’ which would give the public a better understanding of what services really cost, and which providers are best at delivering those services. Ultimately, this change would lead to the development of better consumer report cards and lists that would rank providers based on cost and quality. Lawmakers and the governor also want to reward the health providers who do a good job by paying them more, and indicate more clearly to the public who isn’t performing at a level to justify higher reimbursement for services.

Making sure that we’re looking at the entire continuum of health care services—from hospital stays to PCA and other in-home services—has been a concern of disability advocates and a focus of the Bridging the Continuum workgroup of the Health Care Access Commission. Many people with disabilities and chronic conditions rely on non-medical services to live independently in the community. Many of these services (such as case management or independent living skills) are now only offered through the Medical Assistance waiver programs and are designed to save money on the acute care, or medical service, side of the state ledger. Preserving these services, and focusing on health promotion and prevention of secondary disabilities for those already living with chronic conditions or disabilities, has been an important part of the ongoing dialogue.

Whether a bill is passed and signed by the governor or not, the issue of improving both access to services and better defining the quality of those services utilized by individuals with disabilities, will be a continued public policy focus. The ongoing challenge will primarily be financial, with the budget deficit expected to grow, not shrink, in the coming months and years

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