Editorial: Veto won't cure health care for poor

The continuing impasse at the State Capitol over health care for the very poor, exacerbated Thursday by Gov. Tim Pawlenty's latest veto, is disappointing in so many ways.

A mature, moral society should have settled long ago on how to humanely and affordably care for the poorest and sickest people in its midst. A state whose economy features a world-renown health care industry shouldn't choose to disproportionately burden that industry with the cost of indigent care -- especially during a recession. A government that strives to spend every tax dollar wisely should have by now created cost-effective ways to deliver a service as basic as health care and contain exploding costs.

And a governor who feels he must bring down the curtain on a costly, fast-growing method of meeting health care needs would shoulder responsibility for putting a workable replacement in place. He would recognize that governing requires not only saying no, but guiding state policy to yes.

Pawlenty appeared to be leaving ample time to do just that when, last May and June, he zeroed out the $400 million required to operate Minnesota's health care program for the very poor for 15 months. He stayed his hand, first until March 1, then April 1, 2010, saying that timetable would allow legislators, program administrators and stakeholders time to find a more affordable alternative to General Assistance Medical Care, or GAMC.

Key legislators in both parties took him at his word. They worked diligently to craft revisions that would cost the state $280 million rather than the original program's $400 million. They heeded the governor's warning to avoid funding sources that so much as smelled like tax increases. They succeeded so well that on Thursday, all but nine Minnesota House Republicans -- including one GOP gubernatorial candidate, Rep. Marty Seifert of Marshall -- voted for the package they created.

Pawlenty's veto came within a few hours of the House's vote. It left legislators who thought they had solved a problem wondering whether they could find a drawing board to go back to, let alone what they would write on it. A veto override attempt was under discussion Friday, but not scheduled. An override would take at least three House Republican votes; none were in evidence Friday.

The governor objected to the bill's timing, coming before the state budget is balanced. Yet only a few months ago he seemed to be inviting early legislative action on GAMC. Action before Feb. 28 would avoid the expense of delivering the legally required one-month notice to recipients that their coverage was being canceled.

Pawlenty objected to the bill's 50 percent whack at provider reimbursements. He's right; it's excessive. But it's also crafted to be temporary, expiring in mid-2011 -- and in that sense, it's akin to delaying payments to schools during the same timeframe.

His veto letter complained about the bill's lack of "meaningful reform." Yet in addition to trimming eligibility slightly, the program contains a promising change. It would allow counties to replace GAMC's fee-for-service payments with county-directed managed care. It would also encourage the establishment of specialty clinics to minimize hospitalization among the largest, most costly segment of the GAMC population -- the mentally ill, chronically sick, often chemically dependent unemployed.

That population isn't likely to be well-served by health insurance that requires a complicated enrollment procedure, copayments, deductibles and the payment of a monthly premium. But that's the only alternative Pawlenty has offered them, through MinnesotaCare. His latest budget proposals indicate that he wants to shrink MinnesotaCare from a subsidized, premium-based insurance program for the working poor to a premium-based program for the GAMC population. The state would save money in part because those people aren't likely to stay enrolled.

That might solve a problem for the state budget. But it would create a host of problems for the larger society. It would mean more sickness for the poor, more job losses for health care workers and more uncompensated hospital costs passed along to everybody else. It's disheartening to think that Minnesota can't find a better way. It would be shameful if lawmakers stop trying.