The legislation that passed in 2008 was far more modest. The new exchange was open only to employees of small businesses that opted to take part. And there was no requirement that Utah residents get coverage.
On the trail, Huntsman now describes the rejection of the mandate as his decision.
But in Utah, people in both parties recall it differently: Huntsman’s team was quite interested in the mandate, they say, but it quickly became clear that it was going nowhere in the conservative legislature. And insurance brokers in the state lobbied against an exchange that would be open to more people.
State lawmakers “were very resistant to the mandate on philosophical grounds,” said David Sundwall, Huntsman’s health director. “It was not going to happen in Utah, and while that was disappointing, it was not something we were going to fall on our sword for.”
Advocates of health reform in Utah still praise Huntsman’s commitment to the issue, particularly his push to make permanent eligibility levels for the federal Children’s Health Insurance Program.
The exchange, the centerpiece of the 2008 reform, remains a work in progress. After a slow start, 314 businesses, with about 3,500 employees, are participating, while 390,000 state residents are uninsured.
“Over the time the number of people covered will continue to grow, not through government dictate but because they will have access to more health-care choices that make sense to them,” said Tim Miller, a spokesman for the Huntsman campaign.
In Minnesota, Pawlenty faced a different landscape as a Republican governor working with a Democratic-controlled legislature. But after his narrow reelection in 2006, he too spoke in ambitious terms about health-care reform. In a speech that November, he referred to an individual mandate as “potentially helpful” and a “worthy goal and one that we’re intrigued by and I think at least open to.”
Fourteen months later, in early 2008, a health-care task force he helped appoint recommended an expansive list of reforms, including a state exchange, an individual mandate and subsidies for those who couldn’t afford coverage.
But by that point, Pawlenty was saying the state needed to focus on controlling costs before expanding coverage. The legislation that passed in 2008 included funding to address chronic diseases and reforms to reward high-quality providers but no exchange and no mandate. In his last year in office, Pawlenty turned hard against the new national law, rejecting federal money to start implementing it.
On the trail, Pawlenty frequently touts his health-care record, particularly his move to encourage state employees to seek out efficient providers.
Minnesota lawmakers say Pawlenty is on more solid ground than Huntsman in attacking the mandate, because, with an eye to the national political scene, he clearly spurned it after the early statement of interest. More problematic, some say, is that the national law includes so many of the cost-control tools that Minnesota has helped pioneer, such as “bundling” payments for certain health conditions and encouraging the formation of “accountable care organizations” that are incentivized to deliver low-cost care.
Others say that Pawlenty’s bigger vulnerability is that his health-care reforms amounted to so little.
“The problem with Pawlenty was the follow-through,” said Larry Jacobs, a political scientist at the University of Minnesota. “There were many good ideas, but there was little that came into place.”
Meanwhile, the percentage of people without insurance has grown, including among children. This is attributed mostly to the recession, but also to state budget cuts. Last year, Pawlenty terminated the state program that covered 32,000 low-income people not eligible for Medicaid. It was replaced by block grants to hospitals, but only four hospital systems agreed to take part, leaving about half of the people in the program with nowhere to go.
Cal Ludeman, Pawlenty’s commissioner of human services, notes that Pawlenty approved a slight expansion of Minnesota Care, through which people without coverage at their workplace can buy subsidized insurance. And he rejected the notion that Massachusetts’ lower uninsured rates are a sign that Romney did more than Pawlenty.
“Any state could close that gap if they’re willing to use public funds,” he said. “Governor Pawlenty would probably look at Mr. Romney and say, ‘Can Massachusetts afford what it covers?’ ”
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