The Smiling Face of Pain

The "new" Tim Pawlenty looks a lot like the old one

By the end of his first term in office, Pawlenty had reliably opposed numerous bills specifically aimed at expanding health care coverage for children and other Minnesotans offered up by DFL legislators. He had diverted approximately $580 million in health care access fund money into the general fund. And according to numbers compiled by the Children's Defense Fund, there had been a 15 percent rise in uninsured children under the age of six from 2001 to 2004.

While fiscal conservatives howled over the perfidy of Pawlenty's embrace of uninsured children, others gleaned a mixture of political calculation and perhaps a pang of conscience in his new stance. As one commentator put it: "The last election affected Tim Pawlenty the way Marley's ghost affected Scrooge." But it took the "new" Pawlenty less than 60 days to reveal himself as more cunning and two-faced than any redeemed Scrooge. In health care, as in education, transportation, and most every other bread-and-butter issue affecting Minnesotans, the budgetary priorities of Tim Pawlenty continue to make it more likely that the Tiny Tims of this state will have to fend for themselves.

 

"Healthy Connections" was the name of the plan Pawlenty unveiled at a January 11 press conference. But connecting children to health insurance was suddenly no longer high on his priority list. Pressed for details, the governor was forced to acknowledge that only about 13,000 of the 70,000-90,000 uninsured children he had cited would gain coverage from his plan, which carried a price tag of more than $40 million a year. "I won't have a fixation on access to a system that is broken," he vowed. But he'd used almost the exact same words back in his November speech, and then still claimed that there would be, and should be, enough resources to cover all kids. And what of the 60 percent—tens of thousands of children—the governor cited who already qualify for state-supported health care but aren't receiving it? Two years ago, Pawlenty cut $1.5 million (half of it federal matching funds) used for health insurance outreach in poor and immigrant communities. The size (from 4 to 26 pages) and frequency (from once to twice yearly) of the insurance application has also grown on his watch. But he didn't mention money for outreach at his press conference and there is no line item for it in his budget. (The governor's office did not return a phone call from City Pages requesting an interview for this story.)

There is, however, $31 million proposed in Pawlenty's "Healthy Connections" plan for the creation of a private Health Insurance Exchange, which would allow businesses who currently don't offer insurance to set up pre-tax accounts for their employees to purchase their own coverage. Pawlenty says this will reduce the "administrative burden" on companies, who will be mandated to offer these pre-tax plans for a minimal cost that he estimates at no more than $300 a year per company.

Another major component of Pawlenty's plan is dividing MinnesotaCare into two parts. Those at the upper end of the income eligibility scale would be given the option of MinnesotaCare II, which would feature lower monthly premiums but higher deductibles and more co-payments. Sen. Linda Berglin (DFL-Minneapolis), one of the founders of MinnesotaCare, said that when legislators were first structuring this national model back in the early '90s, a similar idea was considered and rejected. "One big reason is because we didn't believe enrolled families could afford high deductibles," Berglin says. "And if they could, that means we'd wind up with a lot of healthier people in one part of the plan and sicker people stuck in another part." This imbalance, known in the health care business as "adverse selection," can create volatile, expensive swings in monthly premium rates. Another danger of high-deductible plans, especially for people whose incomes are modest enough to be eligible for MnCare, is that rudimentary and preventative care is put off to avoid the high up-front cost, creating more expensive trips to the emergency room later on.

In other words, there is a great distance between the humble, conciliatory Tim Pawlenty of election night, the one apparently determined a week later to provide all Minnesota children with health insurance, and the architect of January's "Healthy Connections." The benefits of the governor's grand redesign of health care are skewed toward the middle class, the people most willing and able to take advantage of the tax breaks he offers. But it does little more than pay lip service to the youngest and most vulnerable citizens, the ones already disproportionately hurt by the budget-cutting of his first term.

 

Of course the most fundamental reason why Pawlenty didn't walk his talk on universal health coverage for children is because it is too damned expensive. Pretending to maintain Minnesota's tradition of shrewd government investments while holding firm on statewide income and sales taxes has made Pawlenty the latest exemplar of "compassionate conservatism," artfully obscuring the nasty fallout from his tight-fisted budgets with buoyant affability and can-do optimism. His recent re-election is a testament to the polish and charisma of his performance, especially when you consider that the DFL made its largest legislative gains in the suburbs, Pawlenty's traditional stronghold, where voters are increasingly concerned about core issues such as health care and education.

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