On the campaign trial – especially the presidential campaign trail – nuance rarely breaks through the fog of generalization. Mitt Romney is the frontrunner and a flip-flopper on the issues. Michele Bachmann is the Tea Party favorite and an evangelical Christian. Jon Huntsman worked for Obama, but might have a good shot in a general election.
Tim Pawlenty? He’s a former conservative governor of a liberal state, with the credentials of Mitt Romney but a better claim to ideological purity. At least, that’s the impression he’s trying to make as the 2012 GOP field takes shape. A deeper look at Pawlenty’s record on health care, however, suggests his views have changed with the political winds and differ quite dramatically from those of Rep. Paul Ryan, the current GOP standard bearer on the issue. For instance, in an interview with Politico this week, and in an interview with me late last year, Pawlenty stressed that he opposes health-insurance exchanges, an idea he championed as recently as 2007 and a centerpiece of the Ryan proposal to transform Medicare into a private system.
When I spoke to Pawlenty, then still governor of Minnesota, last November, we talked about how states could resist implementation of the Affordable Care Act. Pawlenty admitted that unless the Supreme Court or Congress overturns the law, “the walls will slowly close in on the states” and they will have to accept the statute. But he said he would do whatever he could to slow this process down, including turning down ACA grant funding to study health-insurance exchanges. (Beginning in 2014, many Americans will be able to purchase individual health insurance or small group plans via these regulated online marketplaces.)
I pressed Pawlenty on why his state would turn down federal money to study a concept long favored by free-market conservatives. He told me that his state had already studied exchanges and found them to be useless. “As it relates to cost savings, they would not advance the ball,” he said, adding that an exchange “introduces the troubling concept of government acting as a market broker…I don’t think they would work.”
Pawlenty is right that the Minnesota Department of Health had already commissioned a major study on health-insurance exchanges. But contrary to Pawlenty’s contention that they would be ineffectual – he told Politico that exchanges are “utterly worthless” – the Minnesota study found that a state exchange would increase consumer choice, reduce administrative costs for many employers and introduce savings of 30% to 50% for individuals. The exchange studied in Minnesota would have required employers to enable workers to purchase health insurance with pre-tax income. Benefits of an exchange would be possible, the study found, when combined with other insurance reforms like an individual mandate, community rating and guaranteed issue.
Halfway through his tenure as governor, Pawlenty had, in fact, introduced the idea of establishing a health-insurance exchange in Minnesota. In January 2007, Minnesota’s Star-Tribune, in a story on a major Pawlenty health-care proposal, reported:
Plan’s key piece: the Exchange
The administration estimates the plan’s cost at $88 million over two years.
At the heart of Pawlenty’s plan is the creation of a private entity called the Minnesota Health Insurance Exchange.
The Exchange would allow employers who don’t offer health coverage to set up pre-tax accounts for employees, who in turn would buy policies through the Exchange.
Not only would all insurers offer their products through the Exchange, but the state would prohibit individual policies from being sold outside the Exchange.
The Exchange would administer the pre-tax accounts, relieving employers of a major burden, and would ensure that policies met certain standards of quality care that Pawlenty says are needed to change the system.
Paul Ryan, the GOP chairman of the House budget committee, has proposed a new plan for Medicare, in which seniors would use federal subsidies to purchase private insurance through an exchange. Ryan’s budget proposal says of his Medicare reforms:
This approach to strengthen the Medicare program ensures security and affordability for seniors now and into the future. First, it ensures security by setting up a tightly regulated exchange for Medicare plans. Health plans that choose to participate in the Medicare exchange must agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking and ensure that Medicare’s sickest and highest-cost beneficiaries receive coverage
In interviews on the campaign trail, Pawlenty has said he would vote for Ryan’s budget if given the chance, but that he would prefer his own plan for Medicare reform. He told ABC News:
…his Medicare plan will allow individuals to choose to stay in the current Medicare system, while offering “a series of other choices so they can pick what’s best for them and their families and then they’ll have the opportunity to be in the driver’s seat.”
Beyond this, Pawlenty hasn’t yet laid out a comprehensive plan for health care or Medicare reform. More in this space when he does.