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No room for the sick in budget balancing
Times are tough, tougher if you are sick.
A vast majority of states, including Minnesota, face massive deficits. Typically, these budgets are balanced to the detriment of health and human services expenditures because they comprise a big portion of state spending.
Some states are going a step further and considering opting out of the federal-state program Medicaid for the first time since its beginning over 40 years ago in the Johnson administration.
Could it happen in Minnesota? Let's consider what's going on around the nation. The two most instructive examples are Texas and Arizona.
Texas is considering a complete Medicaid opt-out. With a budget shortfall projected at $21 billion dollars and no-new-taxes conservatives controlling legislature and the governor's office, budget cuts are the only option left.
In the competition to out-conservative one another, Rep. Warren Chisum, R-Pampa, TX, specifically cited opting out of Medicaid as part of his platform to become the next Texas House speaker.
Various proposals to replace Medicaid with a cheaper state program are being considered but none fully replace the 3 million+ Texans the joint federal-state program currently covers. The plan seems especially cruel when the details are revealed: Currently Medicaid covers at least some of the cost for 60 percent of all Texans living in nursing homes and half of all births. Cuts would leave 2.6 million Texans without insurance if they were unable to afford anything else.
In money terms, the move would amount to $15 billion less federal funding for Texas.
South Carolina and Washington are considering similar moves while Nevada and Wyoming have ordered studies to see if it would benefit their deficit burden enough to consider.
While some contemplate, Arizona has acted. Reducing $4.5 million from the state's Medicaid program, the state legislature is garnering national attention by cutting certain transplant operations out of coverage plans. This has left at least 100 known cases of Arizonians who need transplants without the funds to get one.
A New York Times story cited such cases as "the father of six who died before receiving a bone marrow transplant, the plumber in need of a new heart and the high school basketball coach who struggles to breathe during games at high altitudes as she awaits a lung transplant."
As conservative leadership takes the helm of Minnesota's legislative chambers with promises of less government spending, one must wonder if they will consider the Medicaid option. Outgoing Governor Pawlenty has already rejected proposals for a Medicaid expansion opt-in.
Whether we go a step further and put Medicaid on the chopping block or not, a disturbing trend unifies all these cuts. They do not seem to enhance the quality of life for citizens. Temporary budgetary relief as dictated by ideology wins over objective statistics that provide tangible long-term solutions to fiscal problems. Any state opting out of Medicaid would place the burden on local communities, meaning higher property taxes for citizens on a regressive level.
Yes, costs are rising. In Minnesota the state's share of Medicaid went from $1.4 billion in 2000 to $2.8 billion in 2009, GAMC went from $127 million in 2000 to $288 million in 2009 and MinnesotaCare from $115 million in 2000 to $342 million in 2009.
This is without a dramatic rise in enrollees to match cost increases. The answer is to figure out ways to practice medicine smarter, better coordinate care and prevention, and control costs -- not just cut those who need medical services.
Minnesota legislators will need to take a long, hard look into the faces of those they represent, those most adversely affected by any cuts made. Instead of just becoming another state to cut off its most unfortunate, Minnesota has an opportunity to move to the head of the pack. We need to learn why the healthcare system broke and fix it with nuance and care, not throw those in the organ transplant line out with the bathwater.