Uncovered in Duluth: GAMC, Medicaid rise to top as 2010 campaign issue


John Micklick’s journey to visit the doctor begins with a call to his mother, who drives up from her home in Albert Lea to his in Duluth to pick him up. 

That’s because Micklick, 34, is on the state’s revamped General Assistance Medical Care program, and the closest hospital that will treat him is North Memorial, in Brooklyn Center.

“I don’t have a license or a car,” said Micklick, a former restaurant manager who said he suffers from mental and physical ailments and is currently unemployed. “It makes me feel guilty for her to drive up here, but she says she’ll do anything for her kids.”

Micklick said he needs surgery on both his knees to repair damaged cartilage that has bothered him off and on for years. But North Memorial doesn’t have any specialists under contract to treat GAMC patients such as Micklick who need knee surgery, so he hobbles around and hopes he’s not doing further damage to his knees.

Micklick says he’s unhappy with Gov. Tim Pawlenty and the Minnesota Legislature’s decision this year to dramatically cut back the GAMC program in a deficit-reducing move that affected an estimated 35,000 childless adults enrolled in the state-funded health care program of last resort.

And he’s beyond unhappy with Pawlenty for passing on an opportunity to enroll the state in an expansion of the federally-funded Medicaid program to cover low-income adults without children and allowed him to go back to seeing his local doctors in Duluth for treatment.

“He’s basically screwing over the poor and the underprivileged,” Micklick said of Pawlenty. “He’s denying us basic health care where we live.”

Minnesota has until January 15 of next year to make its final decision on whether to take the early opt-in to the Medicaid program or wait until 2014, when it would have to join anyway. That could make the decision, and health care overall, one of the key issues in this fall’s election campaign for the next governor and Legislature.

When Pawlenty announced in late June that he wouldn’t take the option to have Minnesota move those 35,000 GAMC enrollees onto the expanded Medicaid, he cited an estimated $430 million cost to the state over the each of the next three years to do so and questioned whether the federal government would keep up its end of the bargain to pay for the expansion.

“Rather than simply expanding these rapidly growing and unsustainable programs, we should reform health care to pay for quality, rather than volume of procedures, and look for ways to provide additional access through the private market,” he said in a statement.

But Pawlenty overlooked $1.4 billion in federal tax dollars that would come Minnesota’s way over those three years, and the fact that the state would save money by simultaneously reducing its spending on GAMC, said Rep. Tom Huntley, DFL-Duluth.

Huntley, who heads the House Health and Human Services Finance Division, was one of the lawmakers unsuccessfully hoping to convince Pawlenty to take the early Medicaid opt-in. He said the true cost to the state would have been $188 million a year, money that was already set aside in a final budget deal this spring.

As a result, Minnesota is “losing $875,000 per day, starting in July,” by not getting the increased federal Medicaid payments, Huntley said. Meanwhile, Minnesotans such as Micklick are getting by with reduced care, as only four hospitals in the state — all in the Twin Cities — have signed on to accept GAMC patients for treatment.

People on GAMC come to Schneider Drug in Minneapolis for advice, information and help as well as for their prescriptions, said Joel Albers, a pharmacist there and activist with the Universal Health Care Action Network of Minnesota.

They’ve also come for candidate forums on health care at which all three DFL candidates for governor — Mark Dayton, Matt Entenza and Margaret Anderson Kelliher — or their representatives have pledged to sign the Medicaid expansion as soon as they take office, if elected, he said.

Likely Independence Party candidate Tom Horner has also said he would approve the Medicaid expansion, while Republican endorsee Tom Emmer has said repeatedly that he would reject the expansion, calling it “Obamacare.”

Albers and others set up a free clinic outside Pawlenty’s office at the Capitol to drive home the point that people are going untreated because of the GAMC compromise, and Albers said he supports the early Medicaid expansion, but it’s not enough.

“All public health, GAMC, Medicaid, MInnesotaCare, state employees, the high risk pool, all public programs should be rolled into one,” he said. “Then add the entire private sector to the pool eventually and we’d have everybody covered and save $7 billion.”

Albers is talking about the Minnesota Health Plan, a single-payer health insurance reform bill championed by Sen. John Marty, DFL-Roseville for the past three years.

Marty, who unsuccessfully sought the DFL endorsement for governor this spring with the Minnesota Health Plan as a key campaign issue, succeeded in getting Kelliher, who won the endorsement, to pledge her support for the bill at the state convention.

Dayton has also said he would support the bill, which received 74 legislative co-authors this year but failed to make headway.

“The insurance companies don’t like it, the pharmaceutical companies don’t like it, no state has ever passed it,” said Marty, who has heard all the reasons why some DFLers, including Huntley and Entenza, have balked at supporting such a comprehensive change to the health insurance system.

“But like with the federal health care reform, as people come to see what they’re getting, it starts to be less scary and they’re beginning to see the benefits of it,” Marty said. “People wouldn’t have to fight the insurance companies for treatment, because it would require care for all. And it leaves the decisions to the patients and their doctors, who they are still free to choose.”

Marty said he supports the early Medicaid opt-in as well, because it will take time to conduct a cost study on the Minnesota Health Plan to give people a better sense of how it would work, before the Legislature would be comfortable passing it.

That puts Marty and Minnesota Hospital Association President Lawrence Massa on the same side of at least one issue. Massa said his organization doesn’t support Marty’s single-payer insurance plan, but he and Minnesota Medical Association President Robert K. Meiches, recently penned an opinion column in the Star Tribune calling on Pawlenty, or his successor, to take the early Medicaid expansion opt-in.

The GAMC fix is not working and will not work because it cut too much funding and put too much financial risk on hospitals, Massa said in an interview.

“I think it’s only going to get worse. We’ll be hearing more and more stories of people falling through the cracks,” he said. “It’s a no-win situation for the population served by GAMC, and a no-win situation for the provider community.”

Massa said his organization is spending significant time lobbying gubernatorial and legislative candidates to support the Medicaid expansion, and that the group will do issue advocacy work in the coming campaign.

“This is a big issue for Minnesotans,” he said.

It’s a big issue for Micklick, who said he’s applying for MinnesotaCare this fall, a more expensive state insurance program aimed at uninsured working Minnesotans.

“I was receiving care here, I had a regular psychiatrist, a family doctor, and now everything’s changed,” he said. “If it wasn’t for my mom driving up here, I’d have to get my prescriptions filled at the emergency room. And I don’t think I’m ever going to get to see a specialist about my knees while I’m on GAMC.”