Health care law quagmire

Unsustainable or part of the budget-balancing solution?

Such was the dilemma faced by supporters and opponents of the omnibus health and human services finance law.

Gov. Tim Pawlenty line-item vetoed $381 million in funding for the state’s General Assistance Medical Care, which assists some of the state’s poorest residents.

An attempted override failed in the House on an 87-47 party-line vote.

Recipients of the state’s publicly funded health program are adults between ages 21-64 who have no children and make less than $7,800 per year. Rep. Thomas Huntley (DFL-Duluth), who sponsors the law with Sen. Linda Berglin (DFL-Mpls), said of the approximately 35,000 on GAMC, many have mental illness, severe physical disabilities or chronic conditions to the point that they can’t work on a regular basis; therefore, they receive state health care at no cost to them.

While some will qualify for MinnesotaCare, a different public program, opponents say many of those on GMAC do not have the mental capacity to maintain eligibility or the finances to make payments MinnesotaCare requires.

Yet, veto supporters say health care costs continue to rise at an unsustainable rate the state can’t afford, and can’t fund when the state’s Health Care Access Fund runs out of money, which it’s projected to do in the future. Rep. Steve Gottwalt (R-St. Cloud) said the state is already unable to pay market rates to hospitals and providers for services they provide to those on GAMC, and the costs that shift to the rest of the state are “bankrupting our health care system.” They also note the cut does not take effect until fiscal year 2011.

But opponents argue costs will increase in the long run when those dropped from GAMC show up in emergency rooms in worse conditions.

“The impact of this item veto and related, anticipated unallotments will not occur immediately. As a result, the legislature will have an opportunity to address this change further if it chooses,” the governor wrote in his veto message. He urged legislators “to continue working next session to slow the growth in the state’s human services spending.”

Other provisions

The law, mostly effective July 1, 2009, implements a 3 percent cut to Medical Assistance and GAMC providers, but it does not cut primary care providers such as pediatricians, family practice physicians and general internal medicine.

“Every one of these cuts is painful and will hurt somebody,” Huntley said. “We tried to minimize the damage best we could.”

“There was tremendous pressure on us to protect hospitals,” Huntley said, noting the 3 percent cut to hospitals is 1/17th of what the governor wanted. Many of them are “in the red,” and the governor’s proposal would have put more of them in the red, he added.

Specialists are cut by about 5 percent in the law. While the cuts will hurt, it’s a push to help change the way the state provides medical care and move toward managing chronic diseases through primary care providers instead, Huntley said.

Other spending reductions include delayed rebasing for nursing homes; a 2.58 percent cut to long-term care facilities; reducing public assistance dental services; and limiting personal care attendant hours to 310 per month/per individual.

A personal care attendant recipient must need help with at least one activity of daily living — dressing, grooming, bathing and toileting — to qualify for public assistance. The governor’s proposal required at least two activities of daily living to be needed for services.

The disability community services comprise about 29 percent of the state health and human services budget, and were cut by that percent.

Money is invested to meet the federal Children’s Health Insurance Program Reauthorization Act of 2009 that could result in an additional $20 million to increase the number of children on public health insurance by easing the enrollment process, said Huntley.

The change will add an additional 22,000 children to MinnesotaCare, but they are children that already qualify but for some reason are not on the program, he said.

Another $4 million is invested to meet provisions of, and receive funding from, the federal Health Information Technology for Economic and Clinical Health Act that is designed to help the state convert health records to electronic form.

A Steering Committee on Performance and Outcome Reforms is established in the law to develop a review process for essential human services programs. The committee is to develop reporting and accountability measures to respond to a county or human service authority that is not achieving performance measures.