The state of Minnesota left $1.4 billion on the table, which would have helped the state's budget woes.
That's the way Sen. Mary Olson, DFL-Bemidji, sees the end of the 2010 legislative session, as Republican Gov. Tim Pawlenty refused to accelerate poor childless Minnesotans into the federal Medicaid program.
Olson, a member of a Senate health care panel, plans to work over the interim on how Minnesota will implement federal health care reform.
"We have a menu of options the states have been given under the federal health care reform that passed," Olson said in an interview. "It's really going to make a difference in the way health care is delivered in this state for several generations, and it will be impacted by decisions we'll be making over the next couple of years in terms of which of those options we select."
It's one of several issues Olson plans to work on in the interim -- before the 2011 session. There's an election in between, but Olson says she's the district's elected senator until January, and she'll either continue at that point or turn her work over to her successor.
"I want to make sure a rural perspective is at the table and that we don't just have metro-area legislators making those decisions," Olson said.
If there is a task force formed, she wants to make sure it is broad enough to represent all of Minnesota, not just DFL leadership that makes the recommendations.
"We want either an expanded health care transformation task force where we have a vote at that table, or we want regular committee meetings where the whole committee is meeting and looking at these things over the interim," Olson said. "If that means we have to spend more time working on that and less time campaigning, most of us have said we'd rather do that."
Legislators had hoped to help balance the state budget by enrolling former General Assistance Medical Care patients into an enhanced federal Medicaid program that requires a 50/50 match. Spending $180 million in state dollars would bring $1.4 billion in federal monies.
"We discussed in our caucus what would the governor want that we could negotiate," Olson said. "Frankly, he didn't want anything. His attention is really not engaged with our state. His staff people gave us a message that the governor really wasn't interested in negotiating."
Olson says she was "very disappointed" in the final budget-balancing bill and voted against it.
"It just pushed the problems down the road by a so-called shift in payments to education," she said. "It's money that won't be coming to our school districts when we have no means in the foreseeable future of repaying that money."
By accelerating payments to the state and delaying payments to others, Olson said it's like a household that goes deeper into debt until they have to file a personal bankruptcy.
"You haven't really changed the circumstances that are going to put you back on a firmer foundation financially," she said.
Olson voted for an earlier budget bill that still shifted school payments into the future, but the trade-off was a formula change in reimbursements to hospitals and the enhanced Medicaid provision that would have meant $5 million more a year to North Country Regional Hospital.
Those provisions were dropped from the final bill.
"We'll never get that money back again, even if a new governor decides in the future to go forward with these two separate federal health care programs," Olson said. "That translates into a lot of jobs in our area. It translates into higher medical health insurance premiums because the loss of those dollars has to be spread around, requiring everyone else to pay more."
Some areas of care at NCRH might not be available anymore, she said.
Moving into the federal program makes sense, she said, but Republicans "just decided they were going to be against this on principle, and Gov. Pawlenty wasn't going to agree to something that when he's thinking about trying to have support from that group at the national level that they were opposed to."
That doesn't make sense, she said, as it only amounts to a better payment structure for Minnesota of an existing federal health care program. Surcharges used to raise the state's match have nothing to do with the federal health care program that Republicans oppose, she added.
"That this is going to be a government-run health program has been a red herring from the beginning," she said.
"The Republican Party, led by Gov. Pawlenty, has not been willing to make honest budgeting decisions," Olson said. "They were locked into a platform of no new taxes and yet at the same time they've been unwilling to vote for the budget cuts and to face taxpayers who would feel the impact on their lives that would be created if we actually had budget cuts that would honestly our state's budget in line with the revenue we have coming in."
The DFL-led Legislature voted two or three times on Pawlenty's proposed budget cuts, but Republicans would not vote for those cuts, she said. "They would have not only led to huge property tax increases, but they would have led to increased costs in other areas of people's financial budgets."
One of Pawlenty's cuts was to reimbursement rates to nursing homes, which Olson if enacted would put many rural nursing homes out of business. To help alleviate that, Pawlenty also proposed repealing the law that says private pay residents pay the same rate as publicly subsidized patients.
Estimates are that doing that would raise the cost to private-pay nursing home residents by $20,000 a year or more, she said.
"You're basically just putting people in the poorhouse that much sooner," she said.
Olson said Pawlenty probably knew such proposals would not be accepted, yet that's what he used to balance the budget.
A bill Olson carried to create a task force to study the merger of environmental agencies stalled in the House, but Olson said the Senate may be able to appoint that task force anyway, chaired by Olson, which will work over the interim.
"It would look at natural resources reorganization and realignment," she said. "We're certainly going to need ideas next session about ways to tackle a huge budget deficit. ... Whether we move forward with this on our own, or we move forward with someone from the House, either way we're going to work on this."
As chairwoman of the Senate Data Practices Subcommittee, Olson also plans interim work on how law enforcement categories investigative data. Law enforcement wants to create a third category -- beyond public and non-public -- that is neither.
It's an issue at the federal level and among states in response to national security issues, she said. "It really would implicate how we handle all criminal investigative data."
Olson will lead a Senate task force on the issue over the interim.
Olson is also a member of the legislative pensions committee, and that also plans meetings over the summer.