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Minnesota House: GAMC solution draining rural hospitals

Local health care providers told members of the House Health Care and Human Services Finance Division how rural health care is managing under newly passed legislation that results in patients under the former General Assistance Medical Care program having to travel to a Twin Cities hospital for treatment. From left are panel members Rep. Erin Murphy, DFL-St. Paul, and Chairman Tom Huntley, DFL-Duluth, and Reps. John Persell, DFL-Bemidji, and Brita Sailer, DFL-Park Rapids. Pioneer Photo/Monte Draper

Democrats on a House health care panel remain convinced, after hearing from Bemidji health care providers Friday, that Minnesota must join early federal Medicaid enrollment.

Gov. Tim Pawlenty vetoed a bill that would have Minnesota join an enhanced Medicaid program, which would have the state paying $188 million but gaining $1.4 billion in federal Medicaid funds over 3½ years. Former General Assistance Medical Care patients would be served under that program.

Barring that, the DFL-controlled Legislature provided that Pawlenty or the next governor can sign an executive order to do the same. Pawlenty has said he won't sign it.

Members of the House Health Care and Human Services Finance Division heard that patients under the former GAMC program are suffering hardships because of the law that did win Pawlenty's approval.

Funding was set up to help reimburse hospitals which provide care for GAMC patients. But because reimbursement formula changes didn't come with it, only four metro-area hospitals are participating, forcing former GAMC patients from rural Minnesota to travel to those hospitals or receive emergency room treatment.

The program took effect June 1.

Since then to mid-July, North Country Regional Hospital has seen 222 former GAMC patients in its emergency room, costing $600,000 in uncompensated care, said NCRH's John Bergquist.

"We passed a fairly decent bill," said panel Chairman Tom Huntley, DFL-Duluth, in an interview. "It got 125 votes of 134 member, and the governor vetoed it. ... We ultimately came up with what is not a good bill; it was better than nothing because it does get some money out, but most of it is going to the metro area."

GAMC patients "are the sickest of the sick, poorest of the poor," he said. It affects single adults at 75 percent or less of the federal poverty level, or $8,123.

"These are folks who cannot work because of their illness status," Huntley said. "They won't get the kind of care they need, particularly in this part of the state."

Huntley told of the case of a mother in Austin driving up to Duluth to take her son with both mental health and physical problems to the Twin Cities for treatment and then home again to Duluth before going home herself to Austin.

"It's just not working," he said.

About a dozen local providers told the panel similar stories, and also about what isn't covered under the new bill with GAMC no longer operating. A person covered for chemotherapy under GAMC is no longer covered so treatment stopped. The new program doesn't cover dental work, so some people needing surgery are unable to get it because they can't clear a tooth infection.

"If they are taking their meds and doing what their supposed to be doing, they're never really going to get really better or be cured, but they can live with their disease if they get the primary care upfront," Huntley said. "If they just wait till they show up in the emergency room, that costs a lot of money and really does nothing to improve their health status,"

"That money is there, it is committed, it's in the budget, and it will be coming to the state of Minnesota," he said of the $1.4 billion in federal funds that would flow to Minnesota if the next governor enrolls Minnesota. Eleven states have been invited to do so, but only one has signed up.

"If we ask for it," he added.

Of the four hospitals in the program, one is no longer taking former GAMC patients and two others are within a week or two of reaching their pre-set caps on the number of former GAMC patients they'd take. That would leave Hennepin County Medical Center as the sole provider for rural GAMC services, said Rep. Erin Murphy, DFL-St. Paul.

"We're asking rural hospitals to take care of these people (in emergency rooms) but we don't have any money to pay you," she said. "That should not be the policy of the state."

"This is not the route the Legislature wanted to go down," added Sen. Mary Olson, DFL-Bemidji.

"It is not fair to me to have to health care systems in Minnesota, one rural an done metro," said House Majority Leader Tony Sertich, DFL-Chisholm, not a panel member but was in Bemidji on Friday as well.

"It seems like we're trying to save money on the front end but spending lots more on the other end," Sertich said.

The Democrats hope to cobble the system together until January, when the new governor enrolls Minnesota into the Medicaid program, provided it is Democrat Mark Dayton.

Jeanne Edevold Larson, executive director of the Northern Dental Access Center, asked if it was such a good idea to enroll Minnesota and get $1.4 billion, then why wasn't it done.

"The federal government is broke," said Rep. Matt Dean of Dellwood, the lead human services Republican on the panel. "Tax dollars are paying for these programs 100 percent, and we have to borrow to pay for two wars. ... The federal government can't pay us the money it owes us today."

Plus, Dean said, the cost of the $1.4 billion is closer to $430 million -- a number Huntley disputes with $188 million -- "and we simply can't afford it with a $6 billion deficit."

And while 11 states and Minnesota have been invited to early enroll, only one state has done so, Dean said.

Maintenance of effort laws also require that benefits be paid at the same level even if the federal funding disappeared, he added."If the federal government comes up short, we still have to pay with state dollars."

He suggested the health care funding won't be around long, "as 56 percent of the people don't want Obamacare," Dean said.

The state would do better on its own and in seeking federal grants without strings attached, the Republican said.

But the current program isn't working, Huntley said, with people needing care still needing care.

"They are seriously ill and can't work," he said. "They live in our communities and neighborhoods. What do we do? Put them out on the street? Or allow the health care community to take care of them.

"That's not the best and most efficient way, as we still must pay for these people," Huntley added. "Somebody will pay."