Can some form of General Assistance Medical Care be saved? That was the question debated this afternoon at a joint session of two House committees dealing with health care.
Gov. Tim Pawlenty eliminated funding for GAMC as part of his solution to a $2.7 billion budget deficit for the current biennium. The program’s slated to disappear as of March 1, 2010. It covers more than 70,000 individuals each year whose annual income is less than 75 percent of the federal poverty rate ($7,800). Roughly 80 percent of those enrolled in the program are dealing with mental illness and chemical dependency problems.
The Pawlenty administration’s plan for individuals currently enrolled in the doomed program: Roll them into MinnesotaCare, the state’s much larger subsidized health-care program. Minnesota Human Services Commissioner Cal Ludeman told legislators at the hearing that he expects approximately 28,000 individuals to transition into MinnesotaCare on March 1. “Our goal is to transition GAMC clients as seamlessly as possible,” he said.
But Democrats pointed out that the state’s Health Care Access Fund, which pays for MinnesotaCare, would quickly go bankrupt if saddled with additional enrollees over the long term. Rep. Thomas Huntley, DFL-Duluth, chair of the Health Care and Human Services Finance Division, argued that people with jobs that don’t provide insurance would eventually have to be kicked off the rolls. “MinnesotaCare was intended to be for working people in this state who don’t get health insurance where they work,” he noted.
Democrats have developed their own proposal for salvaging GAMC through a combination of eligibility changes and revenue increases. The proposal would raise between $225 and $290 million to continue providing services for the bulk of individuals currently covered by GAMC. The biggest share of the money, roughly $160 million annually, would come from higher surcharges on hospitals and HMOs. But the Democratic plan would also eliminate coverage for pregnant women (who are eligible for federal medical assistance) and jail inmates.
Rep. Erin Murphy, DFL-St. Paul, who introduced the legislation, described it as a work in progress. She noted that Democrats are still waiting on feedback from the Department of Human Services on exactly how much the proposal would cost.
“Minnesota is in a unique time,” Murphy said at the hearing. “We are short on resources in Minnesota, but we are rich in conscience.”
Rep. Matt Dean, R-Dellwood, offered his own legislation consistent with Pawlenty’s plan to absorb GAMC clients into MinnesotaCare. Among other things, his proposal would require a census of all individuals who have been enrolled in GAMC over the last three years. The purpose: to find out how many might be eligible for other programs.
“It’s a very difficult group to cover,” said Dean, noting the high rates of mental illness among GAMC clients. “They tend to be a group of patients that’s very difficult to monitor.”
It’s doubtful that any solution will fully satisfy health care providers and advocates for people who rely on GAMC for health coverage. That’s because any legislative compromise will likely include some combination of eligibility reductions and increased revenue.
Mike Opat, chair of the Hennepin County Board of Commissioners, warned of devastating effects on Hennepin County Medical Center if GAMC is completely eliminated. He noted that 40 percent of the insurance program’s enrollees live in Hennepin County and that the hospital receives roughly $50 million annually through GAMC.
“Find the ways and means to maintain coverage for the poorest of the poor,” Opat insisted. “There is a difference between health care standards worthy of Minnesota and stepping over people on the street.”