Who are we asking to fix the state budget deficit?

Recently I was interviewed by Minnesota Public Radio for a story on the cuts to General Assistance Medical Care (GAMC). It was broadcast and posted on their website the same day the most recent forecast of the state budget deficit was released. The timing was appropriate as these stories are obviously related.

GAMC was unallotted by Governor Pawlenty at the end of the 2009 legislative session. GAMC provides medical care for poor adults without children. In 2008, 26,227 people in Hennepin County were enrolled in GAMC and 70% (about 18,000) of those enrollees lived in Minneapolis. The program remains in statute but unless the legislature finds a way to refund it this session, some 35,000 of the poorest Minnesotans will be without medical care.

To help these people get medical care, the state will transfer GAMC enrollees onto MinnesotaCare and counties will need to pay the monthly premium (approximately $5) until people re-enroll – a cost of $600,000 for Hennepin County alone. Unfortunately, 28% of GAMC enrollees are homeless making it nearly impossible to ensure they’re enrolled or able to pay their premium if they are. Also, it doesn’t offer immediate coverage as GAMC did for uninsured patients who seek care at a hospital emergency room. Therefore, hospitals will absorb cost for uncompensated care. And if people are enrolled, MinnesotaCare has a $10,000 annual cap on hospitalizations. We all know how quickly this cap could be reached which would again force hospitals to absorb the cost.

I know the state is faced with difficult decisions right now in trying to balance the books as we emerge from one of the worst economic downturns since the Great Depression. I do not expect anyone to go unscathed when it comes to budget cuts. I understand that we are all expected to brace ourselves for the worst and work together to emerge from the situation as quickly as possible and hopefully, economically stronger than we were before.

What I don’t understand is why we are asking the poorest of the poor to shoulder this burden. Continuing to refuse tax increases, the responsibility of state budget balancing has simply and systematically been transferred to cities and counties and then, in this case, on to a population in greatest need. With this particular cut, urban safety net hospitals like Hennepin County Medical Center are being asked to absorb costs or turn people away.

Just as irresponsible is the belief that this will decrease costs. There are public safety concerns when someone is forced to go without anti-psychotic medications. Resources are stretched dangerously thin when police are expected to provide crisis intervention in the back of a squad car for people who have no place else to go. When people don’t have medical care, services aren’t delivered until it’s an emergency with astronomical costs. Homeless shelters will be forced to say no to an influx of requests for help with buying medications. The ripple effect of this budget cut are sure to be even more dangerous and significant than we can imagine. Unforeseen consequences will be just as costly, if not more so, than the original allotment of funds for GAMC.

Yesterday a bipartisan leadership panel was hosted by the Cities United Way to discuss the “New Face of the Uninsured.” Panelists acknowledged that it will take partnerships across party lines and with the governor to find a solution to this unallotment. Perhaps if that had been the approach in the first place, we wouldn’t be scrambling now to ensure that some of our City’s residents most in need continue to have medical care.

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