GAMC “Fix” is Needed

Written by Jeff Johnson on February 16, 2010. Posted in General

Cost of Healthcare for the Indigent is Falling Disproportionately on Hennepin County Taxpayers

We’ve heard a lot of talk over the past few months about the scheduled elimination of the General Assistance Medical Care (“GAMC”) program. GAMC is a state program providing health care coverage to the very poor in Minnesota who are not covered by other state or federal programs. GAMC served over 35,000 Minnesotans in 2009, many of them mentally ill, disabled or chemically dependent.

Governor Pawlenty unalotted GAMC last year after proposing reforms to the program that the legislature failed to consider. Funding for the program is scheduled to end on April 1, 2010.

The largest percentage of GAMC patients in Minnesota use Hennepin County Medical Center (“HCMC”) for their care. HCMC is a public safety-net hospital that is subsidized by the taxpayers of Hennepin County. If the Governor and legislature do not find a way to restore a part of GAMC funding this session, HCMC will receive about $43 million less in state funding in 2010 than it did in 2009.

The Hennepin County Board has already promised $18 million of taxpayer money from the 2010 property tax increase to fill part of that hole. HCMC plans changes in its service delivery and operations to fill another portion. There will still, however, be a gap.

In 2009, prior to the elimination of GAMC, Hennepin County taxpayers contributed about $32 million to HCMC for an operating deficit based on people who received health care but could not or did not pay, known as “uncompensated care.” The $18 million in 2010 is expected to be in addition to that same approximate amount for uncompensated care, so over $50 million from the taxpayers of Hennepin County to HCMC to cover healthcare for the poor. That, by the way, is supplemented by several million more in tax dollars for capital projects over the past few years.

Some of the GAMC patients served by HCMC come from other counties to receive free or subsidized medical care. This presents a very significant problem: Without some sort of GAMC “fix”, Hennepin County taxpayers will be footing a very inordinate share of the bill to provide health care to the indigent throughout the state of Minnesota.

Of course, some of us would argue that Hennepin County taxpayers were already footing an inordinate share of the bill even prior to GAMC elimination with our annual contribution to uncompensated care, but now the inequity will be magnified even more.

As an aside, HCMC also provides free services to people from outside of Minnesota (and, yes, even to illegal immigrants), but that is a topic for a different post.

The immediate issue: The legislature and Governor must find a way to provide some relief to safety net hospitals after the elimination of GAMC.

I don’t advocate just reinstating GAMC as it existed. Everyone but the most naïve in St. Paul recognized long ago that the GAMC program (one of the most generous in the nation) could not be financially sustained long-term. There was serious talk of elimination of the program as far back as 2002, when I was in the legislature.

I also don’t subscribe to the strategy of simply trashing Governor Pawlenty at every turn and proposing a “fix” that we know he won’t sign (which has at times seemed like the favored plan of some in county government).

Pawlenty made a difficult decision last year to eliminate GAMC after watching the legislature play games for over four months. There was little or no interest on the part of the legislature to come to a mutual agreement on budget issues, including reform of GAMC. Left with the options of calling a special session – which would likely have lasted months and accomplished little – or balancing the budget himself, he chose the latter. Most of us would argue that it was not the preferred method of governance, but it was probably the best option available.

And now, we have a problem. It requires a solution upon which the DFL legislature and the Republican Governor must agree – which is why I’ve been surprised in the past that our strategy on the Hennepin County Board seems to include repeated attacks on a Governor whose help we need.

I don’t have the answer. Sen. Linda Berglin has a proposal that at least partially makes sense. Rep. Matt Dean has a bill that deserves consideration. And, of course, there’s always that crazy concept of funding this priority by cutting something else that’s less important.

Bottom Line: One basic function of government (at least in my opinion) is to provide help to those who are most vulnerable in our society – including the physically and developmentally disabled and the mentally ill. It should not, however, fall on the backs of the Hennepin County taxpayer to support that function of government for the entire state.

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