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Enrollees tell legislators about their need for a GAMC funding solution

One by one today, Minnesotans in a state health-care program for the poor outlined what will happen if coverage goes away or if they’re switched to MinnesotaCare.

One by one today, several enrollees in a state health-care program for the poor outlined for legislators what will happen if coverage goes away or if they are switched to premium-based MinnesotaCare on March 1.

Some said they had college degrees and at one time held jobs with employer-paid insurance. Some lost their jobs in economic downturns; others lost their jobs and insurance after becoming ill.
Franklin King, who has been unable to work because of incurable prostate cancer, said the four $3,000 injections he gets a year are keeping him alive. David Skulborstad, who grew up two blocks from the Capitol in St. Paul, said the hospital bill for repairing his leg after he shattered it on ice was $47,000. Trixy Weddig said she doesn’t know how she’ll manage to pay rent, MinnesotaCare premiums and co-pays on $203 a month she receives from General Assistance.

They spoke at a joint meeting of the state Senate’s Health, Family and Human Services Committee and the Health and Human Services Budget Division. (Video of the hearing can be found here.) Although the Legislature does not convene until Feb. 4, legislators have been trying to get a jump-start on a fix for the General Assistance Medical Care (GAMC) program. DFL senators and representatives announced in December a temporary 16-month solution, which would restore part of the funding.

Funding runs out March 1
If no solution is passed by the Legislature and signed by the governor, funding for GAMC, which covers up to as many as 70,000 people in a year, will run out March 1. Last May, Gov. Tim Pawlenty used his line-item veto to strike $381 million in 2009-2010 funding for GAMC and unallotted an additional $15 million.

Although the Department of Human Services plans to move enrollees to MinnesotaCare, some legislators and GAMC’s many stakeholders say it isn’t a good fit for transient people who make little more than $200 a month. MinnesotaCare also has a $10,000 annual cap on hospitalization.

“How would the governor feel if he had a loved one who got cancer and got his medical care cut?” said King, who once worked as a county social worker.

Monica Nilsson, president of the Minnesota Coalition for the Homeless who introduced King and other enrollees, placed stacks of thick envelopes on the witness table to illustrate why she doesn’t think MinnesotaCare will work for her clients at St. Stephen’s Human Services. The mailings, which include insurance cards for GAMC enrollees, never reached their recipients because “they’re on the streets,” Nilsson said. Each envelope, she said, also represents a $1,000 monthly payment from the state to a health insurance plan.

Care management under a health plan isn’t working for the homeless population, said Nilsson, who tries to get health services for ailing clients and shuttles them to providers. “The reality is that care management … is my Blackberry … and transportation is my Jetta.”

The future of GAMC has united a broad group of stakeholders across faiths, labor, health-care providers, advocates for the poor, and police departments worried about the impact of homeless people going without medication for mental illness.

Police Chief Dolan’s view
Minneapolis Police Chief Tim Dolan asked senators to “try their hardest to make sure” the funding gap is filled between March 1 and federal plans to expand Medicaid down the line. “This program is working well for this population.”

Chief Tim Dolan
Chief Tim Dolan

DFL Sen. Linda Berglin, a co-author of the proposal to restore GAMC, thanked enrollees for testifying. “I know it’s not easy to tell your stories in front of legislators,” said Berglin, chair of the Health and Human Services Budget Division. “Stay with us. We’re going to walk this journey with you, and we’re going to win.”

Sen. Paul Koering, R-Fort Ripley, brought up the state’s cash-flow problem and competing interests such as colleges and universities in need of funding. He also came to Pawlenty’s defense. “It’s easy to beat up on the governor, but … he’s a very compassionate man … trying to do his best,” he said, noting a few laughs in the crowd. “Please don’t vilify the people who are trying to do their jobs.”

During the three-hour hearing, Pawlenty took some hits for an apparent disconnect between his oft-stated desire to help war veterans and his cuts to GAMC, which serves some veterans who don’t qualify for full benefits from the Veterans Administration.

Later in the hearing, DFL Sen. John Marty, chair of the Health, Family and Human Services Committee, said he doubted that veterans who testified today about the loss of GAMC “would call Minnesota a veteran-friendly state.”

A work in progress
In laying out the provisions in the DFL proposal, Berglin said it was a work in progress. “I would hardly characterize this as the perfect solution,” she said.

The proposal includes 50 percent cuts in payments for inpatient services, a temporary surcharge on hospitals and a 10 percent share from counties. Already, outstate providers and lawmakers are expressing worries that Twin Cities providers will get a better deal because they serve the largest concentration of GAMC patients.

But Art Gonzalez, chief executive officer of Hennepin County Medical Center, said the safety-net hospital’s break-even budget will be short $37 million under the proposals.

Mary Krinkie of the Minnesota Hospital Association said the group was doing something it rarely does: endorsing “significant” cuts in payments to its constituents. The association also endorses a “shared pain, shared responsibility” approach, she said.