Every week since a gubernatorial veto handed a death sentence to General Assistance Medical Care (GAMC), the state's health care program for Minnesota's poorest citizens, St. Paul's Regions Hospital has been telling the stories of GAMC recipients.
E-mails from Regions' CEO Brock Nelson have introduced Bob, 61, an uninsured driver who had a heart attack behind the wheel and ran up $192,000 in medical bills. And Andrew, 44, a low-wage worker with no insurance benefits. When he was diagnosed with leukemia, he lost his job and quickly ran up a $135,000 bill. And Tom, 55, a homeless man whose leg swelled dangerously after a few weeks of living in his car. Treatment for a deep-vein blood clot came to $100,000.
Bob, Andrew and Tom's huge hospital bills are covered for now, thanks to GAMC, which pays the medical and prescription-drug bills of Minnesotans with incomes of less than $7,800 per year. But a veto by Gov. Tim Pawlenty in May, and a subsequent unallotment, slated GAMC for elimination on March 1.
Earlier this month, the Pawlenty administration announced that Bob, Andrew, Tom and about 28,000 other GAMC recipients will be automatically enrolled in MinnesotaCare, the state's subsidized insurance program for the working poor. For up to six months, their premiums, about $5 per month, will be covered by the county in which they reside. After that period, the former GAMC recipients will need to pay their own premiums, plus copayments for medical treatment.
That's a reasonable move for some GAMC clients. MinnesotaCare might serve Bob, Andrew and Tom fairly well, if their conditions and lifestyles stabilize enough for them to cover these costs.
But if Bob has another heart attack, or Tom another blood clot, they'll be back at Regions. MinnesotaCare will pay only the first $10,000 of their inpatient bills. For the rest, the patient and the hospital are on their own.
The same goes for the uninsured, low-income patients who appear in hospital emergency rooms after March 1. They too can enroll in MinnesotaCare. But a four-month waiting period will elapse before coverage begins. Hospitals and patients will be on the hook for costs that accrue during that four-month interval.
Those MinnesotaCare shortcomings are why Region's Hospital called Pawlenty's move "an appropriate administrative response to the current situation." But, the hospital added, "It is not a solution to the elimination of GAMC."
What's more, taking on the costs of the GAMC population for more than a few months will put MinnesotaCare itself in jeopardy. The fund earmarked for MinnesotaCare could fall into the red as soon as 18 months from now, according to one legislative analysis, if the needy people now covered by GAMC are added to its rolls.
That's why the Pawlenty administration's move to enroll GAMC clients in MinnesotaCare ought to be seen as a stopgap measure, not a permanent fix. It preserves the needy's access to clinical care and medication for at least a few months more. Those months ought not be wasted by policymakers.
The 2010 Legislature should not adjourn without finding a way to provide health care to the poor that's affordable for both them and the hospitals that serve them. Ideas are surfacing that involve asking hospitals to provide some charity care, but capping the amount; pooling hospital resources, so that Regions and Hennepin County Medical Center don't bear a disproportionate burden; and stepped-up efforts to keep chronically ill poor people out of hospitals and enrolled in other health care programs.
Pawlenty said he zeroed out GAMC's funding because its $350 million annual cost is excessive, and growing too rapidly. That criticism is warranted. But his action obliges him to participate in finding a more cost-effective, lasting alternative. Though his MinnesotaCare move is helpful, he should keep looking.
