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At Issue: More compromise, more reductions

Published (5/15/2009)
By Patty Ostberg
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Co-chairs Rep. Thomas Huntley and Sen. Linda Berglin confer during the May 12 omnibus health and human services finance conference committee meeting. (Photo by Andrew VonBank)Rep. Thomas Huntley (DFL-Duluth) said there are “500 million reasons to vote against it,” referencing the monetary cuts in the omnibus health and human services finance bill conference committee report. Passed 80-51 by the House May 11, and 47-18 by the Senate, it now goes to the governor. Sen. Linda Berglin (DFL-Mpls) is the Senate sponsor.

When combined with a 7 percent ($600 million) target below the forecast for the biennium, and an estimated $90 million loss for health care providers in federal money, Huntley said HF1362*/SF695 adds up to a more than a $1 billion hit. He said Gov. Tim Pawlenty sought a $1.5 billion cut that would have cost providers $3.5 billion.

“Every one of these cuts is painful and will hurt somebody,” Huntley said. “We tried to minimize the damage best we could.”

Rep. Paul Kohls (R-Victoria) said the report is deceiving because the cuts are actually reductions from previously proposed increases. He said the bill increases spending by approximately 20 percent from the current biennium.

Cuts and investments

The report calls for a 3 percent cut to providers of Medical Assistance and other programs, but it does not cut primary care providers such as pediatricians, family practice physicians and general internal medicine.

“There was tremendous pressure on us to protect hospitals,” Huntley said, noting the 3 percent cut to hospitals is 1/17th of what the governor wanted. Many of them are “in the red,” and the governor’s proposal would have put more of them in the red, he added.

Specialists would be cut by about 5 percent in the bill. While the cuts will hurt, it’s a push to help change the way the state provides medical care and move things toward managing chronic diseases through primary care providers, Huntley said.

Other spending reductions include delayed rebasing for nursing homes; a 2.58 percent cut to long-term care facilities; reducing public assistance dental services; and limiting personal care attendant hours to 310 per month/per individual.

A personal care attendant recipient must need help with at least one activity of daily living to qualify for public assistance. The governor’s proposal required at least two activities of daily living to be needed for services. Activities of daily living include helping dress, groom, bathe and toileting.

The disability community services comprise about 29 percent of the state health and human services budget, and were cut by that percent, Huntley said.

Money would be invested to meet the federal Children’s Health Insurance Program Reauthorization Act of 2009 that could result in an additional $20 million to increase the number of children on public health insurance by easing the enrollment process, said Huntley.

It would add an additional 22,000 children to MinnesotaCare, but they are children that already qualify but for some reason are not on the program, he said.

Another $4 million would be invested to meet provisions of, and receive funding from, the federal Health Information Technology for Economic and Clinical Health Act that is designed to help the state convert health records to electronic form.

In an effort to get a jump start on a second proposal should the governor veto the first, the omnibus health and human services finance conference committee took more public testimony May 12-13 on more potential human services cuts.

Huntley and Berglin presented a proposal to cut an additional $400 million from the omnibus health and human services finance bill. “(It is) what we need to do if we don’t get some additional revenue to balance the budget,” Berglin said. The cuts would come from up to 25 percent additional rate reductions to long-term care facilities, nursing homes and inpatient hospital reimbursement rates.

Making severe cuts to hospitals could cause some of them to go out of business. It’s like a dangerous game of Jenga, said Cathy Barr, chief executive officer for Bethesda Hospital in St. Paul. “If you take Bethesda out of the stack, what will happen?” The specialty hospital supports some of the most vulnerable in the state.

Mary Krinkie, vice president of the Minnesota Hospital Association, said an additional cut would make a dramatic difference in the types of services hospitals would be able to provide. Hospitals would have cut services such as mental health, dialysis and obstetric services, limit hours and operations for emergency rooms, and reduce services to the 60 nursing homes attached to hospitals in the state, she said.

— Assistant Editor Mike Cook contributed to this story.

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