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Future of GAMC uncertain

Published (2/11/2010)
By Lauren Radomski
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Several hundred people rallied in the Rotunda Feb. 4 urging the Legislature to pass a bill early in the 2010 session for continued funding of the General Assistance Medical Care program. (Photo by Tom Olmscheid)Minnesota lawmakers are pushing for the quick passage of health care legislation targeted at the state’s poorest, sickest residents.

General Assistance Medical Care (GAMC) is a state-funded program that pays for certain health care services for low-income Minnesotans, many of whom are single adults. Funding for the program is scheduled to run out by the end of March, the result of a line-item veto and unallotment by Gov. Tim Pawlenty last year. That’s prompted legislators to take quick action early in the session, with the chance a proposal to continue GAMC could be on the House floor by next week.

Sponsored by Rep. Erin Murphy (DFL-St. Paul), HF2680 would create a scaled-back, temporary GAMC program effective March 1, 2010, through June 30, 2011. To pay for the program, grants to counties for adult mental health and children’s services would be reduced. Hospitals would be reimbursed less for the GAMC patients that they treat, and increases in surcharges on hospitals and HMOs would capture additional federal Medicaid dollars.

Murphy described the legislation as a collaborative effort that is still a work in progress.

“I remain open to everyone’s ideas and I really am confident in our ability to solve this problem this session,” she told the House Health Care and Human Services Policy and Oversight Committee Feb. 4.

Murphy said the bill would serve as a temporary fix to the GAMC problem, giving legislators more time to discuss major reform. She estimates the legislation would reduce the state deficit by $160 million.

Mixed reaction

So far the bill has been met with mixed reactions. Supporters of the temporary program say the loss of GAMC would mean major funding cuts to hospitals, which would be forced to shift costs to patients or reduce services.

“GAMC funding impacts everyone in the state, not just the poor,” said St. Paul Fire Chief Tim Butler, “because the services that will be cut will impact all aspects of hospital operations and those operations serve all residents regardless of economic status.”

The projected financial impact of the bill varies from hospital to hospital — and those estimates are rough at best. Large hospitals forced to make substantial contributions toward the temporary GAMC program would also see some funding increases. Rural hospitals receiving increased funding for certain groups of patients could take other cuts especially hard if their facilities are not part of a major health system.

Meanwhile, counties are stuck between a rock and a hard place. A temporary GAMC program is better than no program at all, said Patricia Coldwell, policy analyst with the Association of Minnesota Counties, but the bill comes at a cost to another vulnerable group: children.

“Is it better to assure that very low-income, chemically-dependent and mentally ill people continue to get health care, or to assure that children are safe from abuse and neglect?” Coldwell asked. “… I have to say that I’m really sorry our state is forced to make those kinds of choices.”

The AMC has suggested a lesser evil: cut county program aid, the state funding comparable to local government aid for cities. County program aid is a broader source of funding than block grants, Coldwell said, and from the AMC’s perspective, it doesn’t make sense for the state to provide property tax relief through program aid, only to cut other funding that counties would have to backfill.

Not everyone is in a hurry to pass GAMC legislation quickly. Rep. Steve Gottwalt (R-St. Cloud) believes GAMC needs significant reform to make the program more effective and sustainable.

“I really think we need to look for the best solution, not just a solution,” he said.

Rep. Jim Abeler (R-Anoka) is concerned the temporary GAMC proposal will have unintended side-effects for Minnesotans not represented at recent hearings.

“I hope that as we go forward with this project that we don’t make things worse for some of the other people that have needs just as great as the people we’re serving here,” he said.

One lawmaker is proposing a contingency plan in case GAMC ends as scheduled. Rep. Matt Dean (R-Dellwood) sponsors HF2736, which assumes people currently covered under GAMC will be automatically enrolled in another public health care program, MinnesotaCare. The bill could result in modified MinnesotaCare coverage for some single adults and childless households.

Murphy’s bill could see action next week. A companion bill, SF2168, sponsored by Sen. Linda Berglin (DFL-Mpls), was passed by the Senate 45-20 on Feb. 11.

Dean’s bill awaits action by the House Health Care and Human Services Finance Division. It has no Senate companion.

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