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Health Cuts Defy All Logic


From Minnesota 2020 (slightly edited):

By Elizabeth Rich

MN2020 Graduate Research Fellow

If you live in Minnesota and have listened to the radio, seen a television, or passed by a newspaper in the past week, you may have noticed blaring headlines. Something along the lines of "Budget Cuts" and "The End of Minnesota." Ok, maybe you haven't see that headline, but for many people in Minnesota, it will feel that way.

Minnesota has a budget shortfall.

About 6 billion, give or take a couple million.

The governor proposed cuts, the DFL controlled house and senate proposed a mix of budget cuts and tax increases.

Pawlenty rejected the proposals and came back with another one of his own. The DFL said no and came back with yet even more proposals.

Rinse and repeat.

This cycle went on for the entire legislative session, all the way up till midnight Monday. And then? Well, a whole lot of nothing. That is, of course, until it was announced that our governor was going to take it upon himself to "unallot" the budget for 2010-2011. That was, of course, after he line item vetoed the General Assistance Medical Fund.

The fund, known as the GAMC covers adults without children making less than 8,000 per year.

Often, they are mentally ill, or have medically debilitating diseases. Take a moment and try to imagine what life would be like if you only had 8,000 a year to spend on food, clothing, medical care, and various sundries that allow people to live.

Now imagine, if you can, your health insurance is taken away.

This means, of course you have to choose between 1 visit to the emergency room with diagnostics and x-rays or your "salary" for the year.

What would you do? Yeah, I wouldn't pay my bill either.

As you're imagining that you're way below the poverty level without health insurance, let's talk about what you are going to do for care. Since clinics and doctor's offices require co-pays up front and emergency rooms aren't allowed to turn people away, tell me this:

Where are you going to go for your care? Your meds?

That's right, the emergency room.

Now, it gets more complicated. Pretend you're a hospital.

People are coming in without health insurance. And for the sake of the argument, let's say, oh about 35,000 of them (the amount of people on GAMC). And you are required to provide care. But now there's no reimbursement. So you are stuck with the bill, which can run into the tens of thousands for a single patient.

Now, you are that same hospital, and you get a call. Something about the Minnesota budget shortfall and cuts to your state funding. Something like several percentage points of your funding. This is on top of the lack of GAMC funding. So you start to look where you can cut your budget. There's no fat left to trim, so necessary services are the first to go. And with the necessary services, jobs go.

So you are forced to explore some more drastic options. Like shutting down that urgent care clinic. Or affiliated nursing home. Or shuttering altogether. Which means even those with insurance will no longer have the option of services from you.

Now, let's make my philosophy teacher proud.

* If we cut funding to the people who need it most, then they will be forced to go to the hospitals.

* If more uninsured people go to the hospitals, then the hospitals will have to absorb the cost.

* If hospitals have to absorb the cost of the newly uninsured population, then they will have to pull the money out of their freshly cut budgets.

* If they have to find the money, drastic things will happen. Which could mean drastic cuts to services for even those among us with health insurance.

THEREFORE, if we don't insure the poorest of the poor, then even those of us with health insurance will lose services.

Since Pawlenty vetoed the GAMC, this little scenario isn't a philosophy class hypothetical. This is what quite possible will happen. And I don't know about you, but I am scared.

I'm scared that there's nothing I can do as I watch the state that I have grown to love face some seriously dark days. Scared that hundreds of our world-class practitioners will have to look for greener pastures since there's no monetary green to keep them here. Scared that people will have to travel 100 miles in the rural areas to get help when they need it most, or to visit a loved one in a nursing home because the closest one was forced to close.

I don't want to see this state fall further down the rabbit hole and into an anti-wonderland
filled with the sick, the ones who need health care most. Because in the end, the harm that this decision will cause will outweigh the $381 million that it will save, not to mention the cost to our state sanity.

And when we have to answer to future Minnesotans, the conversation won't be pretty.

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