Pulse
Net Work
Minnesota’s two largest safety-net hospitals are waging an online campaign to save GAMC.
If there’s a physician who understands the need for a health care safety net, it’s Kevin Larsen, M.D. An internist at Hennepin County Medical Center (HCMC), he witnesses every day the importance of the care he provides to some of the state’s poorest residents. He also sees the need for the state-run health insurance program, General Assistance Medical Care (GAMC), which pays for some of the care he provides. “I see a lot of patients with diabetes, high blood pressure, heart failure. In order to afford the meds they need to keep their disease under control, they need [GAMC] insurance,” he says.
The GAMC program, which provides health coverage to about 32,000 low- income Minnesotans in any given month, is scheduled to end on March 1 as a result of Gov. Tim Pawlenty’s line-item veto of the program and unallotment of funding for it last year. When the program goes away, it will leave patients, such as the woman Larsen treats for diabetes and heart disease, who often must choose between paying the GAMC copay for the medications that keep her out of the hospital or buying food for her grandchildren, having to make even harder decisions.
This grandmother and other patients like her are one reason why Larsen decided to help develop a website that seeks to explain to the public why GAMC and the safety-net hospitals such as HCMC it helps fund are important to everyone in the state—not just poor Minneapolis-area residents.
In early December, HCMC launched www.willyoulose.org, a website focused on the effect the governor’s decisions will have on the facility. The site, which emphasizes HCMC’s role as a resource for the entire state, has an interactive map showing the extent to which the medical center served every Congressional district in the state in 2008 and the value of care provided to those districts. It also includes personal stories of people who have been served by HCMC, a description of the hospital’s role in disaster preparedness and in teaching residents and health professions students, and an easy way for viewers to send messages to their elected officials urging them to restore funding for GAMC.
“Our campaign is motivated by the fact that the people who are about to become uninsured really don’t have much of a powerbase,” says Mike Harristhal, vice president of public policy for HCMC. “We really wanted to heighten the visibility of what was happening.” In addition to launching the website and holding town hall meetings and one-on-one sessions with lawmakers, HCMC officials are using social networking sites such as Facebook, Twitter, and YouTube to get the message out. “So much of the world is now connected to electronic media, it seemed like a way to reach as many people as we could,” Harristhal says.
Looking for a Quick Fix
HCMC isn’t the only hospital to take the cause of GAMC to the public. In early June, Regions Hospital in St. Paul started posting weekly reports on its website showing the number of GAMC patients who visited each week. “It was an effort to make it personal and more real,” says Geoff Bartsh, director of government relations for HealthPartners, which owns Regions. “When I see numbers that show 200 to 300 patient visits per week, I can comprehend that a lot better than 35,000 enrollees over a year’s time or $23 million annually, which is the loss to our hospital in terms of reimbursement.”
Regions’ weekly countdown can now be found on the Fix It Now website (www.fixitnowmn.org), which also launched in early December. Fix It Now is a campaign by Regions Hospital, HCMC, North Memorial Medical Center, HealthPartners, the Minnesota Safety Net Coalition, the National Alliance for Mental Illness Minnesota, and other organizations to create awareness about the importance of GAMC to the health care safety net.
The website includes a clock ticking down the number of days, hours, minutes, and seconds until GAMC goes away, arguments for preserving GAMC, the stories of people served by the program, updates about efforts to promote awareness of the need for GAMC, and easy ways to contact lawmakers and write letters to local newspapers about why GAMC should be saved. Fix It Now is also using Facebook, Twitter, and YouTube to connect with the public.
So far, the effort to get the word out appears to be working. “We’re getting more and more groups signing on to support this,” Bartsh says of Fix It Now. He says two of the most recent ones are the Center for the American Experiment and Growth and Justice, organizations that typically hold very different views on policy. “Every group we’ve talked to understands that the impact isn’t limited to the individuals who use the service, it affects the community in general,” he says.
No Clear Solution
It’s that larger impact that has Minnesota’s health care community concerned. According to the Will You Lose and Fix It Now websites, approximately 55 percent of GAMC funding goes to hospitals that are obligated by law to care for the state’s poorest residents regardless of whether they get paid for it, and about 65 percent of GAMC patients receive care at Regions and HCMC. “That population is still going to need medical services,” Bartsh says. “They will still be treated by hospitals. If they’re not covered by a state program, how will that care be paid for?”
For Minnesota hospitals, which altogether provide more than $460 million a year in charity care, the only options will be to pass costs along to other patients or cut services. The effect of cuts has already been felt at HCMC, which eliminated nearly 200 jobs and put plans to build a new ambulatory center on hold after losing $5 million in Medical Assistance supplemental payments and $7 million in funding to offset the cost of training medical students and residents through unallotments that took place in December 2008.
With the elimination of GAMC, the medical center will need to cut an additional 150 to 200 positions and close its outpatient cardiac rehab program and senior care clinic. In addition, HCMC will no longer provide nonemergency outpatient and pharmacy services or clinical care to uninsured patients who live outside Hennepin County starting in April.
That could compound the challenges for Regions and other hospitals and, ultimately, lead to similar restrictions. “If Hennepin County is forced to limit uninsured patients coming to their clinics to only those who are residents of Hennepin County, I will assume that a large number of those from other counties will come to Regions Hospital. The impact of that will quite clearly force us to consider changes similar to those Hennepin is talking about,” Bartsh says.
Lawmakers are currently looking for ways to provide insurance coverage for Minnesotans who will lose their GAMC coverage. In late November, the governor proposed moving most of the people on GAMC into MinnesotaCare, the subsidized insurance program for the working poor. Unlike GAMC, Minnesota-Care charges monthly premiums and has a $10,000 annual limit on inpatient hospitalization charges and a three- to four-month waiting period before coverage kicks in. (GAMC has no cap on hospitalization charges or waiting period. People can enroll when they come to the ER, and the program pays for the cost of care starting with that visit.)
In December, DFL leaders proposed a temporary fix that would keep GAMC afloat for another 16 months through a surcharge increase on insurance premiums and net patient revenues at hospitals. Their hope is to buy time until the federal government finds a way to extend coverage to the people currently receiving GAMC.
Both Harristhal and Bartsh are optimistic that lawmakers and the administration will come up with a way to make sure the poor will get needed care and prevent the safety-net hospitals from having to cut services. And, they believe the Fix It Now and Will You Lose websites are having an effect. Bartsh says more than 400 people used the Fix It Now site to send letters to their legislators and the governor during its first three weeks. By the beginning of January, more than 60 had sent letters through the Will You Lose site.
“We certainly talk about this within our walls,” Larsen says of the need to save GAMC. “But I’ve heard it talked about in the broader context as well. I’m from Willmar originally and was recently talking to people there. They are very aware that HCMC is a resource for many different kinds of referral care—burn care, trauma care, mental health care. … By eliminating GAMC, we put our safety net at risk if we don’t come up with another way to fund it.”—Kim Kiser