MMA Viewpoint
Health Care Isn’t Free
February was a busy month, as the MMA focused on trying to save the state’s General Assistance Medical Care (GAMC) program. Because of Gov. Tim Pawlenty’s veto of the program and unallotments last year, health insurance coverage for GAMC recipients is scheduled to end on April 1.
I had the thankless job of telling lawmakers and the public that although saving GAMC was essential, the proposals on the table were not viable solutions. During my testimony at the Capitol and in an op-ed piece published in the Star Tribune, I sent the message that the governor’s approach, which is to shift GAMC enrollees to the MinnesotaCare program, is really just an attempt to cut coverage for these individuals. It is believed that most of them will be unable to manage the required application process and pay MinnesotaCare’s monthly premium.
The DFL plan, which would provide safety-net hospitals such as Hennepin County Medical Center some payment for treating these patients, would shift the cost of their care to other hospitals, clinics, and health care providers. The plan also would cut payments to medical clinics by 50 percent.
These are cuts to payments that are already absurdly low, given that the state’s current reimbursements are based on charges from 1989—the year Roseanne was the top-rated television show and the Soviet Union officially pulled out of Afghanistan. Lawmakers have only implemented one across-the-board increase of 3 percent in the last 18 years, while practice costs have risen by more than 30 percent.
This has led to an odd sort of thinking about health care, which is that it is all right for the state to require clinics to deliver their services at a financial loss. It’s a philosophy that would result in outrage and lawsuits if it were applied to other businesses. Can you imagine the state telling contractors that they had to build roads and lose money while doing it?
Minnesota’s public program payments to clinics are often less than half what private insurers pay. And they’re considerably less than what Iowa, North Dakota, South Dakota, and Wisconsin pay for office visits. A recent Health Affairs article found that Minnesota was one of only two states in the nation that did not increase clinic payment rates between 2003 and 2008.
It’s these ridiculously low rates that DFL lawmakers proposed cutting by 50 percent. Under the DFL plan, clinics would receive about $23 for an office visit, out of which they’d be expected to cover the doctor’s and nurses’ time as well supplies and overhead. This is less than most people pay for a haircut. No business in the state would accept such a deal, and neither can the clinics of Minnesota.
In the past, lawmakers have gotten away with chronically underfunding these programs because they know physicians feel a professional responsibility to treat all patients. But today’s marketplace is forcing many of us to make a very difficult decision—limit losses or risk being forced to close our doors altogether.
It is time for lawmakers to hold up their end of the bargain and adequately fund the state’s health care programs. If that means doing it through a broad-based tax increase, then so be it. The MMA remains committed to the goal of universal health insurance coverage and supports the role that the GAMC program plays in achieving it. But reaching such a goal does not come free.