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January 24, 2005
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| Dr. Richard Gray, an emergency room physician, says the cost uncompensated care will continue to rise if cutbacks are made to GAMC and other state health insurance programs. (MPR Photo/Tom Scheck) |
St. Paul, Minn. — Scott Henschke is the perfect example of why General Assistance Medical Care was created in 1976. He's 44 years old and hasn't worked full time since 2002. When he was laid off from that job, he also lost his health insurance. Since then, he's gone without health insurance while working temporary jobs.
"I couldn't afford to have insurance," Henschke said.
Henschke managed to live without insurance until last November. That's when he was forced to go onto General Assistance Medical Care after he fell and broke his ankle. After a hospital stay and two surgeries, Henschke is now able to walk around his apartment. While he says he's ready to start looking for work again, he says there's no way he could have paid the $30,000 medical bill out of his own pocket.
"If I didn't get this help, I don't know, I guess I would file for bankruptcy," Henschke said. "I never thought of that before, but that would be the position that I would be in. I would just have to say 'I don't have a job. I don't have any money. How do you want me to pay these bills?'"
There are about 35,000 Minnesotans who are on General Assistance Medical Care or GAMC. In order to qualify, you have to be an adult without children who makes no more than $600 a month. It's supposed to help those who have no other options for health insurance. Many on the program are homeless. Others work part time.
The problem with GAMC is it's expensive. The state paid $243 million to run the program last year. It's projected to increase to $379 million by 2007. Gov. Pawlenty says the growth of GAMC and other state-run health care programs need to be reined in. Minnesota is only one of a handful of states that offers a program for low-income single adults.
In December, Pawlenty hinted that GAMC will see significant changes.
"If you're not a senior, you're not disabled, if you don't have children in other words you're an able-bodied, single adult who can otherwise perhaps find an opportunity in the marketplace," Pawlenty said. "Those are the kinds of people we're going to look at and say, are our benefits out of line?"
Pawlenty would not elaborate on how state-run health care programs would fare in the upcoming budget. But some who advocate on behalf of the poor worry that Pawlenty will eliminate GAMC and roll the people currently on it into MinnesotaCare. That's the state's health insurance program that requires a enrollees to pay a monthly premium and offers fewer services. They say many people would opt out of the program because of the cost of the premiums and would go without care, at least until it's absolutely necessary.
No one is more concerned about the future of General Assistance Medical Care than those who work at the Hennepin County Medical Center in Minneapolis. HCMC's emergency room is always bustling with activity.
Officials with HCMC and others who serve the uninsured say cutting the growth of GAMC would only shift the cost of care from state taxpayers to hospitals and clinics that treat the poor and uninsured.
The problem is HCMC is seeing a growing number of patients without insurance.
In 2003, HCMC provided $24 million worth of care to people who couldn't afford to pay. In 2004, the cost of this uncompensated care went up to $31 million. HCMC recoups that money by increased property taxes and assistance from the federal government.
Dr. Richard Gray, an emergency room physician, says the cost of uncompensated care will continue to rise if cutbacks are made to GAMC and other state health insurance programs.
"That's going to filter out everywhere. It's going to impact our ability to provide care for all of our patients," Gray said. "That cost is not going anywhere. You can shift it however you want, and you can try to push into dark corners where you're not going to see it -- but what happens is you're going to have a more expensive health care system."
Gray says getting medical care at the emergency room is the most expensive form of treatment. He says people who no longer receive state subsidized insurance will forego basic treatment to save money, only to seek out the most expensive kind of care in the emergency room when they get really sick.
HCMC CEO Jeff Spartz says Gov. Pawlenty is balancing the state's books by cutting health programs for the poor, but isn't really solving the problem of treating those who can't afford to pay. He says HCMC and other clinics will get hit with a double whammy if GAMC is cut back. Spartz says HCMC will lose state funding, and will see more people who can't afford to pay.
"There's no free lunch when you cut these programs," Spartz said. "There's a price to be paid and some of that price can be hidden. It's not simply the state saves $50 million and there's no issue here."
Minnesota Human Services Commissioner Kevin Goodno says he understands the uncompensated care dilemma. But he says those on state health insurance programs need to take a greater personal responsibility for their own health care costs. Goodno also says hospitals and clinics have always complained about their uncompensated care costs.
"The hospitals were -- even when we were adding programs and expanding coverage -- were complaining about uncompensated care," Goodno said. "It seems to be a perennial issue, regardless of if we're in surplus and spending money on their programs or if we're cutting programs and are in deficit situation."
State figures say 50 percent of those on GAMC have some sort of mental health problem, and 40 percent have a drug or alcohol problem. Many others are on the program because of an injury.
In fact, GAMC is also used as a stopgap measure for people who are waiting to qualify for Social Security's disability program -- people like Sherry Cason, 50, who was diagnosed with a form of emphysema in October 2002. She could no longer work and applied for Social Security benefits. Two years later, she was awarded the benefits. She says she was forced to rely on GAMC to pay her health care costs.
"If they cut that out, my God, people are going to be suffering," Cason said. "I thank God for GAMC because that helped me a lot."
But Commissioner Goodno says Minnesota needs to do something to slow the rate of growth of Minnesota's subsidized health care programs. Goodno says GAMC, MinnesotaCare and Medical Assistance are projected to increase about 20 percent over the next two years.
"Even if you raise taxes this year to solve that problem, it doesn't solve it next year," Goodno said. "We'll be back at the table discussing it. So we have to take a long-term solution, and look at what the role of government is and how far we should go in taking care of people in trying to compensate for personal responsibility issues. And we need to take a greater role in how we manage our costs moving forward."
But hospital officials and clinic administrators say cutting people from state health care programs will not make them and their illnesses go away. Some suggest that Minnesota and other states need to look at different ways of financing the U.S. health care system.
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