Cuts will hurt state’s poor

Cuts to state funding will have a major impact on Hennepin County Medical Center and the many poor and uininsured patients it serves. The Hennepin County Board of Commissioners approved the 2010 Health Services Plan submitted by Hennepin Healthcare System Inc., (HHS) the public corporation that governs day-to-day operations of Hennepin County Medical Center.

HHS operates as a subsidiary under the auspices of the County Board, which has final approval of HCMC’s mission, policy, budget, major capital improvements, significant debt or venture, and the Health Services Plan, which describes the role HCMC/HHS plays in service to the community.

The plan cites “the very constrained budget” that has resulted from the loss of the state-funded General Assistance Medical Care Program (GMAC), and that a variety of economic factors has “altered the trajectory for health service planning and severely threatened our ability to meet our health services objectives.”

HCMC is faced with the loss of $43 million in 2010 payments with the termination of GAMC, a total of $73 million in reduced revenue for the current biennium. The report cites “a budgeting conundrum and potentially an operational crisis” and outlines services that may need to be curtailed. A crisis at safety-net hospitals will immediately impact the poor, but also will affect the middle class as services become more limited and fewer health professionals are trained.

HCMC serves 20 percent of those enrolled in state health care assistance programs. It is the state’s largest health provider for the poor; nearly half its patients are low-income. Mental health services continue to operate at capacity. It’s estimated that 60 percent or more of GAMC patients have mental illness, chemical dependency, or both. In 2008 and 2009, HCMC provided service to patients from every county in the state. Approximately 20 percent of HCMC’s patients were born in other countries. The hospital has recently experienced a 29 percent increase in International Clinic volume.

It is also an important training hospital. Nearly half the state’s practicing physicians have received training at HCMC, and 67 percent of doctors who graduate will establish practice in Minnesota. HCMC also annually trains more than 1,800 students in more than 50 other health professions, including nursing and lab technicians, paramedics and other first responders.

A wave of cost-cutting that has rippled across Minnesota’s health care system, from clinics to med-tech companies to insurers, has arrived at the doorstep of this premier public institution—a facility that treats 480,000 patients annually, trains 300 medical residents at any one time and serves as the state’s leading safety-net hospital.

Already this year, the hospital has cut 200 positions and slashed overtime. It is poised to shed more jobs and services as it braces for another $43 million cut in revenue when the state terminates a key program for the indigent.

Doctors say a cut that size would threaten the hospital’s very mission: treating everyone who walks in regardless of ability to pay. It would “tip this hospital over and create a crisis,” said Dr. Joseph Clinton, chief of emergency medicine. “It would mean unacceptable deaths for patients who can’t get care.”

Gov. Tim Pawlenty has struggled to close a record state budget deficit, including cutting funds for health care. Last winter, HCMC lost $12 million of state funding in a budget process known as unal-lotment.

Next, the governor eliminated GAMC, a relatively unusual state program that covers the very poor who are not eligible for Medicaid. That program will end March 1, and most of its 36,000 recipients will be temporarily rolled into a health plan for the working poor, MinnesotaCare. But after that, advocacy groups worry that this population—many chronically ill, with mental health and chemical dependency problems, will fall through the cracks.

HCMC estimates it would lose $43 million in reimbursements next year and another $50 million in 2011, the biggest budget cuts in its history, if GAMC disappears.

“These were difficult decisions, but they were necessary in order to balance the state budget during a time of unprecedented economic challenges,’’ Pawlenty spokesman Brian McClung said.”Even with reductions to some programs, Minnesota has among the most generous publicly subsidized health care and safety-net programs in the nation.’’

Regions Hospital is facing similar problems. The former St. Paul-Ramsey Medical Center is now owned by Health-Partners, but continues to serve a significant low-income population.

Regions expect to lose $24 million next year when GAMC goes away and $26 million in 2011. Officials there have already shelved plans for a new mental health center, even though the current one, housed in 40-year-old former nursing quarters, is bursting at the seams. Next month, officials are expected to propose additional cuts for 2010.

Advocacy groups predict ripple effects across the state. GAMC patients aren’t going to just disappear, said Becky Lentz, a spokeswoman for Catholic Charities. Food shelves, homeless shelters and community health centers, as well as police, will have their hands full with the drug-addicted and the mentally ill who will be off their medications and on the streets, she warned. [Source: Hennepin County, Star Tribune]