Spring may be finally here, with the melting of the snow in the southern parts of Minnesota and the lakes nearing ice-out. We’re also at the halfway mark of our state legislative session. With only a couple months left, our legislators have a lot to do.
At the beginning of the session, it looked like we were going to have a huge deficit, but that deficit was cut in half to about $627 million in the March projection by an upswing in the economy. Things were looking up and it seemed that Gov. Mark Dayton was leaning toward helping reverse some of the devastating cuts of the last decade to Health and Human Services programs. But just before the session recess in late March, the House and Senate’s revised targeted budgets came out and it looks as though disability advocates will again be struggling to convince the governor and many legislators to maintain Health and Human Services (HHS) funding to serve the most vulnerable of our citizens. Disability supporters were asking for increases in HHS funding to reverse the ruinous cuts of the last administrations. Advocates may have misread their intentions, though, because their budget includes a cut of $150 million to HHS’s budget.
Even some of our other legislators were shocked at the target budgets that they eventually proposed. Rep. Tom Huntley (DFL, Duluth) said, “I’m very upset. I came close to resigning as chair. If that’s what the Democrats are going to do, what’s the difference between that and what the Republicans have done over the last two years?” Sen. Paul Thissen (DFL, Minneapolis) said that HHS in the last 10 years has borne the brunt of the budget cuts, but he believes that recovering overpayment to health plans, continuing reforms and efficiencies and taking advantage of changes in Federal healthcare coverage could make up some of the $150 million. He believes that “it’s possible to provide the same level of services to make sure that people can live their lives fully and with as much dignity as possible, but spend less money.” I certainly hope the senator is right, and I certainly agree with him that our goal needs to be “to make sure the money we’re spending is directed to the people who are suffering from very serious health issues…keeping our focus on the patient and letting them make the decision on the specific services they need to buy.”
Last month there were hearings on various provisions of the Affordable Care Act. The first issue was income standards for people who use the state’s Medical Assistance program. Because of a provision of the Affordable Care Act, the eligible income standard was increased from 100% to 138% of the Federal Poverty Level. This means that people would only have to spend their income down to 138% of poverty level to maintain their MA eligibility… and for a family of two people, that would mean that they could have about $20,300 per year to live on (or have income less than 138% of FPL to become newly eligible). Unfortunately, citizens over 65 and people with disabilities were not included in the ACA’s language. Call it oversight, unintentional or cost-savings, but these two categories of individuals are stuck spending down to 100% of the FPL. What all that means is that seniors and people with disabilities on MA are allowed less income per month than others using the same programs.
In the same Minnesota legislation dealing with income standards, people with disabilities who are married but have their spouses’ income disregarded (using MA-EPD) could lose that disregard and be forced into impoverishment to maintain MA. Although employed, married people often have private health insurance; most employers’ health insurance does not cover PCA services. It makes no sense to impoverish people and remove their incentive to work. Not only do they add to the state’s income tax rolls, they purchase goods and services with their income, and they use private insurance for 80% of their healthcare needs, like durable medical goods, prescriptions, hospitalizations, doctor visits and emergency room visits. The end result of removing the spousal disregards will mean that the state would spend more taxpayer money on the married couple.
So nothing’s stable in healthcare right now, at the state or federal level. One final issue in my current list of concerns is that Medicare has begun competitive bidding for reimbursement of durable medical goods, which seems to be a lose/lose proposition. The medical suppliers that won the competitive bidding will lose because they undervalued the cost of the goods. The small medical supply companies that didn’t win the competitive bids will lose income on the products they won’t be selling because reimbursements aren’t available. And soon all of us will lose because there won’t be any Medicare-reimbursable goods available, period.