GAMC – What just happened?

The poorest Minnesotans – more than 20,000 people, an estimated 80 percent struggling with mental illness or chemical dependency – were the target of Governor Pawlenty’s budget cutting last year. Under his plan, they were to lose General Assistance Medical Care (GAMC) coverage on March 31, leaving them without a way to pay for medical care or for desperately-needed prescriptions.

Now they will continue to be covered, thanks in large part to the two representatives who, according to the Strib’s Lori Sturdevant, worked tirelessly to engineer some kind of agreement that could pass. They are DFL Representative Erin Murphy and Republican Representative Matt Dean.

The GAMC deal will continue coverage through the 2012-2013 budget year, but the compromise looks like an awkward beast designed by a committee. Here are the sketchy, and often ugly, details, as reported by Politics in Minnesota and by Minnesota Public Radio:

• GAMC will continue through May 2010, funded with $28 million from the Health Care Access Fund.

• Provider payments (to hospitals, clinics, doctors, dentists) will be cut by about 75 percent.

• Prescription drug payments will be capped at $45 million for the remainder of the 2010-2011 biennium, and $83 million for 2012-2013.

• After May, some the state’s largest hospitals will be forced into “coordinated care organizations” and paid with block grants for providing coverage to the poor. The number of hospitals in the CCOs is not clear, but probably somewhere between 17 and 24.

• As the Pioneer Press points out, “any of Minnesota’s other 131 hospitals still must treat indigents who show up in emergency rooms.” The PiPress says they will be paid from a pool of $20 million for six months – and after that, there’s no plan.

This solution leaves a lot of questions, such as how urban or rural hospitals can continue to provide care at 25 percent of what they now receive for GAMC patients – when the current GAMC payments are already considered low. One likely, if partial, answer: they’ll charge insured patients more, in order to make up their deficit.

The cost of care provided through the “coordinated care organizations” will add $116 million to the state budget through the end of 2011, increasing the budget deficit to $1.1 billion. Pawlenty proposes to pay by cutting other health and human services programs – as if they had not already been cut to the bone and beyond.

The good news:

• There is a plan to continue medical care for the indigent.

• The governor will not be allowed to rob the Health Care Assistance Fund, which was set up to help pay for MinnesotaCare. Only $28 million will be transferred from HCAF to the general fund to pay for the new plan.

• The governor will have to drop his proposal to eliminate MinnesotaCare eligibility for all single adults making more than $8,000 per year.

The bad news:

• There’s just not enough money in the plan to pay for medical care and prescriptions.

• Already-struggling hospitals will have to deliver care for way-below-cost payments.

• The governor promises to use this as a reason to slash other health and human services programs even further.

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