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MinnesotaCare adults could lose coverage

St. Joseph's Area Health Services - and the people it serves - will be strongly impacted if Gov. Tim Pawlenty's budget proposals are adopted by the Legislature.

Under the governor's plan, more than 100,000 people - virtually all adults on MinnesotaCare - would lose coverage, said Ben Koppelman, St. Joseph's president/CEO. Adults who are currently covered would be thrown into the growing pool of uninsured patients.

Children and pregnant women would remain eligible for state health programs.

Health care funding would be reduced by nearly $900 million statewide over the next two years under the proposal, Koppelman said. Direct cuts to SJAHS during that period are projected to be approximately $1.1 million.

"It could potentially affect some services and could affect some jobs," Koppelman said.

"But people aren't going to stop getting sick. Legally, as a nonprofit, we can't deny care. We can't turn people away."

Cutting people from programs doesn't keep them from getting sick or needing medical care, Koppelman said. "It just leaves them without insurance coverage."

The projected $1.1 million shortfall doesn't take into account people showing up at the emergency room without insurance, he said.

People without health care coverage will delay care until they are really sick and then, unable to go to the clinic, will end up in the emergency room, where care is the most expensive, he said. This increases charity care and bad debt for the hospital.

Charity care, he said, is up 22 percent in the last six month over the budgeted amount. "I'm projecting those numbers will increase. I think we're seeing the tip of the iceberg.

"When you factor in the adults who will lose MinnesotaCare coverage in our area, if all those individuals sought care in our emergency department, it could amount to as much as two or three times the direct cuts of $1.1 million over the next two years in non-reimbursed care," he said.

Ultimately, the cost of the care is shifted to private payers, which translates to higher health care premiums.

MinnesotaCare, he explained, is funded by a 2 percent tax imposed on providers - dentists, doctors, chiropractors and other medical professionals.

What's frustrating for health care providers, he said, is during Pawlenty's tenure, more than $450 million has been taken from Health Care Access Fund (HCAF) to balance the budget. "This was money that was supposed to have been used to provide health insurance coverage for Minnesotans."

The governor is also proposing the HCAF be merged into the general fund, a move meeting opposition from the medical community.

Another proposal being weighed by lawmakers is to cut Medical Assistance rates by 3 percent, Koppelman said. But the hospital is currently being reimbursed on 2002 costs - less 15 percent. That creates a difficulty for facilities depending on reimbursement of services to patients on public assistance.

"We are already providing costs for less than the reimbursement," Koppelman said. "One thing that many people don't realize is that, as a general rule, for every dollar we cut in medical assistance, we lose a dollar in federal matching money."

The proposed measures "reduce coverage for the most vulnerable and needy," he said. "The people who need them most."

MinnesotaCare was initiated for the working poor, people who cannot afford insurance, he said. An economic downturn is when people most need the assistance.

The reductions in funding for medical education research costs will impact rural facilities' ability to recruit physicians, he said.

The proposal also calls for money being taken away from preventative efforts to reduce smoking and obesity.

"One of our biggest concerns is eliminating the critical access dental payment," he said of the clinic on Pleasant Avenue providing service to those with state-funded insurance.

If Pawlenty's proposal is adopted, the dental clinic could face a loss of $250,000 in funding per year. SJAHS dental clinic is a mission-based service that serves patients who have Medical Assistance or MinnesotaCare.

"It would be devastating," Koppelman said of the clinic that "barely generates a profit. We just break even. Losing $250,000 would make it very difficult to sustain."

And the people who would have been going to the dental clinic will be heading to the emergency room. "That's not appropriate," he said.