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Legislators tackle health care in visit

Rep. Paul Marquart (DFL-Dilworth) asks a question during a state House Health Care and Human Services Policy Oversight Committee meeting held in Detroit Lakes on Wednesday. (Jason Adkins/DL Newspapers)

Health care reform continues to be a tricky issue to wade through.

A few members of the state House Health Care and Human Services Policy and Oversight Committee came through Detroit Lakes on Wednesday to solicit comment from local stakeholders on what is needed in health care reform.

"We need to get the perspective of those on the ground," said Committee Chairman Paul Thissen (DFL-Minneapolis).

St. Mary's Innovis CEO Tom Thompson said that the elimination of the state General Assistance Medical Care program will hit hospitals hard, since those without insurance will turn to local emergency rooms for medical care.

"It's one thing to complain about cuts, but we're facing a world with difficult decisions," Thompson said.

Thompson said that the reality for St. Mary's Innovis is that over half of its revenue comes from the federal and state government in the form of Medicare, Medicaid and other public insurance programs.

He said that his organization is what's called a "tweener" hospital because it's too big to qualify for critical access payments, but too small to offer more profitable services that hospitals in major metro area have available.

With the cut to GAMC, Thompson said that St. Mary's Innovis stands to lose $3.5 million in revenue. The total operating budget for the organization is $76 million.

He said that the goal for health care reform should be to provide coverage for everyone.

Becker County Human Services Director Nancy Nelson said that Becker County, along with adjacent counties, suffers from a disproportionate number of people living under the poverty level. She said that the poverty rate in the county is about 12 percent, while the statewide average is around 7 or 8 percent.

She said that 449 people in the county have GAMC, about one percent of the total county population.

"It serves the poorest of the poor," Nelson said."

With the elimination of GAMC, she said that the ultimate cost of providing health care for the poor would fall on taxpayers under the current system.

Rep. Paul Marquart (DFL-Dilworth), whose district covers the city of Detroit Lakes, said that the current system is unsustainable.

"If we don't get a handle on this, it will take up all of the budget," he said.

What's not up for discussion is cutting back on services, Thompson said.

"We sure as heck won't cut care," he said.

St. Mary's Innovis physician Dr. Bob Koshnick said that a system of assigning people a medical home would help cut down costs.

Under such a proposal, those who have GAMC or similar coverage could only see a doctor in one health organization. The definition of a medical home is still subject to debate.

Koshnick said that a medical home would be more efficient and stop people from physician hopping.

"If you have a personal relationship with a medical home, you reduce costs," he said.

Besides a medical home, the poorest of the poor may also need help with stable housing and mental health care, Nelson said.

She said that mental health holds at hospitals cost up to $1,000 a day. Those who need help with drug and alcohol detoxification cost $300 per day.

And the ER isn't a solution either.

"It is not the place to receive primary care," Thompson said.

Rep. Erin Murphy (DFL-St. Paul) said that solving the ER problem is tricky.

"Are we under the false assumption that we could change people's behavior so that it will drive down costs?" she said.

Ultimately, a solution will depend on what the federal government does with an overhaul to the health care system.

"We need to come together and make the best use of these resources," Murphy said.