Healthcare access fund in danger of cuts

A $200 million healthcare access fund is a tempting target to lawmakers desperate to keep Minnesota from going broke.

And Hubbard County Social Services director Daryl Bessler is worried about that fund in desperate times.

"I expect MinnesotaCare, instead of growing, there's going to be a retrenching of eligibility because the money isn't going to be there," Bessler said. "I think they're going to raid the healthcare access service fund as a way of helping to balance the budget.

"There's more in there than the rainy day fund the state has and I think they're looking for pots of money," he said. "If that happens maybe we'll just see a reduction in eligibility for programs but then what are we going to do with the people" who need healthcare?

Gov. Tim Pawlenty recently slashed state funding to cities, counties, human service programs, state colleges, state agencies and a minerals account - $271 million in all. He drained the state's reserve fund first, more than $150 million.

The state's finances are $5.3 billion out of whack, and that's what concerns Bessler. The cuts and reserve fund, $426 million, the amount of the current deficit, barely make a dent in the state's overall fiscal pickle. Solving the quandary will be up to the Legislature Jan. 6 when a new session convenes.

"It's really hard to say anything definitive at this point," Rep. Brita Sailer said about potential cuts and targets.

" I would hope that we will be able to put in some level of protection for some of these really basic programs because certainly something that I see, the level of stress that everyone is under, the more we need these programs and yet they're very difficult to fund at this point - any program is when there isn't money coming in."

"Maybe these concerns are not justified but the biggest driving force of the state budget right now, or at least one of the major driving forces, is healthcare," Bessler predicted. "I think they're going to tighten up on eligibility because that will save them money."

And that troubles the department manager who sees requests for state health coverage increasing by the day.

He asked the county commission to allow his office to continue processing eligibility forms for people in need of medical assistance, to shorten the waiting period. It isn't a great moneymaker for the county - each case processed brings $30 to county coffers - but it's a benefit to people awaiting a decision.

"They may wait two, three, four months" for a determination if the state processes the initial application," Bessler said. "That weighs on people's minds. They wonder: 'Am I going to be eligible? Am I not? How am I going to pay for this operation if I don't get it?'"

Hubbard County workers can generally process a request for state medical assistance or an application to join the MnCare program within 30-45 days. And now, in the face of looming deficits, Bessler wonders if it's all for naught.

"They're talking about eliminating some programs, which would ease some of the burden... but what are people going to do who are no longer eligible for medical assistance, MnCare or whatever the program?" he questions. "They still need the care, the help, the services."

"That's part of that whole situation with not coming to grips nationally with having a single payer system where people in our country actually have health insurance," Sailer said.

"That has made so much difference for businesses, schools, counties trying to cover those costs," she said. "And now of course we're in the economic situation we see ourselves in. We're not very well able to cover those costs that formerly we did and when we need it the most we have the least availability to cover the people that need it."

Bessler said tightening eligibility for state-funded healthcare programs will simply shift the costs, creating other burdens.

"Likely what's going to end up happening, the provider will have to provide the service," he said. "People showing up in emergency rooms, they'll have to be served. And those costs will have to be pushed on to those that do have insurance or those that are paying out of their back pocket without insurance. Where else can it go?"

"We'll be looking at them very carefully," Sailer said of healthcare cuts. "I know that last time around health and human services took a big hit and I know hospitals did so I would hope we would not have to be looking at additional major cutting in that area.

"It's easy to say we'll trim and look for efficiencies but actually we've already done that everywhere, from schools to court systems to human services, there's not much to trim," she said.

"I think state programs that we know of, those may go by the wayside, some of them, that are the ones funded with 100 percent state dollars," Bessler said. "You're still going to see the federal dollars, where there's a match, you'll see those programs in place because bringing in federal dollars helps alleviate a need."

Essential services will get very close scrutiny, Sailer said. "I think there will be some cuts across the board to some extent or another" but she said she also wants to see agency directors given some latitude to decide what's best because they're in a better position to decide than the state.

Sailer said she "will look very strongly" at mandates because they burden state and local agencies and units of government. "That's always been such a sore spot," she admitted.

In good times laws to enact protections seem like a good idea, but when the economy sours, and "the cost of paying for it falls on your county or school district it becomes very difficult.

"That isn't going to make up $5 billion, it just isn't, but that's our challenge is trying to figure out which cuts will hurt the least to the state of Minnesota at large," Sailer said.