It had all the trappings of a political football; a blue state’s extremely unpopular Republican governor — looking toward a possible presidential run a year after his term ends — used his partisan hardline to threaten veto of one of the most well-funded social programs for healthcare delivery to the state’s working impoverished, all the while setting the stage for a political attack on his character for all of the nation to see at the hands of the opposing party. The apparent newfound conciliatory stance taken by Minnesota governor and 2012 prez hopeful Tim Pawlenty concerning the threatened veto of GAMC headed this scenario at the pass, however, as the healthcare delivery safety net for thousands of the state’s working poor got a last-minute reprieve to continue being funded, albeit scaled back. Of course the negative PR surrounding a pending lawsuit by three beneficiaries of the program didn’t make eating crow any easier for the chief executive.

Though funding for the program was supposed to end on April Fools Day, the brokered change in funding commitment means that service providers will see less in reimbursements. Also,

[u]nder the agreement, hospitals will receive $71 million from the state’s general fund for the year starting July 1 and $131 million the following year. About 12 to 15 hospitals likely can start serving patients in the new program on June 1. For others not yet ready, $20 million will be set aside to pay for uncompensated care for six months.

The key is in acute care — often the first and only mode by which this underserved patient population will continue to receive care. With a decrease in monies to provide it — even with a grace period of sorts for charity care — the level of participation of acute hospitals is emblematic of both ongoing problems with funding (providing care) and simply surviving as they continue to operate in a program whose demand will only increase until reform is achieved on the national stage. | LINK

The process of unallotment^[1] chosen by the governor of Minnesota — as is his right by law — has raised the ire of lawmakers in the Democratic-controlled legislative branch. Through this action, Governor Tim Pawlenty, who is widely believed to have designs on a presidential run in 2012, has unilaterally made cuts into many programs overseen by the state’s Department of Human Services.

Many of those of programs are Medicaid-funded and, most notably, include Minnesota’s General Assistance Medical Care.^[2] While proposed cuts to programs such as this have made the headlines, it is a lawsuit by six indigent patients against the governor that is shining a spotlight on a state program that covers special diets for terminally ill patients. The program’s entire $5M budget is slashed because of Pawlenty’s unallotments, leaving the nearly 5100 elegible patients for the program vulnerable. | LINK

1. The Governor has the authority to reduce the amount of state spending to prevent a deficit. Minnesota’s Constitution requires a balanced budget. Total: $2.76B, $236M from the Dept. of Human Svcs. [↩]
2. Human Services expenditures make up almost 30% of the state general fund and are largely responsible for dramatically increasing state government costs. In an effort to limit direct impacts to individuals, as well as avoid further reductions to hospitals and nursing facilities, targeted reductions include ending General Assistance Medical Care (GAMC) coverage on March 1, 2010 [↩]

The governor of this state is acting more and more like a presidential candidate all the time, although from all present accounts, it is getting easier and easier to attack Obama’s first official Achilles heel:

For the second day in a row, Gov. Tim Pawlenty this morning ripped into the Obama administration’s plan to overhaul the nation’s health care system. On his weekly radio show, Pawlenty called the plan “terribly flawed,” adding, “we need reform, but this is headed in the wrong direction.”

Are the gloves coming off for our governor in 2012? | LINK

The legislative power (allowing for unallotment) by which the governor of Minnesota is unilaterally able to remedy the state’s budgetary shortfall hasn’t spared healthcare the ax. Within the almost $236M he has proposed for cuts to the Dept. of Human Services, the biggest brunt of ambulatory and hospital (acute) care benefits will be felt by the state’s GAMC fund, which serves low-income adults, ages 21-64, who have no dependent children under age 18 and who do not qualify for federal health care programs. Gov. Pawlenty not only proposes cuts to the program, but also its total eradication for the second year of the upcoming legislative biennium (2010-11). Heavy, indeed. | LINK

What’s one way to get the attention of a Republican governor in a state with a Democratic-controlled legislature who wishes to use his executive powers to cut the state’s largest healthcare safety net in 2010? Put a face on those cuts by sending weekly “updates” to the governor which describe how the money is being spent. To wit:

… [T]he letter highlighted a 23-year-old auto mechanic with no health insurance. After he came into the emergency room with a headache, doctors diagnosed a brain tumor, which despite two surgeries, left him blind in the right eye. He can no longer work as a mechanic, but he doesn’t qualify for state medical programs because he is not completely blind and is not considered disabled. His bill so far: $150,000.

Regions Hospital, located in Saint Paul, MN, is the state’s second largest provider of acute care services to patients who qualify for Minnesota’s Gen. Assistance Medical Care (GAMC) program, and it is making sure Governor Pawlenty gets an eyeful of data. | LINK

THEME ART FOR MN STATE FAIR UNVEILED

Dubbed “The Great Minnesota Get-Together”, the state fair in Minnesota is home to everything “state fair”: from fried cheese curds on a stick to the ever-popular 4-H exhibits. The two-week event boasts some of the healthiest employment opportunities for a state fair in the country, though I suspect this year, competition for spots will be fierce. On a brighter note, the fair organization is celebrating the 100th anniversary of its grandstand. Taken some hits in  recent years for many unknown or just plain horrible acts in recent years, the music on the midway this year is very promising. Kelly Clarkson, Kid Rock, and Bonnie Raitt will be just a view of the acts taking part. | LINK

“I’m trying to avoid a panic attack,” Sen. Linda Berglin, DFL-Minneapolis, said Wednesday. [...]  ”Where will low-income people go if we toss them off health insurance programs?” she said. “They’ll go to emergency rooms, jails, prisons and mental health treatment centers — at far greater cost.” [...]

[Y]our timing is terrible,”[Rep. Tom Huntley, DFL-Duluth] told Human Services Commissioner Cal Ludeman Tuesday. “You want to cut off health benefits for thousands of people just when the unemployment rate is going to hit 9 or 10 percent, and thousands more will lose their employer health insurance.” [...]

“Some parts of the governor’s budget are probably all right,’ Berglin said, “but we need a lot more creative thinking to avoid an even worse economic disaster.” [...]

“Everybody is going to be hurt somewhat” when the state finally hammers out a budget for 2010-2011, Huntley said. “This deficit is a disaster, and we can’t tax our way out of it. We have to make cuts — even in health and human services.”

And so it begins…the opening salvos in one of the most contentious debates in Minnesota’s 2009 legislative session — those involving the cost of healthcare for those who don’t either have it or are on the verge of losing it amidst enormous budget cuts, with a $5B deficit at the root of the problem. | LINK

Until as recently as last month, the prevailing wisdom — at least among leading healthcare policy watchers — was that the healthcare industry, as an economic sector, was immune from the short term effects of a recession. As long as there are people getting sick, they’ll always come to the doctor, right? With all of the recent reports detailing  job losses week after week, it was only a matter of time before the ripple effect would be felt by healthcare organizations and their providers. Job lay-offs and losses mean lost benefits, which means a loss of margin for healthcare orgs. Consider the financial squeeze felt by the insurance companies (the providers of reimbursements to healthcare) and cuts to government payers (Medicare and Medicaid) as states get the pinch; one doesn’t have to think that lay-offs occuring among healthcare line and support personnel will not occur in short order. In fact, they already have — starting with the least senior staff in many healthcare organizations. Hit especially hard are markets in which managed care is king — like the Twin Cities region in Minnesota. | LINK

When Minnesota Governor Tim Pawlenty gets ready to address the state today over its projected budget cuts, the damage to healthcare delivery may be the headline maker of the day. Chief among the affected arenas include many local systems — such as county and municipal services (a fact felt by the single most important care provider to poverty-stricken and working poor patients in Minnesota’s most populous county). However, there is much discussion on how the governor’s plan to cut state healthcare expenditures will affect the largest guarantor of coverage in the state — Medicaid.

Not only does the annual expenditure attributed to Medicaid represent about 20 per cent of the state’s annual budget, but cuts to this agency will also come with a dollar-for-dollar decrease in what the state can reap from federal funds, increasing the pain low-income and dually-eligible elderly patients will feel with respect to affordable access to healthcare. Free clinics, nursing homes, and the General Assistance funds will all be affected. It’s hard to see how Medicaid-financed healthcare here in Minnesota will only be affected minimally. Passionate debate over the next legislative session is guaranteed. | LINK

Minneapolis-based UnitedHealth, which also happens to be the largest healthcare insurer in the state of New York, has settled out of court to pay $50 million to establish a new database that will be used to determine rates for patients who choose physicians outside of the insurance giant’s network. An investigation begun by NY Atty. General Andrew Cuomo concluded a UnitedHealth subsidiary known as Ingenix Inc. was rigged to limit payments to doctors and, therefore, forced consumers to pay more. Cuomo also alleged that there was a conflict of interest because UnitedHealth owns the database.

Typically, patients usually pay 20% of their medical visits to out-of-network physicians. The overall base amount (which also includes the 80% the insurer pays) is determined by a complex method which uses data obtained from that patient database to determine the insurer’s charges to the patient and payments to the provider. Factors such as geographical data and age demographics also play a part. Patients are not supposed to be shortchanged because of this alleged “oversight” by UnitedHealth, says Cuomo. | LINK

Happy New Year! from Doctor Pundit. Posting to resume on 1/2/09.

• Minnesota’s most populous county will end fee-for-service Medicare. Sign of the troubled economy? Docs gotta put food on the table, too.
• Medicare Part D open enrollment to end on 12/31.
• Healthcare plan beneficiaries scramble to take advantage of last minute procedures before benefit resets on 1/1. Looks like some docs will put food on the table.

At a time when the weak economy is hurting the industry, medical groups say they are grateful for the bump in business, however temporary. To cope with demand, doctors are adding hours and delaying vacations. High-deductible plans with health savings accounts were introduced in 2004 and now cover about 10 percent of insured Minnesotans. At the same time, deductibles for traditional plans — known as preferred provider organizations — also have jumped, with a $1,000 deductible now the national norm, according to benefits consultant firm Mercer.

The reports of sexual abuse in nursing homes which two recent cases catalyzed the issue into the national spotlight is a mixed blessing. For years incidence of these cases was rare, simply because of the stigma involved among all parties. Over the past 10 years, however, it has been brought squarely into the spotlight, undoubtedly the result of massive paradigm shifts in patient advocacy and Boomer generational values — as the latter group represents a potentially affected age demographic. The recent cases of bizarre abuse of nursing home residents in southern Minnesota at the hands of female staff illustrate how atypical this issue is, and how atypical the need to contain such episodes needs to be. | LINK

We here in Minnesota are probably not taking too kindly to the latest health index power rankings via the 2008 America’s Health rankings survey, a collaborative between the United Health Foundation, the American Public Health Association and Partnership for Prevention. Prior to last year, our state ranked #1 for four consecutive years.

With an increase in child poverty and a decrease in public health spending, the state slipped to No. 4 this year from No. 2 last year, according to annual rankings released Wednesday by the United Health Foundation. [...]

But the data used in the report may have put Minnesota at an unfair disadvantage [...] [T]his year the Legislature approved $47 million for public health programs to reduce smoking and obesity, money that was not included in the latest analysis, but which could improve Minnesota’s ranking next year.

Interestingly, the bottom 5 states in the survey are conservative Red states. The top 4 — deep liberal Blue. | Full report PDF can be downloaded here.