HCMC struggles with budget choices

DFL state lawmakers will announce on Thursday their plan to to restore funding for General Assistance Medical Care. Gov. Pawlenty cut the program earlier this year to help balance the budget. GAMC reimburses hospitals that treat uninsured patients.

The hospital that will suffer most under the cut is the Hennepin County Medical Center in downtown Minneapolis. County officials say the hospital will lose more than $90 million over the next two years.

Earlier this year, HCMC staff tried to find a way to make up for the loss of General Assistance Medical Care funding in 2010. They proposed to cut nearly 200 jobs, close two clinics and limit some hospital services. Despite those moves, it's still not enough to close a $25 million budget gap.

HCMC is a "safety net" hospital, meaning it can't refuse emergency medical treatment to people who can't pay for it.

That won't change. But because so many of their patients don't have insurance, HCMC relies heavily on programs like general assistance for reimbursement.

The hospital is more than a last resort for the poor. It boasts the state's largest level one trauma center, and features a top-rated burn unit and poison control center.

On a recent weekday afternoon, the HCMC emergency room is relatively quiet. However, doctors like Doug Brunette have plenty of patients. Brunette is aware of the budget gap caused by the loss of general assistance, but he says it won't affect how he and his colleagues do their jobs.

"These people aren't going to go away. Their medical conditions and problems aren't going to disappear, whether or not they're covered by an insurance program by the state or the county," said Brunette. "It's a question of how we continue to take care of them without getting paid for it."

HCMC CEO Arthur Gonzalez says the county can recoup some of the lost funds, as the people on general assistance switch to MinnesotaCare -- another state-funded health care payment system. But Gonzalez says MinnesotaCare won't reimburse them at the same rate as general assistance.

"We believe the state's estimates are optimistic. They believe that 75 percent of these people will re-enroll and come over," said Gonzalez. "We know the population. We treat them every day. Our estimate is closer to 25 percent. So, $43 million may be going away -- probably only $6 million coming back."

Gonzalez says the county will close an eldery care clinic and a cardiac rehab unit. They will delay capital improvements, and deny clinic and pharmacy access to people who live outside Hennepin County.

Gonzalez says other counties should either provide the same service, or pay HCMC to do it.

"Four [counties] in particular ... we'll be sending a letter to from our board to theirs, asking them to develop a formula and asking them to consider reimbursement for that, so we can keep providing services to everyone," said Gonzalez.

Hennepin County officials hope state legislators can restore GAMC funding, and help them avoid more layoffs and service cuts in the years to come. Next week legislators will discuss the DFL plan to restore General Assistance Medical Care.

House Speaker Margaret Anderson Kelliher, who's also a DFL candidate for governor, didn't provide details of the DFL proposal. But she said restoring general assistance is a top priority.

"That plan will give some real options for what a solution would look like," said Kelliher, "that would preserve the jobs of so many Minnesotans working in health care at our hospitals and clinics, and also be able to provide the needed health insurance coverage for these very sick and poor Minnesotans."

The House holds a hearing on the DFL proposal on Monday. Despite talk of a solution, that proposal isn't likely to have any immediate impact, because on Tuesday, the Hennepin County Board has to approve the 2010 HCMC budget.

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