The DFL-controlled Legislature is on the brink of extending a state program that would pay health care costs for about 85,000 of Minnesota's poorest and sickest residents over the next 16 months.

The question is whether Republican Gov. Tim Pawlenty will sign this stripped-down version of General Assistance Medical Care (GAMC), the program he vetoed last year.

The measure was approved by the Senate last week and is scheduled to come up for a vote Thursday in the House. The legislation could be headed to Pawlenty in a little over a week.

While he won't say for sure, the governor hinted Friday that he might not sign it.

"This latest DFL proposal simply re-creates the old program with no reform, spends money the state doesn't have, and slashes reimbursement rates to providers," said Brian McClung, Pawlenty's spokesman.

GAMC is scheduled to end March 31, and the governor is poised to move most of the people currently in the program to MinnesotaCare, state-subsidized health insurance for low-income working people.

Trade groups for Minnesota doctors and hospitals want to keep GAMC and regard MinnesotaCare as a bad fit for people earning less than $8,000, many of them homeless and coping with mental illness and addictions.

Sponsored by DFLers Rep. Erin Murphy of St. Paul and Sen. Linda Berglin of Minneapolis, the legislation would create a 16-month GAMC program funded by some federal dollars as well as decreased reimbursement to health care providers and cuts to county social services grants. It also would change some mental health care.

Hospitals generally favor the proposal as "better than nothing. We may lose $100 million instead of $160 million if GAMC ends. The patients are still going to need care. They'll just come to our emergency rooms," said Lorry Massa, CEO of the Minnesota Hospital Association.

Mayo Clinic had opposed the bill when it included a surcharge on hospitals, but said Friday it now supports the measure.

But doctors say the 50-percent cut in payments for care is too steep.

"We'll work with anybody" to save GAMC, said Robert Meiches, CEO of the Minnesota Medical Association. "But the current rates are below our costs of treating patients, and cutting them in half does not make sense. I understand the economic problems we all face, but we really need to overhaul how we care for those patients."

Murphy, chief sponsor of the House bill, said she intends to pursue that for the 2011 session, "but we don't have the luxury of time right now."

She said she and Berglin have met regularly with officials at the Department of Human Services and have changed the legislation several times to meet their objections -- most recently last week.

"We want a bill the governor will sign, one that will do the least amount of harm," Berglin said. "It would be a whole lot easier if the governor would tell us what he would like instead of what he doesn't like."

State poised to act

Unless the Legislature and governor agree on a GAMC extension, in two weeks the state Department of Human Services will start revamping its computer system to shut down GAMC and soon after will mail letters to its clients telling them they will be shifted to MinnesotaCare.

Advocates say many enrollees, with no permanent address, won't get the letters.

"They're going to start calling our hospitals because when their regular coverage ends, they know we won't turn them away," Massa said.

"If we don't get some kind of [GAMC] extension, there's going to massive confusion among all of us, docs, hospitals and patients," he said. "For us, it's just confusion. For many of the patients, this will be much more serious."

Warren Wolfe • 612-673-7253