With most hospitals opting out, a program to cover state's poorest residents is in danger of unraveling.
A compromise plan to provide health care for thousands of the state's poorest residents appeared to be unraveling Tuesday, after Hennepin County affirmed its decision not to participate and legislators scrambled to find a solution.
The health program for more than 35,000 people, brokered last month by legislators and Gov. Tim Pawlenty, is supposed to take effect June 1. But by late Tuesday, it appeared that as many as 16 of the 17 hospitals that were to participate may refuse.
"We can't be a safety net hospital for the entire state,'' Hennepin County Commissioner Gail Dorfman said after Tuesday's board vote.
Commissioners said the terms of the new hospital-based "coordinated care delivery systems," envisioned to replace the General Assistance Medical Care program, could overtax the capacity of Hennepin County Medical Center (HCMC) to care for poor people seeking treatment, especially if other hospitals refuse to participate. Each participating hospital is to receive a set amount of money to treat all patients in the program who choose it or are assigned to it.
Without the program, hospitals would treat those patients for free, as they did before it began in 1975.
The revised program "won't work with so few hospitals,'' said Sen. Linda Berglin, DFL-Minneapolis, an architect of the compromise after Pawlenty vetoed funding for the original program. "This is very frustrating.''
Berglin has offered legislation to scrap the program entirely and cover those patients with an expanded state-federal Medicaid program on June 1.
Rep. Jim Abeler, R-Anoka, was preparing a different solution. He planned to submit legislation to address Hennepin County's concerns. But he expressed frustration with the hospitals' position.
"The problem is that ever since the federal health reform bill passed, the hospitals have gotten this vision of Medicaid expansion -- something we can't do because it's just too expensive," Abeler said. "They're chasing a mirage. They're entranced by a picture of steak and they're refusing the bowl of porridge we put in front of them."
Pawlenty, meanwhile, seemed unmoved by the Hennepin County decision.
"If the hospitals are interested in creating patient caps, they should tell us which patients they don't intend to serve," said spokesman Brian McClung. "We remain committed to working with hospitals to make this reform work. We believe that ultimately, hospitals will choose to participate, given the option between this funding and no funding at all."
In an interview Tuesday afternoon, Hennepin County Board Chairman Mike Opat said McClung's remarks were "unhelpful and oversimplified the complexity here."
"We as a county or as a medical center cannot accept sole responsibility for the state's uninsured, nor can we accept an inordinate amount of responsibility for the state's uninsured," Opat said.
Since the board first signaled its discontent with the state program last week, county and HCMC officials met with state Human Services officials to negotiate terms of the new program. Opat said the county primarily sought limits on the number of program patients that HCMC would serve and guarantees that HCMC wouldn't have to pay to treat enrollees of other hospitals. Participants in the program are childless adults earning less than $8,000 a year. Many are homeless, and most are dealing with chronic illnesses, addiction or both.
In the end, Opat said, state officials said that they didn't believe the new law allows negotiation. "We prefer that they take a little more expansive view of the statute -- or change it," Opat said.
The plan, enacted into law last month, called for 17 hospitals around the state, serving 80 percent of the GAMC patients, to set up coordinated care systems offering complete health care and some social services. After initially saying that program was better than nothing, most hospitals now have refused to participate, arguing -- as the Hennepin County Board did -- that the financial risks are too high.
Now only Regions Hospital in St. Paul says it likely will participate.
North Memorial in Robbinsdale said last week that it would follow HCMC's lead. On Tuesday, a spokesman for the Fairview Health Services said it is "greatly concerned" about Hennepin County's decision and has not decided whether its University of Minnesota Medical Center, Fairview, in Minneapolis and Fairview Ridges in Burnsville will participate.
But Mike Harristhal, HCMC's vice president for public policy, said there is still hope for a compromise. "I could envision us not joining in the first quarter, seeing how our patient flow is, and then revisiting the question later. It's not real likely, but I could envision it."
Warren Wolfe • 651-222-0973 Kevin Duchschere • 612-673-4455