Lori Sturdevant: An imperfect remedy for GAMC veto

The conversation turned to panhandling by vagrants, and its detrimental effect on customers' desire to come to downtown Minneapolis, at a recent gathering of city businesspeople and government officials.

As the story was related to me afterwards, a city official in the know about the impact of a particularly onerous gubernatorial veto piped up.

"You think panhandling is bad now? Wait until homeless people lose GAMC next spring, and can't get their meds," warned the person familiar with General Assistance Medical Care and its elimination, slated for March 1. "It's going to get much worse."

I recalled that tale when word came last week from the Pawlenty administration that most of the 30,000-plus impoverished people GAMC serves would be automatically transferred to MinnesotaCare, the state's health insurance program for the working poor, on March 1.

As a result, the GAMC folks' ability to go to a clinic and get prescription drugs would be preserved for up to six months longer, at county expense. (It's another of those unfunded mandates county officials complain about.) If the new MNCare enrollees are able to pay a modest premium, say $5 a month, and some copays, their MNCare coverage could continue indefinitely.

Problem solved?

No. Problem kicked down the road -- and not very far at that.

That's the assessment not only of the hospitals, health plans and health policy experts at the Legislature who have been huddling for months to figure out how to provide medical services to people who make less than $7,800 a year, after the program that serves them now goes away.

It's also the judgment of Sam Grabarski, head of the Minneapolis Downtown Council for the past 13 years and -- increasingly -- health care policy wonk.

Like people in a lot of walks of life, Grabarski is discovering that health care is intruding on his agenda. He's finding that he can't be an advocate for spiffing up downtown's business appeal, and not care about the medical fate of the poorest city dwellers.

"Based on what we know, shifting people to MinnesotaCare isn't going to solve the problem," Grabarski said last week.

There are three main reasons that's so. One: Automatically switching the March 1 GAMC population to MinnesotaCare doesn't deal with the needs of an uninsured, no-income person who appears for the first time in a Minnesota emergency room on March 2 or beyond. Neither does it do much for long for those whose lives aren't orderly enough to expect regular payments of MNCare premiums, however small.

Two: MNCare only covers $10,000 per year in inpatient care costs. Many GAMC patients' hospital bills run much higher. That situation leaves hospitals stuck with uncollectable bills.

Three: Using MinnesotaCare in this way hastens the day when its earmarked state fund runs dry, and it must reduce coverage. That grim day could come as early as the spring of 2011. If MNCare shrinks, more people will be at risk of medically induced poverty. (Will the feds come to the rescue? If a reform bill passes this fall, it likely won't make a difference until 2013 or later.)

This is a statewide predicament. But it hits hardest in downtown Minneapolis and at Hennepin County Medical Center, which Grabarski described as an important business asset.

"HCMC's stability as an institution is in our business interest," Grabarski said. "Having an emergency care facility of that caliber does truly matter, from much more than a convenience standpoint. They'd be the service provider, if we needed them." They're also a resource for downtown employers who seek a provider partner in programs to reduce employee health care costs, he said.

HCMC's services will shrink if it is stuck with tens of millions of dollars in additional uncompensated care costs each year. The county property tax burden will grow, too.

The human toll of a fraying health safety net is also a business worry, Grabarski said. Panhandling is only part of that picture.

"Part of our competitive edge is to have jobs at all skill and salary levels available," he said. "To downtown's ability to be a thriving center economically, it matters that all people have affordable health care and access to medicine."

Grabarski's take on the latest gubernatorial move on GAMC is that it buys time for the search for a better solution. But not much time. "Everyone at the State Capitol ought to go back to the table and keep working on this, to keep as much of the program that existed before now in place as they can," he said.

His part of the business community is ready and willing to take a seat at that table, he said. Seats ought to be reserved for other Minnesota business leaders, too.

Lori Sturdevant • lori.sturdevant@startribune.com