Additional cuts will deplete the care system reform requires.
An object lesson for would-be reformers of state government's Big Hurt -- health care spending for the chronically ill and disabled -- was administered this year.
The lesson: Even when both partisan sides at the State Capitol agree on a goal for serving people better while spending less, achieving that goal isn't quick or easy. And cutting health care spending while working on systemic change can make the reform task more difficult -- and more urgent at the same time.
To illustrate, consider the fate of a Lutheran Social Services (LSS) proposal called "My Life, My Choices."
In essence, it would have given disabled people and their designated nondisabled "partners" (a relative, friend or guardian) more control of the funds government is already spending for their assistance.
They would be free to purchase the help they need to live as independently as possible -- and would no longer be compelled by complicated, hyper-controlling regulations to pay for more help than they need or want.
This appealing concept has bipartisan acceptance. Provisions that would have launched it found their way into the Legislature's May budget. That budget was vetoed.
When the bills were reshaped two months later, the LSS language had disappeared. GOP legislators said it was scuttled at the Dayton administration's request.
That's not because DFL Gov. Mark Dayton dislikes LSS's idea, said Human Services Commissioner Lucinda Jesson. On the contrary: It's because the idea is so good that a version of it could apply to more recipients of Medicaid-funded long-term care -- the frail elderly as well as the developmentally and physically disabled.
The best way to do that, Jesson said, is to start with a request for permission from the federal government to waive the usual Medicaid rules governing long-term care. She will convene a group of stakeholders soon to help prepare a waiver request by year's end, she said. That ought to be a broad-based group, including people who are not wedded to the status quo.
Jesson contemplates fast work by government's usual standards. But waiver requests often take a year or more to churn through Washington.
Meanwhile, the state budget is expected to keep bleeding red ink. Cuts enacted this year to services for the disabled are already taking a harsh toll on some vulnerable people and their families (see box above for one example).
They are also straining the system developed during the past two decades that allows a larger share of disabled people to live in noninstitutional settings. Providers of services that make noninstitutional living possible are being squeezed hard.
The availability of those services is already slim in some parts of the state. That problem is likely to worsen -- and as it does, the practical opportunity for more disabled Minnesotans to gain cost-saving control of their own lives will diminish.
"We agree with reform," said Steve Larson of The Arc of Minnesota, a leading advocacy group for the disabled. "But we don't want to pull out the safety net before we get to that point." That possibility is too real.
Granted, this year's cuts could have been worse. They were softened by the Republican majority's desire to spare the disabled from the brunt of cost-cutting and Dayton's insistence on spending $1.4 billion more than the original GOP budget would have over two years.
A sizable plot of common ground on human-services policy was discovered by the Dayton administration and Republican legislators during the otherwise contentious weeks leading up to the July 19-20 special session. That unexpected positive development gives LSS-style long-term-care reform a real chance in the next several years.
But the state budget was balanced with one-time measures that all but guarantee more red ink in 2013. If reform of long-term care is still a work in progress when the 2013 Legislature convenes, another round of system-depleting, life-diminishing cuts could be in the offing.
State leaders ought to strive mightily to quicken the pace of change. But the 2013 Legislature's majorities also should be prepared to build a bridge to fully implemented reform -- and bridges aren't built with spending cuts.
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