The Minnesota Department of Human Services offered an 11th-hour gift to thousands of Minnesota's sickest people this week. Let's hope it's a gift that keeps on giving.
Beginning Jan. 1, services covered under a medical safety net, called Emergency Medical Assistance, were to be dramatically scaled back. Due to a flurry of appeals, DHS has postponed implementation until Jan. 8.
Policymakers and community leaders are now scrambling to mitigate the potentially dire impact of the cuts made during the Legislature's one-day budget special session last July. Most of those affected by the cuts have only recently gotten wind of their effects.
DHS sent out a letter on Nov. 29 informing about 2,300 EMA enrollees and thousands of providers that 2012 payments will cover only emergency-room visits and hospital in-patient services, with few exceptions. Among jettisoned programs: dialysis, chemotherapy, prescription drugs, dental services and mental health services, the kind of care that keeps people out of emergency rooms.
The issue is a hot potato because most of those affected are "non-citizens." Some are on their way to becoming Americans; others have fled repressive regimes. Others are repairing your roof or caring for your elderly parent in assisted living. If I can't convince you that it's immoral to withhold chemotherapy or mental health services from anybody in our community, how about this: It's not smart business.
Without the safety net, an influx of increasingly ill patients will be forced to turn to the already overburdened emergency rooms of Hennepin County Medical Center in Minneapolis, and Regions Hospital in St. Paul. Those exorbitant costs will then be passed on to taxpayers.
"I can't think of a more expensive way to cover health care," said Rep. Carlos Mariani, DFL-St. Paul. Mariani was on the House floor when the bill was passed in July, "and, still, I'm not sure I know the extent of how many people are affected," he said. As details of the cuts became clearer, "my heart just sank," he said. "This is not just a budgetary adjustment. We did permanent, statutory law change."
Hennepin County Commissioner Gail Dorfman also was caught off-guard. She said she heard "some rumors" right after the special session. But she didn't realize just how severely the bill would hit certain populations and the facilities that serve them until county staff met. About half of those losing services live in Hennepin County.
About 3,600 people receive EMA services annually, at a cost of $44.5 million. About one-third of that amount was cut out in July. Rep. Jim Abeler, R-Anoka, one of the bill's sponsors, stands by his decision.
"We had a $44 million annual budget prior to this for emergency situations," Abeler said. "But the word 'emergency' evolved to 'almost emergency' or 'pretty serious' or a catch-all for things that were not an emergency. Pretty soon, you're way off policy with a program that has grown to serve people who were not designed to be served by it."
He denies that the bill targets immigrants. "The immigration piece has nothing to do with this," Abeler said. "It's one more program that's grown beyond its original design. I'm quite comfortable that no one will come to any harm."
But Capitol insiders suggest that even some Republicans were surprised by the bill's full implications and are receptive to finding ways to avoid the most serious unintended consequences.
Deputy DHS Commissioner Anne Barry said that the issue "has been a struggle for a lot of people inside our agency," as they weighed emergencies "on the continuum," constricted by state and federal funding mandates. Parents of a child with autism, for example, or people living with dementia, need services, she said, "but they don't fit the definition of an 'emergency.'
"A number of us certainly have concerns about what will happen to people in the middle of dialysis or who are undergoing chemotherapy. But chemotherapy and dialysis are not defined as an emergency because they are not provided in an emergency setting."
And when they are provided there, out of desperation? "It may cost us more to take that particular route, that is correct," Barry said. "We are open to a discussion of how to expand this conversation."
It's a conversation we need to have in a hurry, and not just amongst ourselves. "Situations like this could be prevented if legislators and government agencies worked more closely with the communities who will be affected by a proposed program change," said Monica Hurtado, with the Alliance for Racial and Cultural Health Equity.
As she and others file appeals and make calls to potential assistance programs, Dorfman holds out hope that EMA will be restored, "but I don't see that happening overnight. Still, as the county with the largest safety-net hospital in the state, we are not going to let our residents die on the street because they can't get dialysis," Dorfman said.
"It's irrelevant to us where they were born, frankly. We have a responsibility to care for them."
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