It was an unusual plea that went out from cash-strapped Hennepin County Medical Center to other metro area counties: Please help pay our pile of medical bills for the uninsured destitute patients who live in your county.
The response was not quite so surprising. The counties are sympathetic, but they don't intend to raise property taxes to cover indigents' medical bills in Hennepin County. It's a problem for the state, they say.
"I do understand the need for Hennepin County Medical Center, which is a true asset to the region, to be maintained," said Scott County Administrator Gary Shelton. "At the same time, I think that in terms of those folks who are truly indigent and require medical care, that's a state responsibility."
It's a discussion that has been heard in county administration buildings across the metro area for the past couple weeks, ever since the state's largest public hospital sent letters to county boards detailing its "financial peril" and the effect of uninsured patients from counties outside Hennepin.
When bolstered by state health care programs, HCMC has been able to digest the cost of treating the uninsured from other metro area counties. For 18 months from January 2008 through June 2009, that amounted to about $6.6 million.
But with the state yanking its coverage for General Assistance Medical Care (GAMC) patients -- and HCMC facing an annual loss of $50 million in funding -- every possible source of funding must be explored, said Mike Harristhal, HCMC's vice president for public policy and strategy.
For HCMC, it's a question of fairness, he said. Hennepin County reimburses HCMC for about 75 percent of the annual cost of treating uninsured Hennepin County residents, currently about $40 million, he said. Why should those taxpayers also cover the tab for, say, Ramsey County residents?
"We are looking for ways to enable HCMC to remain a viable organization," Harristhal said. "Who can we turn to if, in fact, the state is going to step away? Our only recourse is to go to those other units of government, the local counties."
No more non-emergency care
HCMC, Minnesota's busiest safety-net hospital for the uninsured and destitute, is in the midst of perhaps the worst budget crisis in its 123-year history.
It had already responded to reduced funding with job and budget cuts when word came that Gov. Tim Pawlenty was ending the GAMC program this year to close the state's budget deficit. The hospital stands to lose $43 million this year and $50 million next year if state leaders fail to restore GAMC funding when the Legislature meets next week for the 2010 session.
Hennepin County commissioners dedicated 3 percent of this year's 4.95 percent property tax levy hike to raise $18 million for the hospital. Even so, HCMC's budgeted expenditures this year still outstrip revenues by $25 million.
Harristhal said that hospital officials will maintain emergency room treatment for patients regardless of where they live. But he said officials are planning later this year to refuse treatment to uninsured patients from outside Hennepin County who are seeking non-emergency treatment at HCMC clinics. About 370,000 people visited those clinics last year.
"We know that HCMC can't continue to be the primary refuge for uncompensated care ... unless some kind of remedy is found," Harristhal said.
The letter sent to the counties, written by HCMC CEO Arthur Gonzalez to the board chairs of six metro area counties (Carver wasn't included because the numbers were insignificant, Harristhal said), doesn't demand payment.
Instead, Gonzalez proposes negotiating a contract to pay for the care HCMC provides that county's uninsured, much like the hospital's arrangement with Hennepin County.
The hospital didn't have a target number for how much it hoped to have reimbursed, Harristhal said.
"I do know that we've got a $50 million hole to plug and so we are looking forward to having discussions with any and all entities that can play a role in helping us plug that gap," he said.
There might be little to discuss.
"We're concerned about a fair and sustainable way to pay for this, but increasing property taxes is not the way to go," said Ramsey County Manager Julie Kleinschmidt. "We have no plans to enter into a contract with HCMC."
Jerry Soma, Human Services Department manager for Anoka County, echoed Kleinschmidt. "This should be an issue addressed by the Legislature and the federal government, versus putting more dollars on the property tax load," he said.
Shelton said Scott County officials would be willing to talk with HCMC about pushing change at the Legislature, which will meet next week for the 2010 session. But signing a contract with HCMC for indigent care doesn't seem likely, he said.
"I'm not sure how that would work," he said.
"Somebody walks in and says they live in Scott County and are unable to pay or don't pay. Are these indigent people? Are they people that didn't pay their bill? Is any elective procedure allowed?"