Health care choices: Cut a lot or cut a lot more

The Minnesota Senate and House approved multi-billion-dollar health and human service bills Monday, as DFLers continued their march toward a showdown with Gov. Tim Pawlenty over a major area of the state budget.

The two bills, which have some notable differences, include what DFL leaders said are painful but necessary reductions in light of the state's $4.6 billion budget deficit. But the reductions fall short of what the governor said is necessary to slow down rising costs.

"I don't think we can take the kind of cut in health care suggested by the governor," said Senate Majority Leader Larry Pogemiller, DFL-Minneapolis, who said Pawlenty was effectively taking a "meat cleaver" to health care programs for the poor and disabled.

The House approved its bill by an 85-49 vote after nearly nine hours of debate. The Senate passed its version 40-23 earlier in the day.

Sen. Linda Berglin, DFL-Minneapolis, said the Senate proposal would lower projected spending by $625 million over the next two years, nearly $200 million more than the House bill would. Much of the difference, she acknowledged, was because the House proposal pushed reductions into the next two-year biennium. Pawlenty has proposed about $1.7 billion in reductions.

The House and Senate DFL majorities both tried to convince Minnesotans that Pawlenty is going too far in pushing people off state-subsidized health care and in cutting funds for hospital and nursing home facilities. In his revised budget last month, the governor proposed savings through changes that would make an estimated 113,000 Minnesotans ineligible for subsidized health care starting in January 2011. State health and human services spending -- which Pawlenty has repeatedly said is ballooning out of control -- would be capped through 2013 at 2010 levels.

DFL House leaders warned that unless a package of tax increases adopted Saturday also is put into law, the proposed reductions in health and human services could rise from the roughly $400 million to as much as $900 million.

Economy vs. philosophy

Berglin said it was the nation's lingering recession -- and not generous health care benefits -- that was causing the state's health care crisis. "It is true that more people [are] without health insurance than at any time that I can remember," she said moments after the Senate passed its bill. "It's all because of the economy."

But Pawlenty spokesman Brian McClung, signaling the philosophical gap between the governor and DFLers, was critical of both the House and Senate recommendations for health and human services. "Minnesota Democrats might not need to try to increase every tax under the sun if they'd implement reforms and slow down out-of-control welfare and health care spending," he said.

House Minority Leader Marty Seifert agreed, saying the House bill did little to tackle needed reform. "It's woefully lacking in reform," said Seifert, R-Marshall. "It expands eligibility while we got billions of dollars in deficits. It doesn't make any sense."

Floor maneuvering

At one point, Rep. Thomas Huntley, DFL-Duluth, sponsor of the House bill, moved to eliminate the state's health care access fund -- even though he doesn't favor such a move.

Huntley said he wanted to force a vote to show how much actual support there was among both DFLers and Republicans for the fund, which primarily pays for MinnesotaCare, the subsidized health program for lower-income Minnesotans.

Huntley's proposal, which would have transferred the money to the state's general fund failed on a 131-1 vote. While the House recommended giving the fund $1.09 billion over the next two years, the governor -- who has proposed tapping the fund for broader budget purposes -- has recommended $540 million.

Republicans decried the maneuver as time-consuming "political posturing." Huntley said the purpose was to strengthen the position of legislators opposed to the governor's proposal as the issue is decided in conference committee and in talks with the governor's office.

But the overall House debate nevertheless signaled again the wideness of the GOP-DFL political gap.

The vote in the Senate also showed that some DFLers don't like their party's plans. Among the 23 senators voting against the bill was John Marty, DFL-Roseville, who recently announced his gubernatorial candidacy and has frequently chastised his party for going too far in health care cuts.

As in previous years, the House defeated -- this time, barely -- an attempt to bar the use of state health care funds for abortion. "We've seen this probably every year," said Rep. Tina Liebling, DFL-Rochester. "What this just does is set up a court challenge."

But Rep. Steve Gottwalt, R-St. Cloud, said such a move would not only be morally correct, but would save taxpayer money. In the end, the move failed on a 66-66 tie.

A focus on fraud

Both the House and the Senate also moved to fortify the number of welfare fraud investigators in Minnesota, a program that the Pawlenty administration had suggested be reduced.

In the Senate, DFLers on Monday recommended hiring eight investigators to try to extend the program's reach to counties not now served.

DFLers in both houses, in addition, moved to remedy the use of personal care assistants, a state program that the legislative auditor said earlier this year was "unacceptably vulnerable to fraud and abuse." The auditor said investigators had found 423 instances in which a personal care assistant claimed to have worked more than 24 hours in one day, yet state agencies paid for the services.

House leaders said their proposal would mean a loss of personal care assistants for an estimated 800 people, as opposed to an estimated 2,200 people losing the service under the governor's suggestion.