Lawmakers unveil plan to replace GAMC

To ease the transition, GAMC will be temporarily extended through May.

by Tara Bannow

General Assistance Medical Care is back on âÄî well, sort of. Gov. Tim Pawlenty, DFL and Republican leaders emerged from more than a week of debate Friday with a new plan that would replace GAMC with a trimmed-down delivery system managed largely by hospitals. Under the plan, hospitals will form Coordinating Care Organizations, or CCOs, and will receive grants on a quarterly basis to provide care to the stateâÄôs poorest individuals. The $71 million theyâÄôll receive from the current budget, however, likely wonâÄôt cover the cost of patient care, providing incentive for them to refer patients to outside services, such as veteranâÄôs assistance. âÄúItâÄôs a new idea that bases health care more on results and less on the number of tests,âÄù Sen. David Senjem, R-Rochester, said. âÄúIt was the most outstanding of any solution that I think we could have arrived at.âÄù While the plan may change in the coming weeks, Pawlenty said it represents a step forward in health care reform, âÄúin a direction towards how we provide health care from an old way of doing it to a new way of doing it.âÄù To ease the transition, GAMC will be temporarily extended through May using $28 million from the Health Care Access Fund. Those currently on GAMC will not be moved into MinnesotaCare, which will continue to provide coverage to adults without children. The new plan will cost $164 million in the current biennium, less than one-fourth the projected cost if the program continued unchanged. Funding will come from the general fund and the Health Care Access Fund. The proposal would also direct $45 million from the stateâÄôs general fund for prescription medication coverage in the upcoming fiscal year and $83 million in the following. Legislators say this will provide for the many GAMC patients who are mentally ill. The bill would name 17 hospitals in the state to become CCOs, a collective that serves more than 80 percent of the GAMC population, Sen. Linda Berglin, DFL-Minneapolis, said. Because hospitals will still experience uncompensated care, the plan may lead to higher premiums. Pawlenty highlighted three hospitals found to be particularly overburdened with providing indigent care that will undoubtedly increase costs: Hennepin County Medical Center, Regions Hospital and the University of Minnesota Medical Center, Fairview. âÄúWhoâÄôs going to pay? The people who already have insurance,âÄù Rep. Tom Huntley, DFL-Duluth, said. âÄúTheir rates are going up because of this, what weâÄôre doing here today.âÄù For the more than 131 hospitals not eligible to become CCOs, the agreement allocates $20 million toward a six-month Uncompensated Care Pool. The bill provides significantly less money for hospitals than the previous GAMC plan that was vetoed by the governor, Berglin said. âÄúThe reform in the bill, including the mental health reform, is all good, but I think itâÄôs underfunded,âÄù she said. âÄúItâÄôs hard to reform something if you donâÄôt even have enough for more than shoelaces.âÄù If continued in its previous form, the GAMC program would have cost $750 million in the current biennium, $930 million in the next one and about $1.3 billion in the following biennium, Pawlenty said. âÄúOne part of our state budget that is growing just absolutely out of control compared to anything else, or the growth in the private economy, is welfare programs, social service programs, publicly subsidized health care programs âÄî particularly the last one,âÄù Pawlenty said on his radio show Friday morning in response to a caller who accused him of disproportionately taking benefits from the poor. The plan will still need House and Senate approval and the governorâÄôs signature to become law. The Senate will start hearing the bill âÄî and may even have it on the floor âÄî next week, Berglin said. GAMC was slated to end April 1 following two vetoes by the governor. At that point, GAMC patients would have been autoenrolled into MinnesotaCare. The planâÄôs unveiling came only hours after a Ramsey County judgeâÄôs decision not to hear a motion to stop the GAMC shutdown. Rep. Jim Abeler, R-Anoka, who voted for the GAMC plan and voted to sustain the governorâÄôs veto a week later, said the additional negotiation was exactly what needed to happen. âÄúI think itâÄôs a very good resolution to a very difficult problem,âÄù he said. âÄúIt serves the greatest amount of need in a very vulnerable population.âÄù