How not to balance the Minnesota budget

The deficit will not go quietly into that good night, but neither should our commitment to social welfare.

It’s hard not to sympathize with state officials struggling to balance their budgets in an era of runaway health-care costs. In states across the country, health care has become the 800-pound gorilla, threatening to drown out competing needs such as education and public safety.

Minnesota is no different. Once again, the state is confronting a sizeable budget deficit – though at $700 million, the red ink is considerably smaller than last year. The budget released by Gov. Tim Pawlenty last week wipes out that deficit in part by sharply reducing health and human services funding. Much of these savings come from cutting more than 30,000 adults from MinnesotaCare, the state’s health insurance program for the working poor.

The governor’s “no new taxes” pledge, however, remains firmly intact.

And that’s where the urge to sympathize should end. Pawlenty has rightly preserved health-care assistance for children, seniors and the disabled – if only because the federal government covers approximately half the insurance costs of those populations through Medicaid. But he is asking working adults, many of whom are parents, to sacrifice their health insurance for an ambitious politician who has staked his political future on a foolhardy refusal to consider income-tax hikes.

Balancing the state’s budget on the backs of the poor and the otherwise uninsured is unwise for a host of reasons. But before delving into those reasons, it’s worth pondering the rationale behind the health-care cuts Pawlenty has proposed.

The governor has consistently argued that Minnesota provides more social services than most other states. In fact, Pawlenty routinely makes that observation when discussing the state’s fiscal future and the need to do more with less. He did so this month when he pointed out that, unlike Minnesota, most states do not provide health insurance for so-called “able-bodied” adults.

Pawlenty’s push to put Minnesota back on par with other states is a sign of the changing times. Suburban and exurban population growth is turning Minnesota from a Democratic stalwart into a battleground state with an expanding Republican base. Along the way, the social compact that once set Minnesota apart for its progressive politics is steadily eroding. Higher taxes, generous social services and a first-rate educational system used to be a bargain that set Minnesota apart from other states. Not anymore.

The competitive pressures of a global economy and double-digit health-care inflation might indeed require a change in the way Minnesota provides its social services. That’s a debate both state Republicans and the DFL should welcome, and one in which health care will figure prominently. Doing more with less is an admirable goal that will help spur new and innovative public policies. But taking health insurance away from low-income workers is hardly innovative. That’s not doing more with less; that’s just doing less.

As for the wisdom of scaling back state health insurance assistance, precisely when health-care costs are skyrocketing, consider a few facts. First, the uninsured don’t disappear and neither do their health problems. Eventually, they show up at emergency rooms and public clinics with more serious – and more expensive – ailments. The medical bills they can’t pay then become the responsibility of charity care providers who rely heavily on government subsidies to remain in business. Either way, you and I and every other tax-paying Minnesotan foot the bill.

Second, many of those 30,000 or so will pay a heavy price for losing their MinnesotaCare assistance. As their drug prescriptions go unfilled and illnesses untreated, their health will likely suffer. Public health researchers and health-care providers can attest to the close relationship between health insurance and health status.

Pawlenty has sought to sugarcoat his bitter pill by giving individuals the option to qualify for

General Assistance Medical Care, but most will not be eligible until they incur significant medical debt.

Minnesota cannot escape the budgetary pressures of today, but balancing the budget does not require jettisoning a decades-old commitment to social welfare. Slashing the “welfare health-care” rolls, as Pawlenty calls them, is a bad public policy that takes the state backward, not forward. It’s now up to the Legislature and the voters to remind Pawlenty that the health of all Minnesotans should be a public priority – even if it means raising taxes.

Jamie Bitz is an Editorial Board member. He welcomes comments at [email protected]