With a May 19 end-of-session
deadline looming, key lawmakers and Pawlenty administration officials
continue to press for a solution that would improve Minnesota’s
health care system.
The House and Senate
have passed different versions of what an improved health system
would look like for both the commercial and public sectors. Pawlenty
favors the House’s approach over the Senate’s,
and in recent days has floated his own solution. As this article
went to press, all parties involved in negotiations believe final
passage is possible.
The current debate is a culmination of many years of task forces,
advisory panels and work groups that have wrestled with how to better
the system and control the cost projections that all agree are unsustainable.
Health costs now consume more than 25 percent of the annual state budget.
The main sticking point in the current negotiations is how to pay
for fixing the current system and expand coverage to more uninsured
Minnesotans. Specifically, there is disagreement on how much should
be drained from the Health Care Access Fund, which was created by the
1992 Legislature to pay for the MinnesotaCare program. Legislators
say the funds should only be used to pay for health care. Pawlenty
wants to use some of it to plug the current $935 million budget hole.
People with disabilities
stand to gain from elements contained in all the proposals now
being debated. Recognizing that our current health system is fractured,
confusing, and tough to navigate, the concept of a ‘health care home’ has been proposed. This would link
an individual to a particular clinic or provider who would agree to
help coordinate all of a person’s health needs. In return, the
service provider would receive a financial benefit for doing so. Advocates
have sought to ensure that individuals with complex needs who may already
have a health care home, (such as children with disabilities in the
TEFRA program, or those in the Minnesota Disability Health Options
program) would not have their current arrangements disrupted. Also
important will be the ability to designate a mental health professional
or specialist as a ‘health care home,’ not just a primary
care doctor. Currently, no one is assisting many of the enrollees
in the fee-for-service Medical Assistance program to ensure their
health needs are being addressed and coordinated.
Additionally, the legislature
wants to expand the Min-nesotaCare program, which would give more
individuals and working families access to affordable health care.
Many current enrollees have complex medical issues or conditions,
but they may not be ‘disabled enough’ to qualify
for Medical Assistance. For individuals in this situation, their pre-existing
conditions may price them out of the private insurance market, so MinnesotaCare
may be the only option they can afford. The governor’s most
recent proposal would include no expansion of the program.
How we pay for health
services—and determining what the real
price is for certain services—would also be addressed in the
reform package. The buzz word is ‘transparency,’ which
would give the public a better understanding of what services really
cost, and which providers are best at delivering those services.
Ultimately, this change would lead to the development of better consumer
report cards and lists that would rank providers based on cost and
quality. Lawmakers
and the governor also want to reward the health providers who do
a good job by paying them more, and indicate more clearly to the
public who isn’t
performing at a level to justify higher reimbursement for services.
Making sure that we’re looking at the entire continuum of health
care services—from hospital stays to PCA and other in-home services—has
been a concern of disability advocates and a focus of the Bridging
the Continuum workgroup of the Health Care Access Commission. Many
people with disabilities and chronic conditions rely on non-medical
services to live independently in the community. Many of these services
(such as case management or independent living skills) are now only
offered through the Medical Assistance waiver programs and are designed
to save money on the acute care, or medical service, side of the
state ledger. Preserving these services, and focusing on health promotion
and prevention of secondary disabilities for those already living
with chronic conditions or disabilities, has been an important part
of the ongoing dialogue.
Whether a bill is passed and
signed by the governor or not, the issue of improving both access
to services and better defining the quality of those services utilized
by individuals with disabilities, will be a continued public policy
focus. The ongoing challenge will primarily be financial, with the
budget deficit expected to grow, not shrink, in the coming months
and years. ![end of story]()
