State would lose $2 billion, then more, under GOP health care bill, agency says

July 06--Minnesota would lose about $2 billion in federal dollars for medical assistance programs in just 18 months if Congress passes the Republican-sponsored health care bill now under consideration in the Senate, according to a state analysis released Wednesday.

The estimate by the Department of Human Services (DHS) found those funding losses would multiply in subsequent years, with the state projected to lose $10.4 billion by 2025 and $31 billion by 2030 in money now used to operate Medical Assistance, the state's version of Medicaid, and MinnesotaCare, the subsidized insurance program for low-income individuals.

More than a million Minnesotans rely on those programs for their health care. About two-thirds of the cuts would be to programs that serve the elderly and people with disabilities.

"The fact that Republicans in the House and Senate would even consider something that could have a devastating affect on over a million Minnesotans is just shameful," Gov. Mark Dayton said at a news conference with U.S. Rep. Keith Ellison, D-Minn., on Wednesday in Minneapolis.

Democrats nationally have been working to rally opposition to the Senate's Better Care Reconciliation Act, the Republican-crafted legislation meant to replace President Barack Obama's signature Affordable Care Act (ACA).

Republicans in the U.S. House already approved a bill to repeal and replace the ACA, with Minnesota's three Republican congressmen -- Erik Paulsen, Tom Emmer and Jason Lewis -- all voting in favor. They have defended the legislation as needed to drive down health insurance costs. The DHS analysis said the consequences in Minnesota would be similar under both the House and Senate versions of the legislation.

Minnesota's Democratic U.S. senators are unlikely to vote for the Senate bill, and it's not yet clear if Republicans can muster the votes to pass it. If they do, the House would have to vote on it again.

Both GOP bills would give states more say in medical assistance programs, but also withdraw billions in current funding; the result would likely be scaling back of programs that provide coverage to the poor, disabled and elderly.

"People need to raise their voices about the dangers of the House and Senate bills as if their lives depended on it," Ellison said. "Some people's lives do depend on it."

Backed by about a dozen DFL legislators at the NorthPoint Health and Wellness Center in north Minneapolis, Dayton said he's deeply concerned about the 1.2 million Minnesotans who depend on Medicaid for health care. He said the proposals would mean the end of MinnesotaCare, used by about 100,000 people, including a large number in greater Minnesota.

Emily Piper, the state's commissioner of human services, said the federal support benefits a range of people, from farmers to people in need of substance abuse treatment. She said Minnesota's opioid epidemic has expanded the need for coverage of babies born to mothers who used opiates. About 80 percent of those babies receive Medicaid to pay for their health care services.

Piper said the federal government also helps ensure that some Minnesotans who buy insurance on the individual market can have their monthly premiums subsidized. She said the state would struggle to make up for a sudden shift from Washington, D.C.

"That amount of money can't be made up in other areas of the budget in Minnesota or any other state," she said.

If big federal cuts come to pass, it would fall on the Legislature to implement the cuts through legislation. The main options would be to reduce benefits, reduce eligibility, pay providers less, ask program enrollees to pay premiums or co-payments, and more managed care with stricter rules and fewer provider choices.

Two Medicaid recipients said they're not sure what they would have done had they not been able to seek help from the state. James Robinson used the program to help pay for substance abuse treatment programs and said he's now on track for a much different kind of life than he once led.

"When there's no health care for you, the only option is to suffer or die," he said. "If it wasn't for [Medicaid], I'd be a statistic: dead or in jail."

Stella Whitney-West, CEO of NorthPoint Health and Wellness Center, said her biggest concern is about the impact of more people showing up at facilities like hers without insurance. She said that will add up to big losses for health care facilities, which could have to lay off workers and reduce services for communities that need them as much as ever.

"People will end up in emergency rooms," she said. "It still is going to cost and be even more costly."

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