Health care spending plans take shape
By Scott Wente
St. Paul Capitol Bureau
ST. PAUL - Hospitals take a funding hit while most nursing homes are protected.
Low-income Minnesotans keep their government-subsidized health insurance while some doctors lose state aid for treating the poor.
Facilities caring for patients with long-term illnesses lose some state support while more children are eligible for public-supported health insurance.
Those are among trade-offs offered in similar, but competing, health-care and human services proposals lawmakers approved Monday. The bills fund the second-largest - and fastest-growing - portions of the state budget.
The Minnesota Senate version passed 40-23. The House approved its bill 85-49.
The House and Senate plans, each spending around $11 billion in the next two years, are vastly different than Gov. Tim Pawlenty's health finance proposal, which cuts some programs to slow health-care spending. The Republican governor argues that unless spending increases are curtailed, health care will consume the state budget.
The House proposes cutting $400 million from what health and human services programs otherwise are projected to cost in the next two-year budget period. The House bill would add 50,000 Minnesota children to the health-care rolls, while at the same time cutting funding headed to many health-care providers.
"That means there's 400 million reasons to vote against this bill," said Rep. Tom Huntley, DFL-Duluth, chairman of the House health finance committee. "I don't like this bill. I think the cuts are going to hurt a lot of people and a lot of institutions."
Just over $600 million is cut from the Senate plan, amounting to a 7 percent decrease in projected spending increases. Sen. Linda Berglin, a Minneapolis Democrat and Senate health finance chairwoman, said her committee "did a pretty good job considering the (spending cut) target we were given."
Senate Democrats have proposed a $2.2 billion tax increase, and yet they also propose cutting funding to nursing homes and other health-care programs, said Sen. Michelle Fischbach, R-Paynesville.
"These are not the kinds of priorities that we want to see in this budget," said Fischbach, a member of the health and human services budget committee.
No one would lose state health care in either the Senate or House proposal. That is one of the biggest differences with Pawlenty's human services budget proposal, which would drop at least 84,000 people from the MinnesotaCare health insurance program.
Nursing home funding is among the most politically sensitive human services programs, and all three proposals delay anticipated state aid increases to the facilities.
However, like Pawlenty's proposal, the House bill makes no reductions to nursing home reimbursements. Other types of long-term care facilities, such as for developmentally disabled patients, lose reimbursement
Senate Democrats' bill would cut $6.5 million collectively from nursing homes that receive the highest level of state reimbursements among facilities in their region.
Rural senators, led by Democrat Mary Olson of Bemidji, tried to change the proposed nursing home reductions so fewer rural facilities would see cuts.
"It does give them a chance to survive another year," said Sen. Dan Skogen, DFL-Hewitt. A nursing home is the second-largest employer in many small towns, he added.
Olson's amendment was rejected 45-20.
In the House, rural lawmakers tried to amend the two-year-old statewide smoking ban. The proposal by Rep. Tom Rukavina, DFL-Virginia, would have allowed smoking in designated rooms outside bars.
"This is a fair approach to this problem," Rukavina told colleagues before they rejected his amendment 69-63.
Like the other spending bills, House and Senate negotiators will begin working out differences between the health finance packages in the coming days.
While Huntley has not met with Pawlenty all this legislative session - despite many other committee chairmen being invited to the governor's office - he has met with Human Services Commissioner Cal Ludeman and they are beginning to work on a final product that Pawlenty could sign.
It has been difficult to put together a bill, Huntley said, because information about federal economic stimulus money that state wants to use has been difficult to sort out. That problem also delayed progress on the Senate's proposal.
Pawlenty modified his health and human services plan after information became available about how federal funds could be used. He promoted the fact that his new budget proposal includes very few cuts.
However, Huntley said, after the federal funds end in two years, Pawlenty's proposal would result in deep cuts.
Democrats, who control both legislative chambers, brought up parts of Pawlenty's health budget proposal as amendments, forcing Republicans to take votes on their GOP governor's plan.
Huntley said it is too early to know if the health and human services budget will need changing due to the spreading swine flu problem.
The Duluth Democrat has been a leader in getting health officials funding they need to combat bioterrorism or other health epidemics. The Health Department already has funds for some flu-fighting medication, but Huntley said he needs to wait until health officials make recommendations whether more funds will be needed.
Huntley did nothing to downplay the importance of fighting swine flu. "I don't think the public understand the seriousness of it."
Senators approved a provision by Sen. Bill Ingebrigtsen that would free up the buyer of a health-care facility from state charges assessed to the former owner.
Ingebrigtsen, R-Alexandria, said his provision will help a health-care facility in his legislative district and at least one other in northwestern Minnesota.
"It's certainly going to help out the community," Ingebrigtsen said.
Rural lawmakers unsuccessfully attempted to change the spending proposals to provide more funding to health-care facilities outside the Twin Cities.
"Rural Minnesota once again gets the shaft," Rep. Rod Hamilton, R-Mountain Lake, said.
Rep. Matt Dean, a top Republican on health care, said lawmakers should realize the health-care proposal does not contain enough spending reductions and is "growing unsustainably."
"We cannot afford this," said Dean, R-Dellwood.
Here is how local senators voted on a finance bill that spends $9.8 billion on health and human services programs:
Tom Bakk, DFL-Cook, did not vote
Steve Dille, R-Dassel, yes
Michelle Fischbach R-Paynesville, no
Dennis Frederickson, R-New Ulm, no
Joe Gimse, R-Willmar, no
Bill Ingebrigtsen, R-Alexandria, no
Gary Kubly, DFL-Granite Falls, no
Keith Langseth, DFL-Glyndon, yes
Tony Lourey, DFL-Kerrick, yes
Steve Murphy, DFL-Red Wing, yes
Mary Olson, DFL-Bemidji, no
Pat Pariseau, R-Farmington, no
Kathy Saltzman, DFL-Woodbury, yes
Tom Saxhaug, DFL-Grand Rapids, yes
Katie Sieben, DFL-Cottage Grove, yes
Rod Skoe, DFL-Clearbrook, yes
Dan Skogen, DFL-Hewitt, no
Yvonne Prettner Solon, DFL-Duluth, yes
LeRoy Stumpf, DFL-Plummer, yes
David Tomassoni, DFL-Chisholm, yes
Ray Vandeveer, R-Forest Lake, no
Jim Vickerman, DFL-Tracy, did not vote
Here is how local representatives voted on a health and human services bill that would spend $9.67 billion in state taxpayer funds:
Paul Anderson, R-Starbuck, no
Tom Anzelc, DFL-Balsam Township, yes
Karla Bigham, DFL-Cottage Grove, yes
Julie Bunn, DFL-Lake Elmo, yes
Matt Dean, R-Dellwood, no
David Dill, DFL-Crane Lake, yes
Steve Drazkowski, R-Wabasha, no
Kent Eken, DFL-Twin Valley, yes
Andrew Falk, DFL-Murdock, yes
Tim Faust, DFL-Mora, yes
Pat Garofalo, R-Farmington,
Rod Hamilton, R-Mountain Lake, no
Larry Haws, DFL-St. Cloud, yes
Bill Hilty, DFL-Finlayson, yes
Larry Howes, R-Walker, no
Tom Huntley, DFL-Duluth, yes
Al Juhnke, DFL-Willmar, yes
Tim Kelly, R-Red Wing, no
Lyle Koenen, DFL-Clara City, yes
Morrie Lanning, R-Moorhead, no
Bernie Lieder, DFL-Crookston, yes
Doug Magnus, R-Slayton, no
Paul Marquart, DFL-Dilworth, yes
Denny McNamara, R-Hastings, no
Mark Murdock, R-Ottertail, no
Mary Murphy, DFL-Hermantown, yes
Bud Nornes, R-Fergus Falls, no
Dave Olin, DFL-Thief River Falls, yes
Mary Ellen Otremba, DFL-Long Prairie, yes
John Persell, DFL-Bemidji, yes
Tom Rukavina, DFL-Virginia, yes
Brita Sailer, DFL-Park Rapids, yes
Marty Seifert, R-Marshall, no
Tony Sertich, DFL-Chisholm, yes
Loren Solberg, DFL-Grand Rapids, yes
Phil Sterner, DFL-Rosemount, yes
Marsha Swails, DFL-Woodbury, yes
Dean Urdahl, R-Grove City, no
Torrey Westrom, R-Elbow Lake, no