April, 2009
April 29, 2009| Posted in Articles, Health Care, In the News, News Media
LEGISLATURE: BUDGET BATTLE OVER HEALTH CARE WILL BE MOST BRUTAL
By Britt Robson, St. Paul Legal Ledger, April 30, 2009
In this session of an historic $4.6 billion deficit, GOP Gov. Tim Pawlenty and the DFL-controlled Legislature are on a sure collision course.
And no collision will be more painful than the one that’ll happen over the health and human services budget, second only to education in the amount of the general fund it consumes.
This week, both the House and the Senate set the stage for their role in the collision, as each passed a Health and Human Services Omnibus Bill that minimizes the carnage wrought by the economic downturn on the supply and demand of government services but compels the need for a tax increase.
Specifically, both omnibus bills ignore two of the no-new-taxes governor’s more controversial budget proposals: Pawlenty wants to tighten the eligibility standards for access to public health care plans, a move that would throw more than 60,000 Minnesotans off the public health care rolls (without the federal stimulus money, that number would climb to 113,000).
Pawlenty also proposes to eliminate the Health Care Access Fund – the dedicated revenue stream used to underwrite the MinnesotaCare program for working Minnesotans who would otherwise lack health insurance – while retaining the fund’s health care provider tax and diverting the revenue into the general fund.
Both the House and the Senate retain the HCAF as a dedicated source for MinnesotaCare and not only resist reducing eligibility for the public health plans, but also seek to insure an additional 20,000 children by removing some bureaucratic requirements for enrollment.
And, of course, these positions aren’t realistic without a tax increase or some other significant new source of revenue.
That said, both the Senate and House bills contain painful cuts, albeit in different areas of the HHS budget. Which providers experience the brunt of the reductions will likely form the grist of the debate between House and Senate members in the conference committee. The Senate bill contains $600 million in spending reductions compared with $400 million in the House – but Pawlenty has proposed $1.7 billion in spending reductions.
The Senate bill imposes higher fees and larger spending reductions on nursing homes than the House bill. Sen. Linda Berglin, DFL-Minneapolis, chair of the Senate HHS Finance Committee, says that was done in part to mitigate budget shortfalls to hospitals. “I think hospitals are in greater financial distress than nursing homes now, with more uninsured and people with nothing left in their health savings accounts. That’s why we cut [payments to hospitals] only one percent. The House cuts hospitals by three percent.”
Her House counterpart, Rep. Paul Thissen, DFL-Minneapolis, chair of the House HHS Policy and Oversight Committee, sees it a bit differently: “I think that depends on what you are counting and the way you count it.” Thissen contends that some of Berglin’s reforms, such as the nearly $18 million she wants to save by establishing less expensive birthing centers, will come at the expense of hospitals.
Noting that reforms make up a larger chunk of the spending reductions in the Senate than the House, Thissen adds, “We need to make sure the reforms are good policy rather than just a way to save money.”
But Thissen does acknowledge that the House traditionally has “made long-term care a priority” and emphasizes that differences between the House and Senate are miniscule compared with the gap between what legislators have passed and Pawlenty has proposed. “The cuts made to hospitals by either the House or the Senate are just one-tenth the size of the cuts the governor would make,” he says.
That’s no exaggeration: During the floor debate on the House omnibus bill, the Minnesota Hospital Association handed out a spreadsheet for 139 hospitals in the state, showing that the impact of Pawlenty’s cuts on these facilities would amount to $763 million, compared with a $76 million impact from the cuts in the House bill.
This is why many observers are predicting a stalemate at the Capitol. While Pawlenty and legislators aren’t that far apart on proposed spending for education, there is a vast chasm between their budgets for health and human services, and it only grows wider in the 2012-13 biennial budget.
In addition to eliminating the Health Care Access Fund, slashing provider payments and cutting eligibility to public health plans, Pawlenty has proposed cutting public health insurance for dental care, physical and occupational therapy, and podiatry.
In fact, the governor – who is contemplating running for a third term – would eliminate some of the basic health care reforms enacted as a result of his health care commission’s recommendations during last year’s session.
These hard-line positions add credibility to his repeated statements that he will not sign legislation that includes a tax increase during this session. On the other hand, it is difficult to see how House and Senate conference committee members reach agreement on a bill that doesn’t require a significant source of new revenue.
“No new taxes” is pithy and powerful message. But the pain such a limited commitment to health and human services would create in every corner of the state is likewise politically potent. When Senate Majority Leader Larry Pogemiller, DFL-Minneapolis, submitted Pawlenty’s HHS budgetary priorities for a vote in the Senate during debate on the omnibus bill, it received just nine Republican votes.
“If there was ever a time for the government to assure people they will have health insurance, it is now, in this economy,” Berglin says. “I cut seven percent of my budget, just like every other [committee chair]. Sure we all wish we didn’t have such a big deficit. But if I cut any more, I’m going to lose the votes I need to pass this bill.”
Thissen concurs about the mood in the House: “No question, the deeper the cuts the fewer the votes. Depending on what happens with other bills, I can see us being unable to get a [HHS funding] bill passed.”
April 27, 2009| Posted in Front Page Slideshow, In the News
RECENT RECOGNITION AND RESULTS:
April 25, 2009 – MOST VOTES – Gubernatorial Straw Poll – Senate District 12 DFL Convention
April 24, 2009 – MOST VOTES – Gubernatorial Straw Poll – MN Progressive Project
April 1, 2009 – TOP-RANKED TWIN CITIES LEGISLATOR – City Pages –
“A real rock star. Any political wannabe would be smart to hitch his train.”
“If he were governor, we’d be much better off.”
March 29, 2009 – TIED FOR 1ST (Who would you VOTE for?) – Gubernatorial Candidate Rankings – MYDFL Convention
February 26, 2009 – TIED FOR 1ST – Gubernatorial Straw Poll – Progressive Majority
April 26, 2009| Posted in Consumer Protection Ideas, Submitted Ideas
Introduction/Background
Growing “dead zones” are threatening the health of water resources.
My Idea
FERTILIZING the MISSISSIPPI
As we observed Earth Day, we paused to consider the state of our natural environment. If we are to care for the Earth, we must include the health of its oceans(71% of its area), and its fresh water lakes and streams(1% of its area). A place to start is with our own Mississippi River system. During the past several thousand years, the river has carried enough silt to build a substantial delta into the Gulf of Mexico. For more than one hundred years, it has carried other products like nitrogen(N) and phosphorous(P) from the fertilized farm fields and sewage systems of mid-America. These nutrients cause algal bloom in both fresh and salt water. As the algae decay, they rob the water of oxygen (hypoxia), making it uninhabitable for fish. This causes so-called “dead zones” in fresh water and at the ocean mouths of many of the world’s rivers.
A joint study from the Universities of Sao Paulo, Arkansas, and Cornell states, “In the U.S., over 60% of the coastal rivers and bays are moderately to severely degraded from nutrient pollution.” The demand for corn and soybeans to make ethanol and biodiesel has caused planted acreage for those crops in the U.S. to increase by 12 million acres from 2006 to 2008. Ten million of those newly fertilized acres came from conservation and pasture lands. This experience is being repeated throughout the world, resulting in coastal dead zones as the P and N from fertilizer nourish the algae.
We are currently producing about 9 billion gallons of ethanol per year, nearly all of it in the Mississippi River Basin. The federal mandate calls for a steady increase to 36 billion gallons by 2022. The above study concludes, “that continuing the current direction in biofuel production, particularly with the focus remaining on grain and sugar crops as primary feed stocks, has serious implications for coastal water quality, and it will almost certainly worsen already serious hypoxic conditions in many locations around the world.”
In adding to a river’s natural content, we tamper with Mother Nature, an activity that has uncertain consequences, often unattractive.
Rolf Westgard
Resources
April 24, 2009| Posted in Articles, Current Issue - Frontpage, In the News, Innovating Government, News Media, Paul's Viewpoint
Bemidji Pioneer, April 24, 2009
As legislators and the governor settle into the next several weeks of budget balancing debate, there will be a lot of talk about reforming state government. As it should be.
But lawmakers will miss great opportunities if we focus too closely on the internal operations of state agencies. The reality is that much of the work of state government, from maintaining roads to providing human services, is delivered in partnership with Minnesota’s counties.
Unfortunately, the state-county relationship has worn thin and grown stale in recent years. That’s why Gov. Pawlenty and the Legislature both have been seeking ways to revitalize and reorganize how the state and counties work together in order to bring transparency, flexibility and most importantly efficiency to the delivery of essential services.
To transform the relationship, two fundamental changes are necessary. First, Minnesota primarily measures the success of human services programs simply by tracking how much we spend, rather than measure how those programs actually improve the lives of Minnesotans. As a result counties are discouraged from creating innovative ways to provide better services to more Minnesotans.
Second, the state government too often has insisted on a one-size-fits-all, “we know best” approach that stifles new ideas. But Minnesota is a large and diverse state. As state policy makers we must respect the fact that local officials know best what is needed and what works best in their communities.
Gov. Pawlenty’s proposal begins and ends with forcing counties to consolidate their human services departments. Unfortunately, that does little to change the broken, state-county dynamic. Consolidating government without measuring or improving results simply turns one broken system into a different broken system. You can’t create better government by simply drawing circles on a map and telling county governments in Duluth and Brainerd to work together.
This top-down forced consolidation will lead to higher costs as counties are required to merge systems, data and staff in ways that might not be compatible. The governor hasn’t considered the ramifications of this mandate, nor does he know how much it will cost to implement it. And worse yet, the forced consolidation jeopardizes the dozens and dozens of innovative cooperative projects county governments are already engaged in together across county lines.
For example, in the northeastern part of the state, St. Louis County has a regional agreement with Koochiching, Itasca and Carlton counties for the delivery of the services to our poorest citizens. These consortiums cut down on redundancies, streamline the delivery of services to residents and save taxpayers money while not compromising quality for the bottom line.
I have been pleased to work with Minnesota counties — large and small — on an alternative proposal to achieve the same efficiency benchmarks and cost-savings goals outlined in the governor’s proposal without adding unnecessary mandates on the counties and without undoing significant multi-county partnerships already in existence.
The State-County Redesign Act fundamentally rethinks the relationship between the counties and the state. Under the legislation, county and state officials will come to the table together as equal partners to shape the way social services will be provided.
Both the counties and the state will make transparent commitments about the level of resources each will provide and agree upon measurable benchmarks on how to serve its residents. Indeed, the most important piece of this proposal is the focus on accountability, measurement and results. The legislation will be a revolution in how we do the business of providing services to Minnesota residents.
If effective, efficient delivery of human services is the goal, then “business as usual” mandates like Gov. Pawlenty’s proposal are not the answer. Counties have demonstrated their ability to create efficiencies that lead to service improvement and cost savings. My bill will give counties the flexibility they need to achieve those efficiencies on a statewide level.
April 22, 2009| Posted in Articles, Health Care, In the News, News Media
By Charley Shaw, St. Paul Legal Ledger, April 23, 2009
With less than a month to go in the regularly scheduled 2009 regular legislative session, Gov. Tim Pawlenty and DFLers in the state Legislature are far apart on health care spending on uninsured Minnesotans.
The political situation is tense. The House Health Care and Human Services Finance Division on Tuesday passed its omnibus bill that maintains funding for the general assistance medical care (GAMC), which Pawlenty cuts.
Minnesota’s hospital industry is also uncomfortable. Executives from some of the state’s largest hospital systems came to the Capitol on Wednesday to argue with Pawlenty about the cuts, which the executives claimed would deepen the already deep financial losses they experienced in 2008.
Mark Eustis, president and CEO of Fairview Health Services, said his organization reported a $114 million loss in 2008. Fairview, which operates seven hospitals, in 2008 took an $85.5 million hit treating patients without insurance, a 17 percent increase in uncompensated care from 2007.
In response, Fairview has refinanced bonds, laid off 200 people since last fall and declined to fill another 300 open positions.
“With the unprecedented changes in our economy and the collapse of capital markets, we are no longer able to absorb the magnitude of the proposed cuts without dramatic changes in the nature and scope of services we provide,” Eustis said.
The House omnibus health care bill, sponsored by the committee’s chair, Rep. Tom Huntley, DFL-Duluth, still reimburses hospitals for patients on GAMC.
Pawlenty proposes changes to GAMC that result in a roughly $170 million cut by steering the money to primary care clinics instead of hospitals.
Huntley’s bill also crosses Pawlenty by maintaining the current status of the Health Care Access Fund (HCAF), which is built up by a tax on health care providers. The HCAF pays part of the money for the MinnesotaCare program for low-income working Minnesotans. Pawlenty drew opposition from Huntley when he proposed in his budget to merge the HCAF with the general fund.
The bill, which contains $9.4 billion in general fund spending, makes $480 million in cuts. The House legislation is based on a $1.5 billion tax increase that’s included in the House omnibus tax bill.
The health care bill makes a 3 percent cut in reimbursements to health care services. But it doesn’t cut reimbursements for primary care providers. Huntley said Tuesday the bill continues health care efforts that were begun in 2008 to pay primary care physicians for the quality of their care rather than the amount of procedures they perform. The bill also cuts long-term care facilities by 3 percent.
“I think it protects the Health Care Access Fund. It keeps MinnesotaCare alive and well,” Huntley said
But the bill doesn’t address the long-term costs of health care programs, which Pawlenty has made a central part of his health care policy objectives as governor. The Republican has pointed out in offering his budget proposal that the state’s health care costs are growing at unsustainable rates.
Administration officials point out that the House bill doesn’t rein in GAMC’s costs.
Brian Osberg, assistant commissioner for health care in the Department of Human Services, said Tuesday at the House hearing on health care that the House bill uses $99 million in one-time federal stimulus money to offset GAMC costs. That funding source is a “temporary solution” that doesn’t address the growth of public health care programs.
Osberg said he will work with legislators toward finding an agreement that puts the state on “a more sustainable path. With no long-term changes in eligibility, the state will be facing similar or more severe budget challenges in future years,” Osberg said.
Rep. Paul Thissen, DFL-Minneapolis, said at Tuesday’s hearing that he wants to work on health care reform – but he doesn’t want to see reductions to GAMC services.
“We think it’s important in these times, especially with the economic pressure that a lot of these families are going through, that they actually have access to health care services,” Thissen said.
In responding to Osberg, Huntley was blunter.
“Your real approach to GAMC is to eliminate the program as far as hospital services are concerned,” Huntley said, adding that right now two Twin Cities hospital systems are on the verge of bankruptcy.
“The governor’s proposal would simply accelerate the rate at which these two hospital [systems] head toward bankruptcy,” Huntley said.
He declined to name the systems facing bankruptcy.
Michael Belzer, Hennepin County Medical Center’s medical director, said Pawlenty’s GAMC cuts would reduce his hospital’s operating budget by $14 million.
“When cuts are made to hospital reimbursement, hospitals eliminate money-losing programs, or limit access to such programs for uninsured persons,” Belzer said.
LEGISLATURE: BUDGET BATTLE OVER HEALTH CARE WILL BE MOST BRUTAL
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