ST. PAUL, Minn. -- Governor Mark Dayton on Wednesday made good on his campaign pledge to expand Medicaid coverage for low income adults in Minnesota. He signed an executive order opting into a broader version of that federal health program before most other states do so.
But the signing ceremony, which normally would attract only supporters and reporters, became an impromptu public forum when Tea Party protesters crowded into the governor's reception room. Many carried "No ObamaCare" signs, because the Medicaid expansion is part of the federal Affordable Care Act.
In an extraordinary twist, Dayton diffused what was shaping up to be a tense situation. He offered detractors equal time in the media spotlight, inviting them to take turns at his microphone to speak against the executive order.
"The great thing about a democracy is we can have different points of view," Dayton explained to the surprised crowd, "This is an office where all points of view are honored and respected."
Dayton's order will bring health coverage to 12,000 adults without dependent children, and allow the state to move 83,000 other adults from state-subsidized health plans into the more comprehensive Medicaid.
Town Hall Effect
Three rose to spoke, including Twyla Brace, a nurse who advocates market-driven solutions to health care through her think tank Citizens Council on Health Care.
"It really puts the state in peril when it comes to costs," Brace argued, "There's something called tails, which means once all of these people are on it will be difficult to get them off and it will be expensive to the state for the long haul."
Among the supporters who spoke was Sarah Anderson, who said her brother Eric experienced long delays getting treatment for cancer while enrolled in the state's General Assistance Medical Care program, or GAMC, for adults who make less than $8,000 per year.
"However we quickly learned that, because of the cuts to GAMC, my brother was denied health care needed to treat his life threatening cancer," Anderson said.
Her brother is still alive, but was traumatized by the uncertainty he faced when he could not see doctors and get critical diagnostic tests. She expressed hope Dayton's action would spare others in similar situations.
Military veteran Leon Moe said federal health care reform is beyond the powers government is granted in the constitution. Moe volunteers at the Minnesota Tenth Amendment Center, named for the amendment giving states and citizens powers not specifically enumerated in the Constitution.
"If you can show me anywhere in the Constitution where it says Congress has the authority to legislate health care let me know," Moe said.
"I have gotten my medical care courtesy of the VA for the past 41 years. I totally understand what government health care is all about. I oppose this legislation."
Dayton's legal authority stemmed from a deal lawmakers made with former Gov. Tim Pawlenty, which granted the governor final say in the Medicaid matter in exchange for saving a less generous state health program.
Pawlenty, a Republican who opposes federal health reform and may challenge President Obama in 2012, decided not to pursue the expansion due to concerns over long-term costs to the state.
Dayton said Medicaid would make it much easier for the state's hospitals and doctors to be reimbursed for care they're now providing at a loss, or by shifting cost to insured patients.
"This money goes to benefit the low income recipients, but really the dollars themselves go to Minnesota hospitals and doctors and nurses, and others who provide essential health care to all these citizens and to all of us."
Dollars and Sense
The enhanced Medicaid plan will dramatically improve coverage rules for mental ill adults, according to Sue Abderholden of the National Alliance on Mental Illness. Patients won't have to qualify for permanent disability through Social Security to get treated.
"One of problems is that people who had a mental illness couldn't prove they were so disabled that they would never work again," she explained, "Which is why they were on General Assistance Medical Care instead of Medicaid."
"You think of a 22-year-old having their first psychotic episode," Abderholden added, "They don't want to say at 22 to the Social Security Administration 'I will never work again,' but they have to do that in order to get treatment. In Medicaid they can get treatment they need, can get better and go back to work."
By joining the expanded program, Minnesota expects to receive $1.2 billion in extra Medicaid dollars in the 2012-2013 budget cycle, which begins July 1st. in the next fiscal cycle, by opting into the expanded program. The state will have to put up $384 million in matching funds.
That cost should be more than off set, according to the state's budget commissioner, by the $416 million the state will save by moving people out of the state-subsidized plans and into Medicaid.
Pawlenty last year, in an effort to drive down health spending, attempted to end GAMC and move those 38,000 persons into Minnesota Care, a health plan for the working poor funded by premiums and surcharges on medical providers.
After wrangling with lawmakers, Pawlenty agreed to move forward with a stripped down version of GAMC, with a different reimbursement structure. Of the 21 hospitals statewide that qualified to be in the program, only four Twin Cities medical centers agreed to participate in the new GAMC.
"That's a terrible burden on the patients, on their families," Dayton remarked, "That's a terrible burden on those four hospitals. And it shifted the distribution of health care from statewide to just within the metropolitan area."
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