The GOP's Obamacare repeal bill may be in murky waters, but the Minnesota Department of Human Services is clear about how much it thinks it will hurt disadvantaged people in the state seeking care.
As of Friday, it was unclear just what sort of bill would emerge the following week when lawmakers came back from their weekend break. Even the Washington Post was stumped.
"On Thursday, most GOP senators could not say what legislation they expected to vote on next week, and skeptics appeared no closer to backing the new plan," the Post said. "Conservatives such as Sen. Rand Paul (R-Ky.), who want to go further to pare back the ACA, and moderates such as Sens. Susan Collins (R-Maine) and Dean Heller (D-Nev.) who worry about leaving millions without health-care coverage, remained undecided."
Interviewed Monday, DHS Commissioner Emily Piper said both the House and Senate bills cap the Medicaid payments to the state, threatening access to health insurance for Minnesotans. Currently, Medicaid pays about 54 percent of nursing home costs in the state.
They also take away the federal share of payment in the state-level Medicaid program, MinnesotaCare, resulting in a $2 billion loss to the state during the first 18 months after the law would theoretically take effect, Piper said. By 2030, the losses will reach $31 billion. Meanwhile, demographic changes mean that by 2030, 1 in 5 Minnesotans will be over 65 years old.
"We're very concerned," Piper said. "We've expressed our concerns to members of our congressional delegation, members of the state legislature, to county boards all across the state, because we think it's important... ."
Cutting off MinnesotaCare access to people impacts the working poor, she said-those who make 138-200 percent of the federal poverty level.
MinnesotaCare disproportionately helps people in greater Minnesota, Piper said. From the 85,000 people that get insurance through MinnesotaCare, 11,000 of them live in the 8th Congressional District-Brainerd's congressional district. More than 15,000 Crow Wing County residents either use Medicaid or MinnesotaCare.
Minnesota is one of 11 states that organizes its human services programs by having counties administer the programs, while the state government supervises them. However, even with this less state-intensive approach, cuts to the DHS budget mean direct impacts to Brainerd employees.
DHS maintains a MinnesotaCare call center in Brainerd that staffs 122 people, a roster which increases to roughly 200 during the busy season. In addition, there are 185 DHS workers in Brainerd dispersed among various DHS facilities with the bulk of them at the central office.
"The Brainerd area workforce of DHS will be directly and hard-hit by any defunding of MinnesotaCare federally," Piper said.
Asked how many DHS jobs might be cut if the bill passed, Piper said there was no estimate yet.
The GOP health care reform plan would completely cut the federal share of the MinnesotaCare program, which this year was about 88 percent of the entire program funding, Piper said.
"The stakes are very, very high," she said.