The multi-billion-dollar spending bills cover public health programs, health insurance, provider reimbursements and welfare allowances.
The House and Senate both cut payments to hospitals, nursing homes, doctors and other health care providers. But health and welfare is another budget area where one-time federal stimulus funds, about $1.8 billion, will help soften the blow.
Still, Rep. Tom Huntley, DFL-Duluth, who chairs the House Health Care and Human Services Budget Division, says $400 million in reduced spending is hard to take.
"I don't like this bill. I think the cuts are going to hurt a lot of people and a lot of institutions," said Huntley. "But my goal, given the target that we have and the state of our economy and the state of the national economy, I have tried to minimize the cuts, and tried to protect those institutions that might close if the cuts were too severe."
The Senate bill reduces spending by $600 million, and takes a similar approach to maintaining eligibility and lessening the cuts to services and providers.
Both bills would also extend health care benefits to thousands of uninsured children. Sen. Linda Berglin, DFL-Minneapolis, chair of the Senate Health and Human Services Budget Division, presented her bill by focusing on what the measure doesn't do.
“I don't like this bill ... but I have tried to minimize the cuts.”Rep. Tom Huntley, chair of the House health care committee
"It does not cut over 100,000 people off of health care. It does not violate the Health Care Access Fund. It does not eliminate dental services for adults, or rehabilitation services, chiropractic services and podiatric services as had been suggested by the governor," said Berglin.
Republican Gov. Tim Pawlenty is proposing deeper cuts -- $1.7 billion -- in this budget area, which he has frequently described as growing at an unsustainable pace.
Pawlenty's spokesman says Democrats in the House and Senate refuse to face reality. And in a written statement, he suggested the DFL might not need to try to increase taxes if they would slow down welfare and health care spending.
Sen. Michelle Fischbach, R-Paynesville, accused Democrats of not setting budget priorities.
"These cuts to our nursing homes, to other programs, they are in addition to a $2 billion tax increase. So with an additional $2 billion tax increase, you'd think that we'd be able to preserve some of these programs," said Fishbach.
Gov. Pawlenty originally proposed cutting tens of thousands of people from state-subsidized health care programs, but he delayed those cuts until 2011 to get as much money as possible from the federal stimulus.
DFL leaders in the House and Senate tried to demonstrate bipartisan distaste for the governor's plan by putting it up for amendment votes. The House rejected individual pieces of the plan, while the Senate voted it down in its entirety.
Senate Majority Leader Larry Pogemiller, DFL- Minneapolis, argued the governor's spending cuts are too deep and too painful.
"During a time of economic crisis, we should not cut 113,000 people off health care. It's not right," said Pogemiller. "We should not lay off 10,500 employees from the health care area. It's not right."
Republicans in both chambers cried foul over the tactics. House Minority Leader Marty Seifert of Marshall accused Democrats of undignified game-playing. In the Senate, Sen. Geoff Michel, R-Edina, described the amendment as an awkward stunt.
"I guess if a Senate Republican K-12 bill or a Senate Republican tax bill had limped out of here with small majorities, then we'd be trying to do some crafty legislative moves too. But we'll take a vote on this today," said Michel.
Under all three proposals, the amount the state pays hospitals and many doctors would fall. The size of the reductions vary by proposal and by type of service.
For example, the House bill would cut payments to doctors, dentists and hospitals by 3 percent for programs covering childless adults and low-income Minnesotans at a savings of $82 million.
The Senate version contains an even bigger cut to specialists. Though primary care doctors are exempt under both plans, the reductions could lead other providers to stop accepting people in those programs.
Hospital leaders have warned that they would have to scale back offerings, such as dialysis centers and nutrition centers serving diabetics, and pull back on mental health treatment.
Both versions maintain dental coverage for those on state-subsidized health care, though services would be scaled back.
The House bill would also see new limits in the use of emergency room care for the working poor on MinnesotaCare, and a 5 percent cut in rates for inpatient mental health care for certain health programs.
About 800 people with disabilities receiving help from personal care assistants would lose that service under the House bill, while the Senate's version would cap the number of hours personal care assistants can bill the state.
The House bill would also cut the state's welfare program for families with children, with about 8,000 people losing benefits. Those in the program would be assessed a penalty if they're also receiving housing subsidies or Social Security disability benefits.
Nursing homes would see a change in their state payments under the Senate bill. For instance, a surcharge assessed to non-state operated facilities would rise from $2,815 to $3,165 per bed.
Abortion opponents in both chambers failed to amend the measures, with a proposal in the House that would have prohibited state-sponsored health care programs from paying for abortions failing on a 66-66 vote. A similar measure in the Senate failed 26-39.
And a proposal in the House to allow bars to have enclosed, ventilated smoking rooms failed 63-69.
The health and human services bills were the final pieces of the state budget to get initial consideration. Senate and House negotiators will soon begin working out the differences between the two bills. Republicans already predict Gov. Pawlenty will veto the final package.
The sides are now set for end-of-session negotiations on the entire state budget, and they hope to finish the job by May 18.
(Associated Press writers Elizabeth Dunbar and Brian Bakst contributed to this report)