Gov. Tim Pawlenty's plan to balance Minnesota's budget is getting some of its stiffest resistance from health care providers.
The unallotment of millions of dollars in health care spending for the poor has them worried about tens of thousands of Minnesotans that may have no more medical coverage next spring.
Democratic lawmakers have been traveling the state this week, trying to come up with another plan for those who are cut off.
Minnesota's financial crisis may hit hardest in downtown Minneapolis, at the sprawling Hennepin County Medical Center. It's the flagship of a public health system that gets gets more more than 300,000 clinic visits alone every year.
Cuts to General Assistance Medical Care, or GMAC, could cost HCMC $43 million over the next two years. The money pays for care for people who make eight thousand dollars a year or less.
Former Minneapolis mayor and hospital board member Sharon Sayles Belton laid out for lawmakers what that may mean.
"We will have to reduce or eliminate the services that are what we call the worst financial providers," she said. "This could include things like our primary care clinic, our specialty services for problems like diabetes, our dental services and some of the components of our mental health service continuum."
It's a story that lawmakers have been hearing all over the state.
But they're offering little hope to health care providers that the cuts will be averted.
State Sen. Linda Berglin, DFL-Minneapolis, pointed out that the cuts are set to take effect next March, just three weeks after the Legislature reconvenes for its 2010 session. She told dozens of people at the House Health and Humans Services Policy and Oversight Committee that there simply may not be enough time.
"I have no idea. If I had a great master plan, in my hip pocket, I'd whip it out and say, oh, look, this isn't so hard," she said.
She urged her fellow lawmakers and the health and state at HCMC to come up with a list of where else in the state they could find $400 million to pay for health care for the poor.
But officials are eyeing ideas, too, and hinted at some of them at today's hearing.
Hennepin County Board Chairman Mike Opat said that the county's hospital won't turn the needy away, but property tax payers may have to pick up more of the burden for their care.
Rep. Julie Bunn, DFL-Lake Elmo, suggested that as many as one-third of Minnesotans in their 20s might be eligible for cheap insurance for catastrophic care they could buy in the private market for less than $1,000 a year.
Committee chair Rep. Paul Thissen, D-Minneapolis, said there may be other programs, like housing or social services, that could avert some of the need for health care among the poor.
He also offered some other proposals, like paring back the overall benefit levels offered to the poor and getting more people signed up for Supplemental Security Income, a federal program for the disabled and elderly.
"And you know the governor proposed putting this uncompensated care, reducing funding significantly but putting an uncompensated care pool in place so that the money would not go toward insurance, and getting insurance so the individuals and just having a pool of money that would support places like HCMC or community clinics," Thissen said.
"We've kind of gotten mixed reviews to that kind of thought, because there is a benefit to getting people insured once they leave the hospital doors."
State and health officials have eight months to come up with a plan B. The existing money officially runs out Feb. 28.