Overheard at the Capitol: GAMC fix is a quarter of a loaf, but…

Let’s be clear: The biggest motive force behind the bipartisan push to restore some version of General Assistance Medical Care (GAMC), which finally resulted in a deal between the Legislature and the governor’s office last Friday, was not to get medical care for the poorest and sickest Minnesotans; the vast majority of the patients in the program use emergency room care, and hospitals by law are required to provide treatment in those situations whether the patient can pay or not. The abiding question was whether hospitals would get paid for providing that care, or would be forced to pass along the cost to others and possibly to close departments or whole facilities.

And from the hospitals’ standpoint, the deal is not exactly lavish. Under the new GAMC, providers will collectively receive roughly one-fourth of the dollars they got under the old GAMC. At the Capitol today, I had a chance to talk with one prominent health care industry lobbyist about the new terms.

“It really depends on how you look at it,” the lobbyist sighed. “It’s true that the cuts are huge. But as a provider, I’m looking at getting a quarter of a loaf when the plate is empty otherwise. I’m getting enough to eat and survive for the next 15 months.

“There certainly will be facilities that have a harder time adjusting to the new world than others. At the start, 17 hospitals will be designated ‘coordinated care organizations,’ and there will be a separate pot of money for the others. Then, I believe after six months, they can apply to become coordinated care organizations, too.

“In addition to getting enough state money to prevent having to pass all those extra costs on to the marketplace, we wanted people to have access to care other than in ERs, and this plan does address that to some extent with its prescription coverage–which is especially important to all the people with mental illness on GAMC who need medications–and some level of primary care, so that it’s not always a matter of coming to the emergency room.

“If most hospitals and clinicians look at the proposal,” the lobbyist added, “it’s clearly not what they wanted. But it’s hard to argue that it’s not an improvement on what we would have had otherwise.”