For Brenda Henderson, trouble came in a whirlwind. She and her son were forced to vacate their apartment within 48 hours. Two days later, she was laid off. A recent transplant from St. Louis, she scarcely knew her way around and had no one's help.
She'd been diagnosed as bipolar, and her circumstances sent her spiraling into deep depression. It wasn't long before Brenda was sleeping at bus stations while her son cycled through friends' homes for days at a time, finding shelter wherever he could.
Then Brenda slipped on a patch of ice on Seventh Street downtown and broke her leg. It didn't heal right and she developed bone spurs. There was a surgery in 2008, and then another one a few months later.
It was the sort of bad luck that often turns the temporarily hard-up into the permanently destitute. But just above rock bottom, Henderson found a safety net: General Assistance Medical Care.
"If I didn't have GAMC to lean on," she says, "I would have had nothing. Nothing."
Henderson is one of the more than 30,000 citizens enrolled in GAMC, a state-funded safety net that protects Minnesota's most vulnerable patients. Like Henderson, most enrollees suffer from mental illness. and live on the streets—the sort of patients who seek medical care from emergency rooms, not doctor's offices.
For over 30 years, GAMC has protected patients living far beneath the poverty line—patients who earn less than $7,800 per year. But on May 14, in the twilight of the legislative session, GAMC became the victim of a line item veto from Gov. Tim Pawlenty's budget. After a vote to overturn the veto failed along party lines over the weekend, GAMC lies on the butcher's block, set to expire in 2010.
From the legislative end, few are more acutely aware of the veto's impact than Rep. Tom Huntley. He's a retired biochemistry professor who has represented Duluth at the state Capitol for 17 years. After nearly two decades campaigning for health care reform as the chair of the Health and Human Services finance division, Huntley sees the cut as a grave danger to patients and hospitals alike.
"If you're a hospital and you're suddenly losing money, you're going to get rid of your money losers," says Huntley. "Your outside clinics for low-income people. Mental health beds. Emergency rooms. Then it doesn't just hurt the poor. It hurts everybody."
For hospitals like Hennepin County Medical Center and Regions, the burden is all but impossible to absorb. Regions is on the hook for $35 million in losses, a full 13 percent of its entire budget for the year, and the Minnesota Hospitals Association estimates that costs to HCMC could exceed $100 million. The two medical giants are already eyeballing pay freezes and layoffs, but the incremental savings likely won't be enough.
"We budget to break even," says Mike Harristhal, HCMC's vice president of public policy for the last 16 years. "Our 1 percent operating margin gives us about a $5 million bottom line if all the stars align. Now take $36 million right out of the picture. I don't want to say it's devastating, but it certainly creates crisis. These patients aren't going to go away just because the state doesn't pay for them."
As hospitals lay off personnel, reduce bed counts, and scale back outpatient clinics statewide, everybody will suffer, but it's the disenfranchised who'll feel the pinch most acutely. Monica Nilsson directs street outreach for St. Stephen's Shelter in Minneapolis, dealing with the city's most isolated, most exposed citizens—the bridge-dwellers. To her, the effect of the veto will be measured in human terms.
"There's going to be a lot more people walking around outside talking to themselves without this program," she says. "Instead of preventative health care, we'll be waiting for the crisis and responding. I know some people wish these people would just die or move away, but the reality is they'll just get sicker and be more expensive for us all."