A government shutdown over health care?

There are only a few weeks left in the Minnesota legislative session, and this would be a good time to ask a question: Is eliminating health care for working Minnesotans worth shutting down state government?

Politicians are about to play a game of chicken, now that the GOP-controlled Minnesota House passed its version of a budget early this morning (see bill), including eliminating the MinnesotaCare program, which allows lower-income Minnesotans who make too much money for Medical Assistance to buy health insurance.

In years past, MinnesotaCare’s surplus — it’s partially funded by a tax on health care providers — has been a favorite slush fund for politicians looking to plug holes in their budgets. Over his term, former Gov. Tim Pawlenty pulled almost half a billion dollars out of the fund.

In its place, the GOP budget offers a state-based tax credit to buy private coverage. But its unclear what the impact would be on deductibles and co-insurance.

Under the Republican plan, the state would ask the federal government for a waiver to allow those thrown off MinnesotaCare to buy insurance outside of MNsure, a program which they rather detest.

But Republicans says there’s waste and abuse in MinnesotaCare eligibility verification, something the Legislative Auditor has been complaining about for years, the Pioneer Press reports today.

A 2014 audit looked at a sample of 193 people in public health plans and found that 32 of them — 17 percent — weren’t eligible for the program in which they were enrolled. With more than 1 million people on public plans, that could mean hundreds of thousands of errors — if the sample reflects the broader population.

But while some of those errors reflected people getting benefits they weren’t entitled to, others reflected people who were getting less generous benefits than they qualified for, so it’s unclear exactly how much money the state would save.

The DFL in turn relies on an analysis by the Department of Human Services, which found much lower initial savings of $16.5 million in the next two years, though those savings would rise in 2018 and 2019 to $142 million.

Republicans said the analysis looked at only part of the bill, but more broadly said that the department couldn’t be trusted.

“We have a department that has for years and years and years been criticized by the nonpartisan Legislative Auditor for not doing their job in this area,” Rep. Jim Knoblach, R-St. Cloud, said. “I really don’t think we can give the department much credence in a place like this.”

The Republican plan forces lawmakers to choose between competing needs.

“If we do not get a handle on Medicaid spending and on our overall HHS spending, we can never ever get to where we want to be in higher ed, or K-12, or any of the other areas that are suffering because this area is growing unsustainably fast,” Rep. Matt Dean, the architect of the GOP plan, said.

The bill passed this morning also helps struggling nursing homes — a rural Minnesota concern — promotes early diagnosis of Alzheimer’s, cuts premiums for employed disabled adults, expands services for homeless youth, and increases mental health services.

All of this is in the DFL’s wheelhouse. The Senate, still controlled by the DFL, and DFL Gov. Mark Dayton are opposed to the move on health care, setting up a showdown that has to occur by May 18, when the Legislature has to wrap up its work.