Minnesota's budget
Health care providers worried about Pawlenty's cuts
by Tom Scheck, Minnesota Public RadioGov. Pawlenty's decision not to seek a third term does not mean his work as governor is over. In fact, this month may be one of his toughest on the job yet -- since he has to balance the state's budget on his own.
After Pawlenty and the legislature failed to reach an agreement, the governor pledged to use his executive power to erase a $2.7 billion budget deficit. That message, along with the cuts that have already been enacted, have some health care providers and the people who rely on them worried.
St. Paul, Minn. — When state officials talk about cutting the health and human services budget, they're talking about Tim Benjamin. Benjamin is a quadriplegic who said a personal care attendant, or PCA, watches him 24 hours a day.
"They shower me. They do my bowel program. They do my range of motion. They dress me. They put me to bed at night," Benjamin said.
Benjamin, of St. Paul, said his PCA also helps him get to work and assists with other daily functions. Before the legislative session ended last month, Gov. Pawlenty signed a Health and Human Services budget bill that will cut funding for personal care attendants. Estimates say as many as 1,600 disabled people will lose PCA services altogether. Another 7,000 people, like Tim Benjamin, could lose hours.
"Two hours doesn't sound like much for many people, but for me, I have respiratory problems," he said. "Without two hours of care, I can drown in my own secretions."
Benjamin said he doesn't yet know whether he'll face a cut in services. The legislation says anyone who uses a PCA will be reassessed to see if they need the full service or should see a cut in hours.
Anne Henry, with the Minnesota Disability Law Center, said she's concerned that the cuts already in law are just the beginning.
She worries Gov. Pawlenty will make more cuts to disability services when he balances the budget on his own.
"Trying to get word out to people about those cuts and even absorb what they are is extremely difficult," Henry said. "The thought that more might come is something many of us can't even seriously consider. We're facing already a really serious problem and to make it worse. I can't even seriously imagine."
When asked this week about his plans for what's called unallotment, Pawlenty said he's considering a menu of options that includes cuts to higher education, local governments and health and human services programs. He said every program has to do more with less in tough budget times.
"Whether you're the university, whether you're MnSCU, whether you're some city, whether you're some program, it is not unreasonable in these economic times to have your total revenues impacted or reduced by a few percent," Pawlenty said at a press conference Tuesday. "And anyone who tells you otherwise is living in a different world and they need to get their head in the game and figure out how to live on 96 or 97 percent of what they got this year just like everybody else."
Patti Cullen, with a group called Care Providers of Minnesota, said she has some difficulty with Pawlenty's assessment.
"The difficulty I have is the last time there was a freeze, the governor had said 'Just wait, hang on. It's tough times. It will get better,'" Cullen said. "And it never got better."
Cullen said the 500 nursing homes and other long-term care facilities that belong to her organization will see no increase in state funding over the next two years. She said that's better than many other programs, which will see cuts, but she said the funding freeze will have an impact.
"A freeze isn't inconsequential. It doesn't mean things won't happen if there's a rate freeze," she said. "There will be lay-offs. There will be reduced hours. It will take longer to answer call lights. All of that stuff will still happen, even with a freeze."
Cullen said she is also worried that the governor could cut either direct payments to nursing homes or services their clients rely on. She said she's looking at all of her options, including a possible lawsuit, if the cuts are severe.
"We don't want to take the lead and say 'What you might be doing might be illegal,'" she said. "I think that's the dilemma that many groups are in. It's the uncertainty of [whether] legally can he do it or not? Every group has the same concern but in different frameworks."
Cullen isn't the only one considering a possible lawsuit to stop Pawlenty from cutting programs. Lawrence Massa with the Minnesota Hospital Association said his group has been looking at the law. He said hospitals took a 1 percent state payment cut in the current budget plan. He worries Pawlenty may cut further.
"This kind of use of unallotment is unprecedented," Massa said. "It's mostly used after the fact. To use this prospectively as a budget balancing technique, it seems unusual. We certainly want to assure our members that we're looking at all options and whether the governor has the ability to do this."
When asked about a potential lawsuit, Massa said health providers were successful in stopping similar cuts in California. That suit said federal medicaid rules require states to set payment rates at a level sufficient to ensure quality of care and accessibility of care for beneficiaries.
For his part, Pawlenty doesn't think any legal challenges will succeed, but he expects one.
"We get sued quite frequently for a lot of different things and, given the importance of some of these decisions, I suspect [we] will," Pawlenty told MPR's Cathy Wurzer last week. "But unfortunately, that's a common thing in our society."
Pawlenty said he hopes to announce his cuts this month. State law doesn't allow him to actually make the cuts until July 1, the start of the fiscal year.
