No more ‘Minnesota nice’ on Affordable Care Act repeal

By Gabby Landsverk

Residents of Minnesota’s 5th Congressional District crowded a conference room April 10 at the Hopkins Center for the Arts to share concerns and seek answers on the impact of the shifting political debate on health care.

Residents packed a conference room April 10 at the Hopkins Center for the Arts for a town hall meeting hosted by District 5 Congressman Keith Ellison, sharing concerns and information about how efforts to repeal the affordable care act might impact Minnesota. Photo by Gabby Landsverk
Residents packed a conference room April 10 at the Hopkins Center for the Arts for a town hall meeting hosted by District 5 Congressman Keith Ellison, sharing concerns and information about how efforts to repeal the affordable care act might impact Minnesota. Photo by Gabby Landsverk

The forum, hosted by Congressman Keith Ellison and led by a panel of experts, was aimed at addressing uncertainty regarding efforts to repeal or replace the Affordable Care Act and how such a move might effort district residents.

Ellison was outspoken about the fact that current Republican-led efforts to change the ACA could have a negative impact on the most vulnerable populations in Minnesota, including the poor, elderly and disabled.

“Our health care system is primarily focused on making certain people a lot of money instead of making a majority of people really healthy,” Ellison said. “We have commodified and commercialized health care and that’s the situation we’re in.”

According to the Minnesota Department of Human Services website, “repeal of the ACA without creating a mechanism for sustaining or replacing the PPHF (prevention and public health funding, provided or expanded through the ACA) would jeopardize core public health services in Minnesota.” The department’s services include economic assistance and care for seniors and families, including food assistance, child protective services, mental health and addiction treatment, and support for those with disabilities.

“We have a very, very large footprint across the state,” said Emily Piper, commissioner of the state Department of Human Services. “What we see with the repeal of the ACA, without a replacement solution, the expansion of Medicaid immediately goes away. This could cost the state budget $2 billion annual, and that would continue to grow as costs rise.”

Piper said that Minnesota has been a leader in health care innovation for residents, resulting in a healthier population. An ACA repeal could also reverse years of work expanding programs to help achieve that goal and, counterintuitively, could result in Minnesota receiving less federal funding than states that spend less on prevention programs.

“It punishes us as an innovative state that chose to cover more residents,” Piper said. “That’s just not fair. We’re going to try to be ‘Minnesota nice’ about this conversation, but it’s getting really hard.”

Information provided at the meeting shows that 166,575 people in CD5 would have their health care coverage directly impacted by a repeal of the ACA.

The current federal Medicaid funding for the district is $913.8 million, a large part of which could be reduced or eliminated by a repeal, leaving major funding gaps for public health programs and other health care and prevention initiatives.

“With that cost comes more risks for the populations we serve. … People across the state rely on these resources to take care of loved ones,” Piper said. “The stakes are really high for legislators as we figure out how to balance the budget and this just isn’t palatable for all the people who rely on this care.”

Stella Whitney-West, CEO of North Point Health & Wellness Clinic, said such gaps could have a wide-reaching impact, even for people who don’t realize how much they rely on the services to care for themselves or loved ones.

“Most people just think of Medicaid as being for poor people, not working families. But a huge amount of that helps seniors and folks with disabilities,” Whitney-West said. “People are now realizing that it’s their mother or grandmother that’s receiving assisted care that they couldn’t afford without Medicaid.”

The consequences of those funding gaps, she added, are higher costs for everyone.

“If people don’t have insurance, they end up in the emergency room,” Whitney-West said. “It’s not just about having it when you’re sick. It’s about maintaining health and wellness. Prevention — that’s the most important thing.”

At Hennepin County Medical Center, uncompensated care was costing taxpayers more than $40 million a year before the ACA.

And for all added costs of a struggling public health system, Whitney-West cautioned, taxpayers end up footing the bill.

“It’s still all money coming out of your pocket, and that’s what you have to watch out for,” she said.

Many residents shared emotional stories and personal fears about family members, children or parents supported by Medicaid.

“We can’t continue to give money and tax cuts to the people who have enough when there are people who don’t have enough,” one resident said. “And we have to stop talking about mental health as though it’s a separate issue — whether it’s my brain or my body that’s ill, I’m ill. Mental health is health.”

Educational leaders shared concerns about young students impacted by a lack of support services, particularly for mental health. Several physicians in the audience attested to the benefits of Minnesota Care in providing freedom for doctors to use a variety of options to best provide care for their patients.

“Why someone would decide to take that away is beyond me,” one audience member said.

Although the forum was directed at CD5 residents, many neighboring residents joined in: Through the discussion, several residents made subtle jabs at District 3 Congressman Erik Paulsen, an outspoken opponent of the ACA, for his lack of town hall meetings, to considerable applause from the audience.

Other concerns include aging populations, in particular those suffering from the onset of Alzheimer’s disease.

Several in attendance pointed out that, while resources in the metro area are strained, rural populations would be even more hard-hit by the problems.

This includes a huge increase in the number of people needing care, combined with a dramatic drop in groups willing and able to provide that care.

“We need to solve these care gaps — we can’t have 60,000 vacancies in a workforce designed to care for the most vulnerable populations in the state,” Piper said.

Andy Slavitt, former administrator for Medicare and a former executive at United Health, emphasized the importance of avoiding distraction by the political controversies of the bill and focusing on the relevant impacts.

“Mostly people have heard repeal or replace the ACA as a promise to replace it with something better,” Slavitt said. “My jaw hit the floor when I saw this bill. It’s about taking $1.3 trillion set aside for low-income people and returning it in the form of big tax breaks. Everything else is a side show.”

Slavitt explained that, in addition to eliminating more controversial parts of the ACA, a repeal, without a thorough replacement, could jeopardize public health initiatives that have been in place for decades.

“To me, this has always been about what year we want to live in,” Slavitt said. “Do you want to live in 2017? Or do you want to live in 2010? Or even 1965?”

Ellison commended residents for taking the time, energy and emotion to speak up and speak out against the potential harm that could behalf thousands of Minnesotans in need as a result of an ACA repeal.

“It is incredibly courageous for you to be talking so forthrightly about the challenges you’re facing. One of the benefits of a forum like this is that folks can realize you’re not alone in the tough times you’re facing,” he said.

He urged the audience to stay involved, to continue holding legislators accountable.

“What can you do about it? You’re already taking the first step, being here tonight. Members of Congress absolutely monitor calls they get and letters they get, and it works,” Ellison said. “The real key to this is active citizenship. This is not the time to say ‘why doesn’t somebody do something about this problem.’ It’s time for us to do something.”