Minnesota Hospital Association


June 15, 2011

State public health care programs are "core functions" that must continue

Statement from Lawrence J. Massa, President and CEO, Minnesota Hospital Association

ST. PAUL, Minn. — The Minnesota Hospital Association (MHA) continues to advocate for a balanced approach to resolve the state’s budget before July 1 so a government shutdown does not occur. If a shutdown occurs, however, continuing to provide meaningful access to basic health care services for our most vulnerable residents — the elderly, the disabled and the low-income families and children in every community — is a core function of state government. Minnesota fulfills this core function by paying health care providers and, in some cases, managed care organizations to provide these members of our communities with health care and coverage they need through the Medical Assistance or MinnesotaCare programs.

The conclusion that these programs must continue unabated during a shutdown has been a consistent precedent in Minnesota’s experience with shutdown preparations. In 2001 and again in 2005, the Minnesota attorney general argued that state health care programs are among the core functions of government. And in each of those cases, the Ramsey County District Court agreed, ruling that they must continue even during a state shutdown.

Earlier this week, Attorney General Lori Swanson continued the state’s position in this regard and petitioned the court for another ruling in case the state shuts down on July 1.We appreciate her respect for legal precedent, and adherence to federal statutory and constitutional law.

MHA remains confident that the court will similarly follow its own rulings from 2001 and 2005. Nothing has made these programs less essential or critical in the past six or ten years. To the contrary, the core function of these programs has intensified along with the increased number of Minnesotans enrolled in them. Therefore, the court should again declare that these programs, including the administration of their benefits, payments and applications for enrollment, are core functions of government.  

We are disappointed that the governor’s attorney submitted court documents that appear to break from this consistent line of legal precedent and that seem to raise doubts about the state’s intention to fulfill its obligations under federal law. The governor’s petition recognizes that public program enrollees must remain covered, but it suggests that the state could fulfill its obligations in this regard even if it does not pay anyone to provide health care services or coverage to those enrollees. MHA is puzzled by this suggestion.

To be clear: Minnesota’s hospitals’ number one priority has always been and will always be providing access to the health care our patients and communities need. Not even a state government shutdown will avert us from that mission.

However, if providers are not paid, inevitably they will need to evaluate their options to manage such a significant financial impact even in the short run. Options might include reducing or closing services and staff layoffs in some areas in order to be able to continue meeting the most urgent health care needs in their community. Unfortunately, these kinds of cuts result in less access to care, fewer services and more unemployment.

The governor’s recommendations and the recent letter that the state sent to public program enrollees demonstrate how a potential shutdown results in confusion, anxiety and suffering for our patients and communities. Implementation of a shutdown will be exponentiallymore problematic and, for some individuals, could be tragic.

MHA encourages the attorney general to remain a champion for continuing to regard these programs as core functions that continue even while the state is shutdown because of budgetary disputes. And we urge the governor and the Legislature to come together to find a budget solution before July 1 so that any negative impacts of a government shutdown are avoided.