Budget cuts have taken their toll on most government initiatives, but few have been hit as hard as those that aid the destitute. In the current fervor of health care reform, Pawlenty aimed to give the General Assistance Medical Care program—a state medical aid initiative serving the most impoverished and needy single adults—a “reform” that was to mesh with his trend of cutting healthcare provisions in favor of lowering taxes.

As of March 23, the GAMC was slated for the ax, due to repeated Pawlenty vetoes on bipartisan- supported Democratic renegotiations of the reform bill. Minnesota Health Care Programs include GAMC, MinnesotaCare, and Medical Assistance that provide aid to those who do not qualify for federal assistance. Minnesota Department of Human Services announced the same day that those who were on the GAMC program would still have health care coverage—they would be shifted to another MHCP. Before that date, a mandatory switchover to Transitional MinnesotaCare was in the works for most of those on GAMC. However, MinnesotaCare would have had to expand such that this mandate would only raise costs for patients and providers, and eventually deplete the standing Health Care Access Fund on which it is sustained.

MinnesotaCare carries a monthly premium, mandatory copays and a host of services available under most insurance plans, most notably alcohol and drug treatment, doctor and clinic visits, dental care, immunizations, surgery and prescription drugs. GAMC offers most of the same critical services without mandatory copays or monthly premiums—and so picks up those chronically poor and mentally ill Minnesotans who can’t afford copays and premiums but may need health care even more than MinnesotaCare members. Proponents of GAMC argue it is critical for these downtrodden that GAMC persists in some form.

Erin Murphy, a registered nurse-turned-State Representative and the champion for the continuation of GAMC, was tearful and outspoken on the floor of the Minnesota House. On March 25, Brian Lambert of MinnPost quoted Murphy, who said, “the people who live in the shadows of our society deserve care…and we have made that promise to them…[w]e have said that you still matter to us, and even though we don’t have a lot of money, we are going to make sure that you get the care that you need.” Due to the successful lobbying and bill tweaking of Murphy and her cohorts, Pawlenty was browbeaten into signing a modified GAMC continuation plan on March 26.

Maureen, who didn’t give her last name, is covered by GAMC. She caught wind of the impending closure of the program and raced to get a host of medical tests performed before the understood termination date of April 1, cognizant of the fact that she would be unable to afford the copays and premium of MinnesotaCare. The communications trickling out of the bureaucracy are apparently insufficient; she was unaware that GAMC had been extended.

Budget cuts being what they are, the GAMC is still due for extermination on June 1. It appears, however, that the Transitional MinnesotaCare got the ax that was originally intended for GAMC; a MDHS bulletin on April 1 instructed care providers not to approve Transitional MinnesotaCare beyond that date. GAMC benefits and eligibility criteria remain essentially the same except that a GAMC qualifier is no longer needed for eligibility. Said qualifiers include receipt of General Assistance, payment under Group Residential Housing, obtainment of disability income, homelessness and other institutionalized proofs of poverty. The MDHS states as of this issue’s press that GAMC benefits and acceptance will continue through May 31, at which point an as-yet unrevealed care coordination system will take effect.
If the destitute are to receive medical care, it must be provided with a reasonable understanding of their poverty level. Paul Farmer, a medical anthropologist—and a vocal advocate for an end to the structural violence that continually crushes the poor—writes in Pathologies of Power that “[i]n the name of ‘cost-effectiveness,’ we cut back health benefits to the poor, who are more likely to be sick than the nonpoor.” Erin Murphy witnessed enough structural injustice in her days as an RN that she asserted the necessary humanity on the House floor throughout March and shifted the tides of reform toward more compassionate shores. Murphy, her cohorts, and the rest of us Minnesotans now have the opportunity to affect how humane the outcome of the new care coordination system will be. Given this chance, we can determine whether this system will be adequate for those who may need medical care more than us, and whether it will help to mediate that structural violence that creates and sustains poverty.

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