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Excerpts from recent Minnesota editorials

May 13, 2019

Minneapolis Star Tribune, May 10

A painful exercise in bending the health care cost curve

Controversy over nursing home funding underscores need to keep state’s provider tax.

It’s far easier to talk about “bending the cost curve” in health care than it is to actually do it. The current controversy at the Minnesota Capitol over a proposed $68 million funding cut to nursing homes offers a real-time illustration of this reality — one that should serve as a cautionary tale to those who push health spending reductions as a painless remedy to budget woes.

From a 30,000-foot view, the changes to the reimbursement formula for long-term-care facilities look like a logical place to find savings in the sprawling state Department of Human Services budget. The reforms were recommended in a report released this year by independent experts from the University of Minnesota and Purdue University.

They found that a 2015 legislative overhaul of nursing-home funding delivered on one key goal — helping boost staff salaries and benefits — but fell short of expectations when it came to improving the quality of care. These experts recommended changes in the state funding formula partly to drive improvements in quality and partly to decrease pressure on the state budget.

Again, a macro-level view of the $68 million cuts, which are spread out over four years, makes them appear manageable. The 2015 overhaul, dubbed “Value-Based Reimbursement,” significantly increased state payments to nursing homes to cover care for patients who qualify for medical assistance. Even if the proposed cuts are approved, because of the 2015 change average monthly payments for nursing facilities are still expected to rise each year. But the increases will be 6% on average instead of 7.5%.

Some additional perspective: $68 million in cuts amounts to 3% of the $2.3 billion the state will spend on this care over the next four years, according to Minnesota Management and Budget. Nationally, 6 in 10 residents of nursing homes are covered by the state-federal Medicaid program, according to the Kaiser Family Foundation, so Minnesota is not an outlier in covering this care.

As the legislative session careens to an end, Republicans have attacked the proposed cuts and have raised justifiable concerns about the impact on smaller rural facilities. The state’s long-term care industry is also battling the change, saying that the big-picture perspective ignores the harm to individual care centers.

North Shore Health CEO Kimber Wraalstad said she’s literally losing sleep at night over the reductions her 37-bed Grand Marais long-term care center would face. The facility appears to be hit harder by the formula change than others.

In 2020, she expects a reduction of $83,000, with that amount projected to rise to a minimum of $220,000 in 2023. The care center’s 2019 revenue is estimated at $4.3 million. Wraalstad said the facility, which is part of a broader operation that includes the local hospital and ambulance service, is already operating at a loss.

“Where am I supposed to cut?” she asked.

Larger facilities in the metro area also are sounding the alarm. Sholom Community Alliance CEO Barbara Klick said the reductions cannot be easily absorbed when margins are already perilously thin and when spending assumptions have been made based on the higher reimbursement level. Sholom operates two long-term-care centers — in St. Paul and St. Louis Park — for a total of 228 beds.

Klick also said the reductions would come at a challenging time when nursing homes badly need to invest in information technology, an area where long-term care has lagged other health care providers. In addition, Sholom leaders have said that the 2015 changes need to be given more time to realize the quality improvements that the legislation’s architects envisioned.

There’s not much time left in the 2019 session, but it would be worthwhile for the Walz administration to convene a meeting with the state’s nursing-home leaders to listen to their concerns and find out if there are measures to mitigate the financial pain that would be felt, especially by smaller care centers such as Wraalstad’s.

And an important note to all who are decrying these cuts: The state pot of money mainly funded by Minnesota’s medical provider tax contributes $439 million a year toward medical assistance spending, which includes long-term care. Extending the provider tax, which is set to sunset this year, is critical to ensuring the robust funding that nursing homes and their patients deserve.


St. Cloud Times, May 10

New players, same train wreck over state budget compromise

This time, it was going to be different. New governor. Lots of new legislators. A clean slate.

Just a few weeks ago, lobbyists and Capitol watchers were telling this editorial board they were optimistic this year Minnesota could maybe — just maybe — avoid the traditional train wreck at the end of the legislative session tunnel.

And then, late Tuesday night, it went off the rails over budget proposals that are about $2 billion apart.

The self-imposed budget deadline missed, conference committees are forced to work on bills for which they have no funding clarity as the clock on this legislative session ticks down to adjournment May 20.

The governor is said to be willing to cut $200 million in spending from his original budget proposals. That’s a good start. However, he’s not talking much about reducing his proposed (and eye-popping) 20-cents-a-gallon gas tax hike.

The House Democrats said they’re willing to put $664 million in proposed spending back on the shelf if the Senate meets them halfway.

The GOP-controlled Senate has made no such public declarations about what they’re willing change. They’re just willing to shift some money around, they said, but they’re not prepared to budge on their number. Nor will they specify what might be cut with their funding shifts.

So let the impasse begin.

Or don’t. How about that?

Walz, Senate Majority Leader Paul Gazelka and House Speaker Melissa Hortman are, in an only-in-Minnesota-moment, scheduled to spend Saturday’s fishing opener together in Albert Lea.

We humbly suggest they board the same boat and use that time wisely, talking through the roadblocks and setting up the legislative session for success next week.

Legislators must go back to work resolved to make good policy, not just good politics. Get serious about making compromises.

And don’t forget the voice of people. In the last election, Minnesotans decided by fairly large margins to keep a DFLer in the governor’s chair and give DFLers more House seats. Republicans held the Senate — barely.

On that note: “No” is not a civilized negotiating stance, at least it’s not a good one. At worst, it’s appears obstructionist. At best (we use the term loosely), it looks as if people who don’t know how negotiations work put the budget proposal together — with no room for give and take. Senate Republicans, please note.

Governing is compromise. Winning at all costs isn’t leadership — it’s tribalism. It’s pandering to the lowest common denominator, the segment of the electorate that can only see their team as a “winner” or a “loser” rather than as a force for good governance.

We are disappointed. Again.


The Free Press of Mankato, May 8

Place names: Choose the parts of history to honor

Why it matters: New names for places is not changing history; it’s selecting what parts of the past are worthy of honor.

Shakespeare’s Romeo assures us that “a rose by any other name would smell as sweet.” But the various debates in Minnesota about some long-standing names — a popular Minneapolis lake, a significant historical site, buildings on the state’s largest university campus — suggest that names matter.

It is important in examining these disputes to dismiss the notion that changing a name is akin to changing history. It’s not. It’s changing what parts of history we choose to honor.

That is certainly the case with Lake Calhoun/Bde Maka Ska in southwest Minneapolis.

An Army surveying team mapping the territory in the early 1800s dubbed it Calhoun in honor of their boss, then the secretary of war. The Department of Natural Resources approved the name change in 2018 at the request of Hennepin County. This month an appeals court overturned that change; the DNR says it will appeal to the state Supreme Court.

Giving Minneapolis’ largest lake one of the names it is believed to have borne before the survey crew arrived changes nothing about John C. Calhoun or his legacy. Whether it is Lake Calhoun, Bde Maka Ska or Shakespeare Lake, Calhoun will still have been a vice president, a senator, a congressman, a cabinet officer, a political giant of his time.

He will still also have been a virulent advocate of slavery and secession, with his fingerprints on the South’s failed attempt to shatter the Union.

Minnesota does not need to honor this man, and we are baffled by those who think we should merely because previous generations did.

In that context, let us note that Rep. Jeremy Munson, R-Lake Crystal, went on tpt’s “Almanac” on Friday to defend the Calhoun name and apparently thought it advanced the discussion to make a smirking bathroom pun off the Bde Maka Ska name. That’s an approach befitting a third grader, not a state representative.

Another dispute that reached the Legislature concerns temporary signs installed at Fort Snelling by the Minnesota Historical Society identifying the site as “Fort Snelling at Bdote.”

This, as detailed in a recent story by Minnesota Public Radio, is part of the Historical Society’s effort to provide a more complete and nuanced recounting of the historical site’s past. It also angered some key legislative Republicans, who are now pushing to slash the society’s state funding for daring to acknowledge any history at the location other than that of white settlers. The society is doing its job; the Legislature should not interfere.

A more complicated dispute involves the University of Minnesota, where the Board of Regents is resisting a campus-driven effort to rename buildings named for former university officials now connected to bygone restrictions on blacks, Jews and other ethnic groups.

It’s more complicated because it involves a variety of individuals and different, not necessarily equivalent, actions and because there is legitimate dispute in some cases of how involved in the now distasteful policies some of the administrators were. The dispute is also colored by the disdain some regents display for the views of the faculty and students who advise the administration.

We won’t pretend to have a specific recommendation to this question, but we do offer this thought: The names the university gives its buildings should reflect both its past history and its current ambitions.

If honoring the past celebrates a legacy of exclusion, the past should not be honored. You can call a coffin flower a rose, but it will still stink.