St. Louis County starts with 12 new workers for Affordable Care ActA compromise hiring plan was approved as the county prepares for an influx of enrollees.
By: John Myers, Duluth News Tribune
St. Louis County commissioners today agreed to hire a dozen new workers to handle the influx of thousands of county residents expected to enroll in the new federal health-care system starting later this year.
County officials in recent months said they’d need as many as 40 new positions to handle an influx of more than 11,000 additional county residents entering the system starting in Jan. 1, 2014.
But that number was pared down to a request for 17 new hires last week and then down again to 11 financial workers and one supervisor in an amendment approved this morning at the board’s regular meeting in Duluth.
It’s expected that fewer county workers will be needed because state officials recently revised their expected St. Louis County enrollees from more than 11,000 to about 9,700, said Ann Busche, who heads the county’s Public Health and Human Services Department.
The dozen new employees are a compromise between those commissioners who wanted to hire more, to ensure good service as new residents apply for coverage under the Affordable Care Act, often referred to as “Obamacare,” and those commissioners who wanted to hold off on hiring new workers and who oppose the new federal health-care system.
Commissioners said they always can hire more workers if the increased caseload becomes unworkable.
“It’s clear to me the idea of the phased-in approach make sense,” said Commissioner Frank Jewell, of Duluth, who previously had supported at least 17 new hires. “This is a good way to start; it seems like a good compromise to get there.”
Jewell said he wants to make sure all residents who apply for coverage under the Affordable Care Act receive good customer service.
“The challenge if we do not have enough resources is we will not do a good job with that work,” Busche said. “I don’t know what the perfect number is.”
While the compromise reached behind the scenes avoided what could have been a heated public debate over the merits of the Affordable Care Act, not all commissioners are enthralled with the county’s roll in the new federal system.
“Make no mistake about it, this is an unfunded mandate,” County Board Chairman Chris Dahlberg of Duluth said. “It does not make sense, this top-down solution.”
Having the federal government run health care for people in Minnesota “is a system that doesn’t work,” Dahlberg said.
Commissioner Keith Nelson said his support for the 12 new positions should not be seen as his support of the Affordable Care Act but as acknowledging the county’s mandate to make it work.
“The verdict is out on this, folks,” Nelson said of the Affordable Care Act. “But we’re going to do the best job we can” administering it.
Commissioner Mike Forsman of Ely agreed, saying it’s good more people will receive health care, but he said most people who have a job still won’t be eligible for the new program because they make more than $7.90 per hour as a single person or $15.80 per hour combined as a family.
“Most of the people I know won’t qualify,” Forsman said, adding that the federal effort could force other health-care premiums higher for people who earn more money.
But Commissioner Steve O’Neil of Duluth praised the county’s role in helping make the Affordable Care Act a reality.
“I’m very pleased to be part of this effort,” O’Neil said, noting about 5 percent of the county, many of whom have never had health insurance, now can be covered. “Yes; it’s not perfect. And it’s an unfunded mandate. But it moves us forward as a nation” toward full health-care coverage.
The 12 new positions are estimated to cost county taxpayers about $238,000 for the first year, although additional federal money could lower that amount, and were approved on a 4-2 vote. Commissioners Dahlberg and Forsman voted no. Commissioners Pete Stauber, O’Neil, Nelson and Jewell voted yes. Commissioner Steve Raukar was in Washington on county business.
The Affordable Care Act was signed into law in 2010, intending to guarantee that everyone in the nation has some sort of health-care coverage. Minnesota lawmakers passed the state’s part of the plan this year and Gov. Mark Dayton signed it into law Feb. 19.
The county predicted the administrative situation last year and set aside leftover general-fund money in 2012 to help soften the blow in 2013 and 2014. The scope of the increase in new enrollees still caught some by surprise.
Under the changes, people newly covered by free Medical Assistance, which is Minnesota’s Medicaid program, include adults without dependent children with income up to 138 percent of the federal poverty guideline, up from 75 percent of poverty now; parents with incomes up to 138 percent of the guideline, up from 100 percent; and 19- and 20-year-olds to 138 percent of the poverty guidelines, up from 100 percent.
The 2013 federal poverty guideline is $11,490 for a single person and $23,550 for a family of four.
This year, 31,618 St. Louis County residents are covered by Medical Assistance. Under the expanded program, the number of people covered will jump to more than 41,000 residents, more than one of every five county residents.
The county now has about 82 caseworkers for Medical Assistance. In March, Busche said the department would need another 29 to 40 caseworkers by the end of this year to handle the increased workload. Since then the federal government has clarified its role, saying it will pay for 75 percent of administration costs and possibly more.