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Viewpoint: Cuts and reforms are the central focus of our efforts

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All three parties to the budget negotiations -- the governor, the Senate and the House -- have included $1.5-$2 billion in revenue sources in their budget solutions.

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This is because without these revenues, even with the federal stimulus money, if the remaining $4.6 billion hole were to be addressed with cuts alone, we would be closing some of our hospitals, nursing homes and prisons, laying off up to 10,000 teachers and over 100,000 Minnesotans would lose some or all of their medical benefits, among them the blind, disabled and aged.

So, I will turn to the primary focus of our legislative efforts -- cuts and reforms.

By historical standards, all three parties to the negotiations have proposed very large budget cuts.

The governor has proposed cuts of $1.5 billion, while the House and Senate have proposed even larger cuts, $1.6 and $2.4, billion, respectively.

How this works in practice is that each agency in the governor's case, and each finance committee division in the House and Senate case, are given dollar reduction targets to hit.

Serving on the Health and Human Services Policy and Finance Committees, most of my time this session has focused on ways to cut hundreds of millions of dollars from the Health and Human Services budget.

My colleagues and I carefully examined the effectiveness and relative merits of programs so we can increase efficiency of program delivery, scale back programs, and cut entire programs in a manner least harmful to the health and well-being of some of the state's most vulnerable citizens.

Finding the necessary $400-$800 million in cuts from this $10 billion, and rapidly growing, piece of the overall general fund budget is a very complicated task, constrained by federal mandates, cost-sharing with federal and local governments, and ethical and societal norms for care of the most vulnerable.

The vast majority of this budget provides care for children, the chronically ill, the disabled and the elderly. As we proceed to make budget cuts, our challenge will be to spread the pain so no one group feels the brunt of it.

The more challenging and rewarding work has been seeking major reforms.

Potential reforms include the streamlining of MinnesotaCare and Medical Assistance for families and children (HF 1935), reducing the human services regulatory burdens on counties (HF 1276), eliminating regulatory burdens on home and community services providers (HF 1110) and modifying the state's personal care assistant (PCA) program (HF 1329).

Combined these systems reforms would save tens of millions of dollars.

While I have had a hand in reviewing and discussing many of these proposals, I was asked by the House Health and Human Services leadership to lead an effort to find very significant savings in our public dental programs.

To achieve this mission, I reached out to my legislative colleagues, to those administering the dental programs in our state agency and to dental stakeholders, and asked for their ideas.

I instructed them that our mission was to shave 25 percent or more from public program expenditures in a way that would provide core cost-effective preventive and emergency care, while avoiding having the uninsured show up at hospital emergency departments.

Many good ideas have emerged. These ideas came from identification of provider abuse in the Critical Access Dental Program and the development of reforms to address it, from the development of an evidence-based, stripped-down set of dental benefits for low-income, blind and disabled adults, that as best possible addresses some complicated behavioral and health situations, and from further refining the children's benefit set.

I mention all this to provide, by example, a glimpse into the extent, and level of detail, of legislative efforts to find waste and abuse, and to cut expenditures.

My dental benefits reform and reduction bill (HF 961) shows fiscal savings of 25-30 percent off current forecasts for our public dental programs. This is approximately $27 million dollars over the next biennium, and over $50 million in future bienniums.

The economic downturn we are experiencing is a catalyst for changes and reforms that will deliver greater cost-efficiency, accountability and transparency to ensure our public dollars are being put to best use.

Bunn (DFL-Lake Elmo) represents District 56A in the Minnesota House of Representatives. She can be reached at (651) 296-4244, by mail at 521 State Office Building, 100 Martin Luther King Blvd., St. Paul, MN 55155 or via e-mail at rep.Julie.bunn@house.mn.

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