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By Clay Masters, Minnesota Public Radio News

Living with spina bifida and hydrocephalus, St. Cloud resident Keith Piskur has learned to concisely tell people all the ways that Medicaid helps him live his life.

“It’s not only needing to tell your story, but knowing what wording to use to be listened to,” Piskur said.

Piskur was the only member of the public speaking at a recent roundtable held by the Department of Human Services at the Whitney Senior Center in St. Cloud. It’s part of a series put together by the state Department of Human Service as state and local health officials prepare for potential cuts to Medicaid at the federal level.

The problem could be severe. Minnesota’s Medicaid program, known as Medical Assistance, costs around $18.5 billion per year; just shy of two-thirds of that is propped up by federal dollars.

Piskur, with his trusty service dog Maya by his side, sat in his wheelchair and ran through all the different ways Medicaid affects his life. It has helped absorb the costs of more than 50 surgeries, his in-home care and his service dog.

“My journey is a long one that will be my entire life. Of course, disability is not my entire life, but it affects my entire life,” Piskur told the group.

In Minnesota, about a quarter of the population is on Medicaid. While local and state health care leaders are voicing concerns, solutions at the state level are few and far between. They might have to be figured out in a special session later this year.

Final details might not be known until later this spring, perhaps after the Legislature sets a budget and adjourns for the year. But some state officials have started doing the math, speculating that the state could lose out on $1.6 billion depending how the cuts get spread among the states. John Connolly, Minnesota’s Medicaid director, said that would trickle down to force difficult choices at the state level.

“Limiting who qualifies for the program, who can actually enroll the services we cover in the program, and then, of course, what we can actually pay providers for the services that they’re offering to people in the program,” Connolly said.

Differing impacts

Dr. Kim Tjaden is a family physician and director of community health at CentraCare Health,  which has 10 hospitals and 30 clinics. She spoke at the roundtable in St. Cloud.

“Rural hospitals are already operating in a very thin margin, and any cuts are going to result in decreased services,” Tjaden said. “We’re really looking at this from an emergency preparedness lens. How are we going to keep caring for folks if these cuts come through?”

In Minneapolis, about 75 percent of Hennepin Healthcare’s patients are on some type of public program like Medicaid, said Dr. Thomas Wyatt, the chair of emergency medicine at Hennepin Healthcare.

Wyatt said people tend to use the emergency department more when they have decreased access to care.

“Our emergency departments are already stressed, many times overburdened,” Wyatt said. “That’s going to just increase this amount of stress. Those ED wait times are going to be longer.”

The cuts would also hit the services that people on Medicaid provide.

Amy Gavanda, director of aging and disability services at Twin Cities Catholic Charities, said the human services agency would also feel the pinch.

“If Medicaid goes away, the clients that we serve will have no option for health care,” Gavanda said.

Gavanda said many of the Medicaid recipients they provide services to didn’t plan to be on the program.

“They hit retirement age and thought they had planned. They thought they were all set,” Gavanda said. “Something happens — a medical crisis, losing housing, a spouse passes away — and they can’t afford their living situation anymore.”

Republicans in Washington still haven’t made final decisions on how to achieve the savings they want from Medicaid as they hammer out a budget deal. As much as $880 billion in potential cuts could have a large impact on the program for disabled, elderly and low-income Americans.

Republicans push back on the idea they’ll be stripping coverage, saying they’re looking for was to crack down on fraud and other slack in the program first.

“No one has talked about cutting one benefit in Medicaid to anyone who’s duly owed,” Republican Speaker of the House Mike Johnson said recently. “What we’ve talked about is returning work requirements so, for example, you don’t have able-bodied young men on a program that’s designed for single mothers and the elderly and disabled.”

But Democrats don’t see it that way.

“It would devastate services and would put incredible pressure on the state budget,” said Minnesota Democratic U.S. Rep. Kelly Morrison.

Morrison points to a letter 14 Republican state lawmakers sent to their counterparts in Washington saying cuts are “contrary to how we Republicans respect the aged and the vulnerable.”

State lawmakers await answers

There’s a lot of conversation about potential Medicaid cuts at the Capitol: pullbacks that could be unavoidable if federal aid shrinks. But without clear answers, there haven’t been a lot of concrete solutions yet.

In the Minnesota House Taxes Committee this month, DFL co-chair Rep. Aisha Gomez presented a bill to create a new income tax bracket for high earners. She said it is a way to plug a gap if one materializes.

“We could be looking at having this giant hole blown in the side of our budget so that we can hand tax cuts to corporations and millionaires while we’re not even here to respond to it,” Gomez said in a hearing.

The Minnesota House has split control between Republicans and Democrats which means the two parties are co-chairing committees. The other co-chair, Republican Rep. Greg Davids, said the bill doesn’t spell out how much money it could actually generate.

“I’ve heard expected cuts. Maybe. Could be. Woulda coulda shoulda,” Davids said. “And I was always taught that if, ifs and buts were candy and nuts, we’d all have a Merry Christmas.”

He’s not on board. “I give it to you for creativity,” Davids said to Gomez. “This is going nowhere.”

Until Congress reaches a deal in Washington, there will be a lot of talk in St. Paul.

Those cuts could come after the Minnesota session is over — perhaps forcing state lawmakers back for a special session to do more than just talk about potential cuts to Medicaid.

Back in St. Cloud, Piskur lingered after the community health forum had ended. He’s eager for more details, even if they’re not firmed up yet.

Piskur, an active volunteer, has his service dog at his side. The pet is named Maya after his favorite poet, Maya Angelou.

He’s a poet, too, and knows the value in public expression. But he’s also on edge

“Honestly, these cuts scare me really badly because it’s my life we’re talking about,” he confides to the state officials on that spring afternoon.