"The foundation of our safety-net health care infrastructure is already challenged, and these federal proposals would exacerbate the unsustainability and result in patients falling through the cracks," the writers say. (iStock)

Opinion editor’s note: Strib Voices publishes a mix of guest commentaries online and in print each day. To contribute, click here.

•••

If we could redesign our health care system from scratch, we likely wouldn’t build it the way it exists today. There is an urgent need to restructure both our payment models and the way we deliver care, even before the sweeping cuts to Medicaid circulating in Washington go into effect. The foundation of our safety-net health care infrastructure is already challenged, and these federal proposals would exacerbate the unsustainability and result in patients falling through the cracks.

The structure of health care disadvantages safety-net health systems — like Hennepin Healthcare System (HHS) — that serve all who need care regardless of their health care coverage. We consistently struggle to survive financially. Hennepin Healthcare is already in a vulnerable financial state, we are not immune to economic challenges across the nation, and we have seen others cut programs and reduce their workforce in response.

Medicaid is foundational to enable systems like ours to continue to provide care. Hennepin Healthcare specifically relies on Medicaid support for nearly half of those we serve, or to nearly 95,000 of our community members. We estimate a potential $100 million loss from Medicaid cuts in current proposals, which will only compound existing shortfalls due to rising costs and a rising percentage of patients who are uninsured. Put simply, we cannot survive or achieve our mission without Medicaid, and we will continue to struggle with the status quo.

Medicaid doesn’t just help Medicaid patients — it supports the entire health care system, including those with private insurance. Medicaid helps cover critical services that are underfunded — or not funded at all. Without it, services cannot be sustained and everyone loses.

Here’s what’s at stake at Hennepin Healthcare if Medicaid cuts take place:

• Trauma care for all Minnesotans: Our Level I Adult and Pediatric Trauma Center — with more than 90,000 visits a year — relies on Medicaid for 62% of patient coverage. Across the state, Minnesotans with commercial insurance rely on this infrastructure when minutes matter.

• Statewide mental health care: As the only inpatient psychiatric Intensive Care Unit in Minnesota, we remain open even as other providers close due to unsustainable payment models. More than half (51%) of patients we serve for inpatient mental health rely on Medicaid. Without it, critical psychiatric care disappears.

• Physician training and access: 60% of doctors in Minnesota trained at Hennepin Healthcare. Medicaid cuts threaten the future of our academic and research programs — leading to fewer doctors in rural communities and a fracturing of the research that shapes the delivery of health care.

• Addiction medicine: An estimated 350,000 Minnesotans need substance use treatment but are not receiving it. Our 30-year-old addiction medicine program includes statewide training for providers and sees 400 patients from across the state per day. Medicaid pays for 73% of the care for our patients accessing addiction treatment.

• Poison control: The Minnesota Regional Poison Center, housed at Hennepin Healthcare, fielded over 43,000 calls last year statewide — helping everyone from toddlers at home to emergency departments in rural hospitals.

• Burn and emergency hyperbaric care: Our regional burn center and 24/7 hyperbaric oxygen services are vital during mass casualty events, carbon monoxide poisonings and more. If lost, patients would need to travel hours for some types of care — at times when every minute counts.

Hennepin Healthcare faces an outsized threat from Medicaid cuts, but even without the devastating blows of proposed Medicaid changes, we must make hard decisions to stay viable. In recent years, the federal government has acknowledged the reimbursement gap in public programs by creating Medicaid Directed Payments, but proposals to cap these payments would devastate our ability to provide care. These payments aren’t optional — they are the only option available to offset years of structural underpayment.

Medicaid cuts would compound our challenges and result in reducing services, disrupting workforce training and forcing more patients to rely on already strained emergency systems. Medicaid restrictions — such as work reporting requirements — would take away health care coverage from Minnesotans, resulting in delayed care and raising uncompensated care costs even further.

The bottom line: The federal proposal does not improve our health care. Medicaid cuts would not just affect those with Medicaid coverage — they would compromise Minnesota’s entire health care system. Whether you have private insurance, Medicare or Medicaid, you depend on the services that our hospitals provide. Undermining Medicaid undermines care for everyone.

Mohamed Omar is chair of Hennepin Healthcare System board of directors. Dr. Thomas Klemond is interim CEO of Hennepin Healthcare.