MINNEAPOLIS, March 30, 2008—Last week Jack Bert, M.D., former president of the Minnesota State Board of Medical Examiners, published a commentary about the misuse of the Health Care Access Fund in the Star Tribune. We reprint the entire commentary with Dr. Bert's permission.

In 1992, as part of a comprehensive reform, the Legislature created a broad plan designed to increase access to affordable health care for all Minnesotans.

To pay for this initiative, it created a new tax on health-care services -- the provider tax -- and put the proceeds into the Health Care Access Fund (HCAF). The idea was that the fund would be used to give more Minnesotans access to preventative and primary care. That, in turn, would lower health-care costs for everyone by reducing uncompensated care, preventable emergency-room visits and other costly medical procedures.

Doctors, health-care workers and hospital administrators were opposed to being singled out as the only professionals to pay the provider tax. However, we all accepted the plan because we were told that the fund had appropriate safeguards that would allow the collected money to be used only to increase access to care for sick patients.

Unfortunately, HCAF has changed into something completely different under the administration of Gov. Tim Pawlenty. Last week, in an effort to balance yet another state budget deficit, Pawlenty again proposed using nearly $400 million from HCAF to make up for lower-than-expected state tax revenues. That is in addition to the hundreds of millions of dollars the administration has taken from the fund to balance previous deficits.

The outrageous attempt to raid this dedicated state health-care account is not only immoral but unethical. We literally have hundreds of thousands of patients who need high-quality health care but have no insurance and do not qualify for programs such as Medicaid, Medical Assistance or MinnesotaCare.

My wife, who is a registered nurse, volunteers every other week at one of St. Mary's 13 free health-care clinics in the Twin Cities. These clinics function with private money and are staffed completely by volunteer physicians, nurses and receptionists.

Every day the clinics are open, there are long lines with people waiting to be served. It's not uncommon to find hardworking people among these clients. They don't have significant incomes, but it's difficult for them to qualify for the health-care programs subsidized by the state or federal governments.

For example, if you're single and make $20,000 a year and have $10,000 in assets -- like a car -- you're considered too well-off to qualify for MinnesotaCare, the state's subsidized health-insurance program, paid for by HCAF. Only 130,000 people qualified last year, meaning that less than 40 percent of HCAF funds were used for medical care. Rather than raising the threshold to allow more uninsured Minnesotans to qualify, and rather than lowering the provider tax, the administration has used this money to pay for all sorts of miscellaneous state expenses.

Raiding HCAF to balance the state budget at a time like this is not only inappropriate but also shortsighted. We owe it to the people paying the tax -- and to sick people --to use these funds to improve access for Minnesotans who have been priced out of the health-care market.

The Health Care Access Fund was created to help such people, not to allow politicians to hide from tough budget choices.

Jack Bert, M.D., is a former president of the Minnesota State Board of Medical Examiners. He has been in private practice with Summit Orthopedics in St. Paul for 30 years and is a clinical professor at the University of Minnesota School of Medicine. 

Jack Bert, M.D., has been in private practice with Summit Orthopedics in St. Paul for 30 years and is a clinical professor at the University of Minnesota School of Medicine.