Medicaid advocates hoping to stave off billions in cuts to the program for low-income and disabled Minnesotans have found an unlikely ally: Republican lawmakers.

“Drastic reductions to Medicaid funding have the potential to impact the 1.4 million people we serve and place incredible pressure on our overall state budget,” Sen. Jim Abeler, R.-Anoka, and 13 other Minnesota GOP lawmakers wrote in a letter to the Republican members of Minnesota’s congressional delegation, President Donald Trump, and the acting administrator of the Centers for Medicare and Medicaid Services.

“There are no other sources to make up the lost federal share beyond severely impacting the seniors and those with disabilities who we serve,” the letter continues. “This is contrary to how we Republicans respect the aged and the vulnerable.”

Republicans in the U.S. House have endorsed a budget proposal that would require cutting $880 billion in funding from programs overseen by the House Energy and Commerce Committee, which includes Medicaid. They intend to use the savings on defense and border spending, as well as tax cuts whose primary beneficiaries would be the wealthiest Americans.

Medicaid, which is known in Minnesota as Medical Assistance, serves 1.4 million Minnesotans, or about one-quarter of the population, including 650,000 children and 125,000 people with disabilities.

“Given some of the large numbers coming out of Washington, we are concerned that there is no practical way to accommodate some of the proposed massive reductions and still provide the kind of care these vulnerable people require,” the state Republican lawmakers write. Steep funding cuts would require Minnesota counties to “raise local property taxes drastically or close services,” they add.

The letter also argues Minnesota has been a “leader in providing access to care and containing costs,” and that dramatic cuts would jeopardize those efforts.

“We need the flexibility to keep doing what works,” Abeler said in a press release accompanying the letter. “Deep, unworkable cuts are not the answer.”

Abeler also criticized the Walz administration for a proposed budget containing smaller spending increases on disability services.

Democrats endorsed the GOP lawmakers’ letter.

“Thanks to the 14 GOP Minnesota legislators who recognize the damage the U.S. House GOP budget would cause,” said Democratic U.S. Rep. Betty McCollum of Minnesota’s Fourth District. “It’s wrong to cut Medicaid — a health care lifeline for over a million Minnesota seniors, disabled, and children — to give more tax breaks to billionaires like Elon Musk.”

In the past, Republican U.S. Rep. Pete Stauber has been critical of Trump administration efforts to cut Medicaid. “I made a promise to protect these critical programs for those who need it most, and it is a promise I intend to keep,” he wrote in a March 2019 press release.

GOP Rep. Tom Emmer spoke in favor Tuesday of Republicans’ budget resolution: “I caution the media against echoing Democrats’ hysteria on where savings will come from.”

Groups opposing the cuts, including the AARP, as well as groups more amenable to them, like the Committee for a Responsible Federal Budget, have pointed out that it would be virtually impossible to hit the budget’s deficit reduction targets without cutting Medicaid.

Minnesota Reformer is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Minnesota Reformer maintains editorial independence. Contact Editor J. Patrick Coolican for questions: info@minnesotareformer.com.

A Republican senator is proposing an amendment to the state Constitution that would radically alter the structure of the Senate and effectively lock in Republican control of the chamber for the foreseeable future.

Like the House, the Senate is currently apportioned by population, ensuring that each senator represents a similar number of Minnesotans. But SF 696, authored by Eric Lucero of Saint Michael, would assign one senator to each Minnesota county, creating a legislative body with 87, rather than 67 members.

The change would dramatically shift the balance of power in the Senate toward voters in small, rural counties. The 1.3 million residents of Hennepin County, for instance, would have the same amount of representation as the 3,000 residents of Traverse County.

A single voter in Traverse County, in other words, would have as much influence over the Senate as 433 voters in Hennepin County.

Voters in rural counties overwhelmingly support Republican candidates. While Democratic presidential candidate Kamala Harris won 51% of the statewide popular vote, she carried just nine out of the state’s 87 counties. U.S. Sen. Amy Klobuchar beat her Republican opponent by 16 points statewide, but won only 21 counties.

Those lopsided margins mean that, barring a massive political realignment, a Senate apportioned by county would likely remain in Republican control for decades to come.

The measure has attracted no co-sponsors this session and has virtually zero chance of passing the divided Legislature, or of gaining majority public support as a ballot question.

But county commissioners in rural parts of the state have previously expressed interest in such a proposal, and Republican Rep. Krista Knudson of Lake Shore last year told the Detroit Lakes Tribune that she would draft a House bill to that effect during the 2025-2026 session.

Rachel Aplikowski, a Senate Republican press secretary, said Lucero “introduced this bill before and it’s just to make the Minnesota Legislature look like the US. Congress, where representation in the House is based on population and in the Senate is based on geography.”

But the U.S. Supreme Court has previously ruled that state legislative chambers must be apportioned by population, and that doing otherwise violates the Equal Protection Clause of the U.S. Constitution.

In 1964, the court ruled in Reynolds vs. Sims that “the Equal Protection Clause requires substantially equal legislative representation for all citizens in a State regardless of where they reside.”

“Legislators represent people, not trees or acres,” Chief Justice Earl Warren wrote for the 8-1 majority. “Legislators are elected by voters, not farms or cities or economic interests… it is inconceivable that a state law to the effect that, in counting votes for legislators, the votes of citizens in one part of the State would be multiplied by two, five, or 10, while the votes of persons in another area would be counted only at face value, could be constitutionally sustainable.”

Lucero’s proposal is “flatly unconstitutional” and “profoundly anti-democratic,” according to Justin Levitt, a professor at Loyola Law School and a former official in the Department of Justice Civil Rights Division. “There’s no particular principle for representing each county equally other than the raw desire for power in less-populated counties, subjecting more-populated counties to permanent minority status.”

Minnesota Reformer is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Minnesota Reformer maintains editorial independence. Contact Editor J. Patrick Coolican for questions: info@minnesotareformer.com.

Welcome to The Topline, a weekly roundup of the big numbers driving the Minnesota news cycle, as well as the smaller ones that you might have missed. This week: The warmest year in Minnesota history; a surge in state government spending; the latest abortion data from the state; a data center’s staggering power needs; and 464 deaths on the road.

The warmest year

The Twin Cities notched the warmest year on record in 2024, and once final data is compiled it’s likely that will hold true for the entire state. Record high annual average temperatures were recorded in Duluth, Fargo and St. Cloud as well.

Mild, unseasonable weather at the beginning and end of the year were major factors, a reminder that climate change is causing winters to heat up much faster than summers. “From 1970 through 2021, average daily winter low temperatures rose more than 15 times faster than average daily summer high temperatures,” according to the Department of Natural Resources.

As of this writing the southern two-thirds of the state is bereft of snow and snow depths are well below average across much of the remainder, prompting the postponement of the Beargrease Sled Dog Marathon in Duluth.

Government spending surpasses $6,000 per person

John Phelan, an economist at the conservative Center of the American Experiment, recently crunched some numbers to look at the change in per-capita state government spending in Minnesota since 1990.

In inflation-adjusted terms, the figure rose from about $3,500 per person in 1990 to $6,100 in 2024, an increase of around 75%. Close to half of that new $2,500 in annual spending has been added just since 2019.

Something to keep in mind: State government is a big consumer of health care and education, and those sectors tend to see cost increases above inflation because of what’s called Baumol’s cost disease, i.e., they struggle to achieve productivity gains while employing lots of people whose wages consistently rise.

Still, Minnesota has a well-earned reputation as a state with high taxes and robust spending on social services. Many residents, like Reformer columnist Eric Harris Bernstein, view that as a net positive. “Everyone depends on the public goods and services that our tax dollars pay for,” Bernstein wrote last year, “and we take for granted a great many public needs that are satisfied through government intervention.”

But conservatives have been sounding the alarm over staggering levels of fraud and mismanagement in state spending, along with the threat of an upcoming fiscal deficit after years of surplus. Evidently, enough Minnesotans shared those concerns to break the DFL’s trifecta control of state government in November.

Out-of-state patients drive abortion increase

Minnesota abortions were up 16% in 2023, driven in large part by a 50% surge in out-of-state patients, according to Department of Health data released at the end of December. Those out-of-state patients accounted for more than one-quarter of the 14,000 abortions performed in Minnesota. It was the highest number of abortions recorded in the state in two decades.

The number of patients traveling from Wisconsin more than doubled between 2022 and 2023, from 383 to 825. The number of abortion-seekers from Iowa tripled from 174 to 520. There was a fivefold increase in patients traveling from Nebraska, rising to 127 individuals in 2023.

More than 92% of Minnesota abortions were performed in the first trimester of pregnancy, while just one abortion happened in the third trimester, at 29 weeks. Nearly two-thirds of the abortions were performed using the drug Mifepristone.

In 2023 the Legislature repealed certain abortion reporting requirements, including women’s reasons for seeking an abortion, their number of previous abortions, and their insurance status.

Staggering power needs at proposed Amazon data center

The Star Tribune’s Walker Orenstein flagged an arresting statistic in a recent Public Utilities Commission filing: Amazon’s proposed data center in Becker will have a peak daily electricity need of 600 megawatts of power, roughly equivalent to the output of the Monticello nuclear plant.

Amazon plans to build the center near Xcel Energy’s coal-fired Sherco plant. Roughly half of Xcel’s new power demand in the next five years is expected to come from data centers, the Star Tribune reported last year.

464 deaths on Minnesota roadways in 2024

Provisional data from the Department of Public Safety shows that 464 people were killed in car crashes in 2024, up from 414 the previous year. The increase was driven in part by a surge in fatalities at the start of the year, possibly due to unusually warm weather.

Through November, pedestrians accounted for 41 fatalities, and 75 motorcyclists were killed on the roads. There were seven bicyclist deaths. DWIs were up slightly in 2024. In addition to fatalities, tens of thousands of people are injured on Minnesota roadways each year.

Minnesota Reformer is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Minnesota Reformer maintains editorial independence. Contact Editor J. Patrick Coolican for questions: info@minnesotareformer.com.

In a note he was carrying when he was arrested, Luigi Mangione paints himself as a man radicalized by statistics.

“The US has the #1 most expensive health care system in the world, yet we rank roughly #42 in life expectancy,” wrote the alleged killer of Brian Thompson, the late CEO of Eden-Prairie-based UnitedHealthcare. “United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but [h]as our life expectancy?”

Mangione is a scion of a rich, connected Maryland real estate family who recently withdrew from friends and family following severe medical issues. The numbers he cites are, in broad strokes, accurate.

On life expectancy, the U.S. ranks somewhere in the 60s among the world’s countries, according to data from the United Nations, falling in between Panama and Estonia. Among the wealthy subset of countries that are part of the Organization for Economic Cooperation and Development, we rate 32nd out of 38.

The U.S. also spends far more on health care than any other country in the world: around $12,000 per person each year, thousands of dollars more than the next-highest spenders.

The discrepancy between the staggering amount of health care spending and our relatively short lives has been perennial fodder for commentary and political debate: Where is all that money going?

The answer, to a significant degree, is that it’s being skimmed off by the private health insurance industry.

“The largest component of higher U.S. medical spending is the cost of health care administration,” according to an analysis by Harvard health economist David Cutler. “About one-third of health care dollars spent in the United States pays for administration.”

Peer countries, even those that have similar systems with multiple private insurers, pay just a fraction as much. “Whole occupations exist in U.S. medical care that are found nowhere else in the world, from medical-record coding to claim-submission specialists,” Cutler writes.

That excess spending adds up to something like half a trillion dollars each year, according to a recent analysis of Congressional Budget Office data by Matt Bruenig of the People’s Policy Project. For every $100 spent on health care, $16 goes directly to private insurance companies and another $16 goes to hospitals to cover the cost of administering care.

Only about $68 goes toward actually paying for medical services.

Under a single-payer system, on the other hand, the CBO estimates that the public insurer would need just $1.60 of that hundred bucks to cover its costs, while the hospitals would only need $11.80 to cover administration, because they no longer have to deal with the hassle of multiple private health insurers.

Under that system, $86.60 would go toward paying for care.

As the nation’s top health insurer and the fourth-largest company by revenue, UnitedHealth Group — the parent company of UnitedHealthcare — is also the chief beneficiary of all those billions in essentially wasted spending. In 2023 the company socked away $22 billion in profits on $371 billion in total revenue, adding up to $25 per share. The company paid investors dividends of $7.29 per share.

Think of it this way: A person who owned a single $500 share of UnitedHealth Group stock at the start of the year would get rewarded, at the year’s end, with $7.29* of America’s health care spending, despite contributing precisely nothing to American health care.

In his manifesto, Mangione refers to the private health insurers as “parasites.”

Those profits, it should be noted, don’t simply generate themselves. UnitedHealthcare has developed a reputation for being especially ruthless in its pursuit of shareholder value. The company “relentlessly fought to reduce spending on care, even as its profits rose to record levels,” ProPublica reported last year.

A U.S. Senate committee concluded UnitedHealthcare, along with other insurers, intentionally denied critical nursing care to stroke patients in order to increase profits. The company has been accused of using rigid algorithms to determine when to cut off payments, regardless of whether or not patients still needed care.

Thompson had been accused of dumping stock before the company alerted shareholders that UnitedHealth Group was being targeted by a federal antitrust investigation.

Virtually every American has their own horror story to tell of the Kafka-esque indignities of fighting with insurers over billing codes, prior authorizations, pre-approvals, in-network providers, and the like. This likely explains the organic outpouring of condemnation launched at the health insurance industry in the wake of Thompson’s killing, which spanned the political spectrum, even as elites of both parties scolded the vigilante apologists.

Doctors say the delays caused by those barriers between patients and their care, which are set up largely to protect insurance company profits, can make patients sicker and in some cases kill them.

In his manifesto, Mangione lamented that so little has been done to solve the profit-driven dysfunction of the health insurance system. “Many have illuminated the corruption and greed (e.g.: [Elisabeth] Rosenthal, [Michael] Moore), decades ago and the problems simply remain,” he wrote. “It is not an issue of awareness at this point.”

The note makes no mention of any personal struggles with the insurance system, despite evidence that Mangione suffered from chronic back pain and underwent major surgery for it.

But at some point — whether driven primarily by personal experience, systemic frustration, or the sheer force of a mental breakdown — Mangione decided to take things into his own hands. “What do you do?” he wrote in a separate, longer document that hasn’t yet been made public. “You wack the C.E.O. at the annual parasitic bean-counter convention.”

Oregon Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Oregon Capital Chronicle maintains editorial independence. Contact Editor Lynne Terry for questions: info@oregoncapitalchronicle.com.

A Stanford misinformation expert has admitted he used AI to draft a court document that contained multiple fake citations about AI.

Stanford’s Jeff Hancock submitted the document as an expert declaration in a case involving a new Minnesota law that makes it illegal to use AI to mislead voters prior to an election. Lawyers from the Hamilton Lincoln Law Institute and the Upper Midwest Law Center, which are challenging the law on First Amendment grounds, noticed the fake citations several weeks ago and petitioned the judge to throw out the declaration.

Hancock billed the state of Minnesota $600 an hour for his services. The Attorney General’s Office said in a new filing that “Professor Hancock believes that the AI-hallucinated citations likely occurred when he was using ChatGPT-4o to assist with the drafting of the declaration,” and that he “did not intend to mislead the Court or counsel by including the AI-hallucinated citations in his declaration.”

The AG’s office also writes that it was not aware of the fake citations until the opposing lawyers filed their motion. The office has asked the judge to allow Hancock to re-submit his declaration with corrected citations.

In a separate filing, Hancock argues that using AI to draft documents is a widespread practice. He notes that generative AI tools are also being incorporated into programs like Microsoft Word and Gmail, and says that ChatGPT is “web-based and widely used by academics and students as a research and drafting tool.”

Earlier this year a New York court handling wills and estates ruled that lawyers have “an affirmative duty to disclose the use of artificial intelligence” in expert opinions and tossed out an expert’s declaration upon learning that he had used Microsoft’s Copilot to check the math in it.

In other cases, lawyers have been sanctioned by judges for submitting AI-generated briefings containing false citations.

Hancock says he used the software that powers ChatGPT, called GPT-4o, to survey the academic literature on deep fakes and also to draft much of the substance of his declaration. He describes how he prompted the program to generate paragraphs detailing various arguments about artificial intelligence, and says the program likely misinterpreted notes he left for himself to add citations later.

“I did not mean for GPT-4o to insert a citation,” he writes, “but in the cut and paste from MS Word to GPT-4o, GPT-4o must have interpreted my note to myself as a command.”

Hancock is a leading national expert on misinformation and technology. In 2012 he gave a widely-viewed TED talk entitled “The future of lying,” and since the release of ChatGPT in 2022 he has published at least five papers on AI and communication, including “Working with AI to persuade” and “Generative AI are more truth-biased than humans.”

Hancock, who has served as an expert witness in at least a dozen other court cases, did not respond to questions about whether he used AI in any of those cases, the number of hours he has billed the AG’s office so far, or whether the AG’s office knew beforehand that he would be using AI to compose his declaration.

A representative for the AG’s office said they would not be commenting beyond the court filings.

Frank Bednarz, a lawyer with the Hamilton Lincoln Law Institute, said that “Ellison’s decision not to retract a report they’ve acknowledged contains fabrications seems problematic given the professional ethical obligation attorneys have to the court.”

Minnesota Reformer is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Minnesota Reformer maintains editorial independence. Contact Editor J. Patrick Coolican for questions: info@minnesotareformer.com. Follow Minnesota Reformer on Facebook and X.