Opinion: Indigent health plan needs support

The debate over how to save Hillsborough County's indigent health care plan needs to start with an acknowledgement of how it got into trouble. Here's the short answer: A few years ago, the County Commission, playing to conservative voters, cut tax support for the program, raided the trust fund for nonrelated expenses and sold the public a bill of goods about a projected growth in sales tax revenue that would keep the program running.

Such dishonesty is what makes this week's discussion over saving the plan sound like deja vu. The county staff and the health care advisory board have come up with some recommendations to reverse years of deficit spending and reform the plan's finances. The ideas are helpful, but they focus almost entirely on cutting and shifting costs, rather than confronting the larger problem of stabilizing the cash flow over the long term.

Cutting services, limiting enrollment and capping eligibility will further undermine a safety net that's already inadequate. It is not a plan for saving anything, and commissioners who say otherwise are deluding the voters and fooling themselves. The challenge is not to find a million here or there, but to learn from the mistakes of 1997 and put the health plan back on solid ground.

Shifting the cost of inmate care and other services elsewhere is appropriate, and will help. But the program needs adequate continuing support from the county's general fund. Without it, the health plan will always teeter on the financial edge and be a target for grandstanding politicians. Preventive care and case management can't exist without the sort of alliances between government and health care providers that come with a stable, year-to-year funding base.

With so much misinformation about the plan being spread by its critics, advocates are struggling to decide what services they most want commissioners to save. There is nothing wrong with the tighter administrative controls proposed by staff and the health care board. Even some reimbursement limits on medical supplies and prescription drugs are appropriate. But the county should not drive residents further into poverty before making available catastrophic care. Such a move would swell the numbers of families forced to cope with medical and financial emergencies. Commissioners also should resist a harsh proposal to deny benefits to legal immigrants. What residents should expect from the commission is a big picture for the future, not a repeat of the dishonesty of 1997. The health plan is a useful tool that serves the needy and the taxpayers well.

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