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Be careful fixing indigent program

Hillsborough commissioners have gotten ahead of themselves in a suspect search for a long-term fix to the county's indigent health care program. While the acclaimed managed-care plan is losing money, the reasons are varied and much of the problem is beyond the county's control. Before considering cutting eligibility and services, commissioners should clarify the plan's mission and get a grip on its finances.

Hillsborough created the health plan in 1991 to stem the rising cost of providing state-mandated charity care. Patients are routed by primary care physicians to a network of health care providers. The managed-care approach has driven per-patient medical costs down by 65 percent by emphasizing preventive treatment for uninsured residents and reducing the number of expensive trips to hospital emergency rooms.

The county wants to retool the program after back-to-back years of multimillion-dollar cost overruns, caused largely by double-digit spikes in Medicaid costs and increased health plan enrollment. This year's $6-million deficit could easily climb next year, even without higher enrollment, as the county's Medicaid costs increase and as prices in the county plan rise an expected 6 to 10 percent.

Commissioners this month pared a range of services to balance this year's $97.5-million budget. Cutting programs to deal with a deficit is appropriate, but raising revenue should be part of any long-term fix. Commissioners should first agree on the program's mission: Should it provide early and limited care for a temporary period of time, or should it act like a broader insurance plan and involve a range of copayments for equipment, tests, prescriptions and services?

The debate cannot proceed without a better idea of what added Medicaid costs the state will push onto the counties. Shifting prescription costs for Medicare recipients to the federal government is expected to save $5-million in 2006. The county also should widen the funding base of the health care program, which is supported by sales taxes. County figures show most clients are employed and temporarily served by the program. Stabilizing the funding base would help ensure that a vulnerable population stays productive in our community.

Above all, commissioners should remain open to new ideas. New Commissioner Brian Blair jumped the gun by pushing hard to privatize the program, even though statistics show that overhead is not the problem. Commissioners also erred by calling for a board to recommend a long-term fix. That move is a slap to the professionals on the county's health care advisory board who have long served that role. If commissioners are more eager to control the recommendations than to have the best options available, then this process is less about health care and efficiency than it is shortsighted politics.

[Last modified February 17, 2005, 01:21:16]