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Cold-hearted Medicaid cuts

By A TIMES EDITORIAL
Published February 26, 2007

In its latest attempt to loot the nation's safety-net hospitals, the Bush administration offers a special insult to Florida. Its dramatic Medicaid cutbacks would also renege on a deal it made with then-Gov. Jeb Bush just 16 months ago. As administrative fiats go, this one is as dishonorable as it is cold-hearted. And Florida's congressional delegation needs to fight it.

The numbers behind the proposed rule, published Jan. 18 by the Centers for Medicare and Medicaid Services, are staggeringly cruel. Florida hospitals that treat Medicaid and indigent patients would lose $932-million a year. Perversely, those that carry the heaviest load would be hurt the most. All Children's Hospital in St. Petersburg would lose $31-million, Tampa General Hospital $64-million, Morton Plant Mease in Clearwater $11.6-million.

As All Children's chief executive Gary Carnes puts it: "There is no way to make this money up."

These hospitals serve an irreplaceable role in modern health care, treating all patients without regard to their ability to pay. That's why they have rightfully received a portion of Medicaid reimbursement through the years that helps offset some of their extraordinary costs.

The need is so compelling that then-Gov. Bush, while devising an experiment aimed at limiting Medicaid costs, negotiated with CMS to allow continued hospital payments through what was known as the "Upper Payment Limit." CMS examined the local taxes used as a match for the federal money and the distribution formula for the hospitals, and approved both.

State lawmakers, in turn, found the hospital payments to be so vital that they made them a condition of the Medicaid reform. "This waiver authority," says the law, "is contingent upon federal approval to preserve the upper-payment-limit funding mechanism for hospitals."

The federal rule, if allowed to take effect on Sept. 1, would undermine both the hospitals and the reform law. Alan Levine, who helped negotiate the federal waiver as secretary of the state Agency for Health Care Administration, says CMS needs to, at a minimum, exempt Florida from the rule.

"It would effectively destroy Medicaid reform from our standpoint," says Levine, who is now chief executive of the North Broward Hospital District. "But we're still in the comment period, and I would hope they make the appropriate adjustments. I think it's premature to call it a betrayal until they actually do it."

Congress in the past has protected these safety-net hospitals from the Bush administration's callous efforts. This time, Florida's delegation needs to lead the charge.

[Last modified February 25, 2007, 21:09:49]