May 2, 2007 — Health care for Florida's neediest appears to have been rescued. It was in jeopardy as legislators were considering budget cuts in Tallahassee.
The Senate's proposed budget had included about $200 million in lost revenue; funds are protected in the House plan.
The proposed cuts to the low income pool involve subsidies to provide safety nets to hospitals for the cost of charity care and the uninsured who don't qualify for Medicaid.
According to the Naples Daily News, House and Senate leaders have agreed to find money for patients treated by safety net hospitals.
Locally, the big hits would hit Shands Jacksonville ($15 million cut) and Baptist Medical Center ($3 million).
Further, according to an alliance of safety net hospitals, reducing the state's support to hospitals would result in forfeiting $85 million in federal funding.
Here is what was at issue:
Another unfunded mandate to local government, right when state lawmakers are proposing cuts in local revenues.
More pressure in Duval County right when this county is undertaking a Medicaid pilot program.
Less access to health care, such as services to uninsured and trauma care.
Delays in capital expenses needed for quality care.
These 14 hospitals in Florida provide half of all the state's charity care, 80 percent of the state's graduate medical education and two-thirds of the organ transplants in the state.
Ironically, the state only pays 14 percent of Medicaid inpatient costs; yet even that small portion was in jeopardy.
Ironically, these cuts would force patients from lower cost clinics to high cost emergency rooms.
Safety net hospitals already lose money on these services, but the losses have to stop somewhere.
Meanwhile, Florida's important trauma centers are in jeopardy if a solution is not found for the funding from Personal Injury Protection insurance.
Funds from that insurance pool are an important subsidy for hospitals treating the uninsured. It is scheduled to sunset this year if nothing is done.
Four in 10 people treated at trauma centers and emergency rooms due to a motor vehicle crash have no health insurance, only Personal Injury Protection.
The insurance industry, frustrated at a lack of reforms and large amounts of fraud, supports letting this sunset.
But hospital spokesmen say that some replacement ought to be found. They support increasing the maximum benefit from $10,000 to $25,000.
In any case, lawmakers would be negligent to abandon one of the state's most valuable health services - the trauma centers available for life's most serious emergencies.
Nobody expects to have an accident.
But it's a comfort to know that Florida's first Level One trauma center is located at Shands Jacksonville.
It cannot afford to lose the $14 million if Personal Injury Protection is allowed to sunset.
The neediest patients
Our Opinion: Fund Hospital Safety Net for Poor Floridians 28 April 2007
The Miami Herald
April 28, 2007 — It would be unwise of the Florida Legislature to cut funding for the Medicaid safety-net program that helps cover hospital care for uninsured and charity patients. Yet this is exactly what a Senate proposal would do. The House plan, which is better, would secure federal matching funds that are critical for communities with large populations of the poor and uninsured, such as are found in South Florida.
Florida could lose
The Senate's budget proposal could cost Florida $209 million in funding that is meant to help cover the cost of hospital care for Medicaid, uninsured and charity patients. Hospitals that would face the biggest cuts are those that provide the bulk of care for Florida's neediest residents, including Jackson Memorial and Broward's north and south hospital districts. This is shortsighted.
The House's better approach would allot $81 million in funding, which would be matched by federal money. This version would add compensation for hospitals such as Jackson and Miami Childrens.
Burden communities
In order to get $144 million in Medicaid funds, Florida needs to put at least $65 million into the state's ''low-income pool,'' which compensates hospitals that provide extraordinary care for Medicaid and uninsured populations. Without that funding, Miami-Dade and Broward hospitals alone stand to lose $95 million. Moreover, the state would shift even more of the costs of charity care and Medicaid to local communities. Lawmakers have done that before, and the cost-shift remains unfair.
The Legislature shouldn't shortchange poor and uninsured residents who use emergency services or the hospitals that care for them. Lawmakers should provide a safety net for the needy. The House proposal does that and deserves support.
Health Care on the Cheap The Lakeland Ledger
The Ledger.Com
April 26, 2007 — It is foolish to assume that indigent care can be provided on the cheap, or even provided at all without adequate funding. But this year, Florida's "safety-net hospitals" - a group of 14 hospitals that provide the bulk of Florida's charity care - stand to lose upward of $209 million in indigent-care funding as a result of spending cuts being proposed in the Florida Senate.
Polk County hospitals would lose $3.8 million, the bulk of which would come from Lakeland Regional Medical Center. It would see nearly $3 million cut from its budget. Winter Haven Hospital would lose about $500,000; Heart of Florida Regional Medical Center, $337,000; Lake Wales Medical Center, $97,000; and Bartow Regional Medical Center, $97,000.
The University of Florida's Shands HealthCare system in Gainesville, one of the largest charity-care providers in the state, could lose more than $9 million if reductions contemplated in the Florida Senate's proposed budget are realized.
Shands at Jacksonville would lose even more - about $15 million. Cutbacks of that magnitude would be impossible to absorb without likewise reducing the scope of health-care services to the poor.
At issue is the Senate's reluctance to join with charity-care hospitals and local communities in providing sufficient dollars to attract federal Medicaid funding for indigent care. Indeed, under the Senate's budget proposal, Florida would have to forfeit $85 million in Medicaid funds. That makes very little fiscal sense, because the feds provide$1.14 for every $1 put up by the state.
And it isn't as though state government is already doing an adequate job of financing indigent health care. In order to tap into the federal government's Low Income Pool Fund, Florida hospitals and local governments have already committed to providing the bulk of the matching funds.
The Florida House budget proposes a modest $81 million as the state's fair-share match. The Senate's budget, in contrast, would unfairly ask local communities to kick in even more dollars (this at a time when the Legislature is determined to reduce property taxes and limit local-government spending). Alternatively, hospitals would be forced to either eliminate indigent services, try to shift more costs to insured patients or both.
The Legislature has an obligation to help communities and safety-net hospitals provide care for those who cannot afford it.
"The House budget is fair and smart," Tony Carvalho, president of the Safety Net Hospital Alliance of Florida, said last week. "It eliminates the need to shift more costs for Medicaid down to local communities and safety-net hospitals. It ensures that Florida maximizes all the federal money available to us to help our neediest citizens. And it maintains Medicaid rates for safety-net hospitals at close to their actual costs."
House leaders should refuse to compromise on their insistence that Florida pay its fair share for indigent health care.
Program Necessary for Needy By Tony Carvalho
South Florida Sun-Sentinel
Broward Metro
April 23, 2007 — Will Florida turn its back on millions of dollars in federal aid for health services to the uninsured and create over $200 million of uncompensated care
--a tab that local taxpayers, safety net hospitals and health insurance premiums must absorb?
That crucial health care question will be answered in the coming days as the state House and Senate battle out their spending priorities in the next state budget. As legislative budget talks unfold, the Senate is proposing $209 million in cuts to Florida's health care safety net for our neediest citizens and the uninsured.
Amazingly, as part of those cuts, the Senate would forfeit $85 million in federal matching money that is already earmarked for our state. The Senate would do this by refusing to fund the required state match that's needed to draw down these precious federal dollars.
Broward County would lose $28.7 million in safety net funding--the second-worst impact in any of Florida's 67 counties, next to Dade County. Palm Beach County hospitals stand to lose $5.2 million.
Consider this: There are millions of Floridians who depend on Medicaid. Roughly one in five of our state residents are uninsured. And the state's health care safety net is straining every day to meet the public's needs. How, then, can the state walk away from this critical federal assistance?
Thankfully, Speaker Marco Rubio and the House recognize just how critical this funding is to local communities and the state's safety net hospitals--which include public, teaching and children's hospitals. The House budget wisely includes the state matching money needed to obtain the federal dollars.
What's at stake here? If the Senate refuses to budge, local communities and safety net hospitals will ultimately be on the hook to cover this $209 million shortfall. Access to health care services will erode for the uninsured. Some health care services will be restricted. And private health insurance premiums will go up--because payors will have to pick up some of these costs.
Medicaid is a state-federal program. But in reality, local communities and safety net hospitals significantly participate in this partnership and are substantially subsidizing this program with local taxes.
In fact, the Senate's budget would increase the tax burden to Florida's local communities for Medicaid to a record $724 million statewide, an increase of nearly 10 percent over last year, while creating a new $209 million unfunded local mandate in the form of uncompensated care.
This current funding crisis evolved, in part, because in recent years, state policymakers have systematically diverted the assistance provided through the Low Income Pool--a program that assists in paying for care for the uninsured--to cover basic Medicaid costs for hospital care.
Safety net hospitals are committed to treating all patients, regardless of their ability to pay. But even safety net hospitals cannot continue to offer the same level of services in the face of multimillion-dollar shortfalls. The Senate's cuts hurt real people in need and further fray the state's already fragile health care safety net.
The House's budget is fair and smart. It eliminates the need to shift more costs for Medicaid down to local communities and safety net hospitals. It ensures that Florida maximizes all the federal money available to us to help our neediest citizens. And it maintains Medicaid rates for safety net hospitals at close to their actual costs.
This issue impacts every taxpayer in Florida, along with the quality and availability of health care in our communities. Tell the Florida Senate to support our state's health care safety net, and bring home the federal support we desperately need--before the legislative session ends May 4 and it's too late.
Tony Carvalho is president of the Safety Net Hospital Alliance of Florida.
Trauma for Florida hospitals Legislature's cuts would hit ER frontlines worst
Daytona Beach newsjournalonline.com
April 21, 2007 — The Legislature spared little attention this session for the plight of Florida's low-income workers struggling to afford basic health care. But there's one issue that should be a no-brainer for lawmakers: Whether or not to accept $85 million in federal money intended to shore up the hospitals that deal most with people whose only source of care is the emergency room.
Volusia County hospitals could lose close to $4 million if the Legislature doesn't provide the match needed to secure the federal money, with the majority of the shortfall hitting Halifax Medical Center in Daytona Beach. The hardest hit are the facilities that already treat large numbers of emergency-room clients who can't afford to pay their bills.
This cut is part of an overall reduction state Senate leaders have proposed to hospitals across the state, which also includes a Medicaid rate reduction. Taken together, the cuts total $209 million -- and shift another $60 million to local property-tax payers, ironic in light of the Legislature's push to cut property taxes overall. The money would come from the state's Low Income Pool, which backstops hospitals in rural and low-income areas and provides for preventive services to keep the uninsured out of emergency rooms.
The House's budget position treats hospitals far more fairly, though it also includes cuts.
It doesn't stop there. Lawmakers appear ready to allow mandatory personal-injury protection insurance to lapse, meaning fewer drivers will carry the coverage. As a result, hospitals are bracing for a new flood of trauma patients who lack even the most basic coverage.
Legislative leaders have made it clear: Money is tight this year. But striking against hospitals already pushed to the limit makes little sense. The Legislature can't reduce the need for hospitals as a safety net; it shouldn't reduce the funding that helps those hospitals meet the demands placed on them.
Florida Comes Up Short in Helping Hospitals Care for the Poor and Uninsured South Florida Sun-Sentinel
Broward Metro
April 20, 2007 — State lawmakers seem to be having a hard time finding enough money to help hospitals pay for health services to the poor and the uninsured.
It's hard to imagine the Florida Legislature having difficulty finding the $65 million from its general revenue budget that is needed to snare even more millions from the federal government for the Low Income Pool Fund, a Medicaid formula for hospitals to help the less fortunate get medical care.
The House at least has budgeted $51 million for the state's share of the pool. The Florida Senate? Zero, zilch, nada, which will make for an interesting debate when lawmakers from the two chambers meet this weekend to craft a final budget.
It would be easy to chalk up the differences to legislative politics. Typically, as the session grinds to a close, leaders in the House and Senate use budget items and legislation as bargaining chips. Lawmakers say this isn't the case, but who knows?
Despite a proposed $70 billion-plus budget, state government is seeing signs of a revenue crunch. Recent revenue estimates have trended downward, which is putting a crimp on state spending.
For hospitals, this is not good news. The state must find the money.
They are already shouldering an increasing share of paying for primary care for low income patients at a time when the costs of medical care climb dramatically. At the same time, they, like other government entities, are under pressure to keep local tax rates down. The squeeze can't last forever.
Hospital officials in South Florida are pushing for the proposed House budget. It's a flawed approach since it uses non-recurring funds to pay for a recurring expense. Unfortunately, there's no Plan B.
That's the job of the budget conferees who will begin meeting this weekend to reach a compromise on a new budget and find the needed funding to help public hospitals to serve their less fortunate patients.
BOTTOM LINE: The Legislature must find the money to help hospitals.
