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Tony Carvalho

Hidden health care threat

Today's economic environment has forced state officials to consider significant reductions in all areas of the budget. Quietly buried in legislation in both houses of the Legislature is the elimination of two health care programs that provide critical coverage to 50,000 very poor and ill citizens of our state.

One reason for the lack of public protest over this decision is that the termination of these programs — the Medically Needy and Meds Aged and Disabled — will not happen until 2010. While both programs have been on the brink of extinction before, there are reasons to believe this round of "Russian roulette" will prove fatal to a crucial part of the state's health care safety net.

These programs primarily serve the elderly, the disabled and Floridians who are uninsured but experience a serious illness or trauma. This coverage provides critical health care for citizens who have no other options.

While these are some of the state's most vulnerable citizens, their well-being is consistently being placed on a health care bungee cord, as the fate of their coverage is repeatedly determined only in the waning days of the legislative session. Contrary to past sessions, when talk of eliminating these programs created intense public debate, this year there is silence emanating from a false sense of hope.

The complacency is partly fostered by the fact that in recent years these programs have been saved at the last minute. Last session, Gov. Charlie Crist and the Legislature produced a small miracle by transferring dollars from the Lawton Chiles Endowment Fund to save these programs — an appreciated but one-time fix.

For the next fiscal year, funding is assured as a result of the federal stimulus program. The extra federal money and the short-term federal prohibition against any Medicaid eligibility cuts saved the programs. However, these programs will vanish without fiscal foresight, especially if the Legislature misses a rare opportunity to dedicate a permanent source of funding for this critical coverage.

The proposed $1 tobacco tax increase provides just such an opportunity and could prevent health coverage for 50,000 very needy Floridians from vanishing.

The gloomy prognosis for these programs is based on the huge shortfalls the state will face upon the termination of the federal stimulus program. If the Legislature fails to earmark a portion of the new tobacco revenues for the Medically Needy and Meds Aged and Disabled, the elimination of these programs will coincide with the end of the federal stimulus dollars as the governor and Legislature attempt to replace $3.5 billion of federal funds used for education, health and human services and criminal justice.

All Floridians will be adversely affected if these programs are terminated. Those unfortunate patients who lose their coverage will place enormous burdens on the state's emergency rooms and public health care facilities.

This is a very inefficient way to deliver and manage health care, particularly for the chronically and catastrophically ill. The loss of health care coverage for 50,000 will shift much of this unreimbursed care to the privately insured patient, transferring nearly $1 billion of costs to the private sector.

The only hope is for the state to find a permanent, dedicated funding source for these critical health care programs.

The Senate's proposal increasing the state tax by $1 per ounce for all types of tobacco offers a rare opportunity to do just that and would raise approximately $1 billion in new, recurring revenues. Dedicating only $350 million of the new revenue will prevent a health care crisis.

The nexus between tobacco use and the cost of the Medicaid program is compelling. At 33.9 cents per pack, the state collects about $40 million in tobacco taxes, yet taxpayers spend an average of $1.3 billion per year on tobacco-related Medicaid costs. The per-pack health cost for smoking-related illnesses is $10, or about $600 in taxes per year for Florida families.

While all Americans hope for a quick economic recovery, the conventional wisdom is that the most difficult challenges for state governments will come the year after the federal stimulus ends. If we do not establish a dedicated funding source for these programs before then, the health care bungee cord will snap for more than 50,000 Floridians.

Tony Carvalho is president of the Safety Net Hospital Alliance of Florida, which includes teaching hospitals, public hospitals and children's hospitals including Tampa General and All Children's in St. Petersburg.

Hidden health care threat 04/16/09 [Last modified: Thursday, April 16, 2009 6:50pm]
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