Sunday, June 24, 2018
Editorials

Simply shifting costs is poor Medicaid policy

State budget gimmicks are nothing new for the Florida Legislature. But next year's Medicaid budget could sink to a new low: Counties — and by extension local taxpayers — could be forced to pay bills they do not owe. Hospitals would see Medicaid reimbursement rates further slashed. Medicaid patients would have limits on emergency room visits, and doctors may not receive a reimbursement increase because of an ideological fight between Republican lawmakers and the Obama administration.

Republican leaders, who will spend this weekend negotiating a final plan, say they are controlling costs. They are really just shifting more health care costs onto private patients and local governments. No one wins.

Next year's Medicaid budget is the result of valuing tax cuts more than investing in Floridians. Gov. Rick Scott and legislative leaders want to raise public school spending by more than $1 billion to make up most of the cuts to schools they made last year. But they won't consider new revenue sources, from initiating sales tax collection on Internet sales to rejecting millions in federal money tied to President Barack Obama's Affordable Care Act. So legislators are shortchanging higher education, Medicaid and other programs.

But cutting Medicaid reimbursement rates is shortsighted; every state dollar spent also draws down $1.67 in federal money. By one estimate, the proposed hospital rate cuts — 7 percent in the House and an average of 12 percent in the Senate — when combined with the 2011-12 rate cuts would mean nearly $1 billion in Medicaid money won't be spent at Florida hospitals. That will affect jobs, hospital services and the prices for private patients.

Suffering the most would be the state's 14 pediatric programs — including St. Petersburg's All Children's and pediatric care at Tampa's St. Joseph's and Tampa General — which count on Medicaid funding for an average of 62 percent of hospital stays. (The House proposes holding All Children's harmless from its cut, but the Senate doesn't.)

Also losing big could be Florida's 67 counties. Lawmakers plan to steal nearly $300 million from these counties to settle disputed claims under the state's Medicaid cost-sharing law. Rather than address obvious errors in the claims — such as double billing or incorrect identification of a patient's home county — legislative leaders plan to just garnishee the counties' share of sales tax revenues to cover 85 percent of disputed bills. The scheme would also apply to all future billing.

Lawmakers also would limit the number of emergency room visits it would cover for Medicaid patients — even as federal law requires hospitals to treat anyone who walks in. That may save money for the state, but not the hospitals or communities that support them. And the House's refusal to accept $440 million under the federal Affordable Care Act to raise physician reimbursements — aimed at increasing the number of doctors willing to serve the poor — puts even more pressure on hospitals.

Both chambers should abandon their extortion scheme for the counties and commit to a thorough review of billing disputes. The Senate should prevail on the House to accept the physician money from the federal government, and both chambers should work to bring the reimbursement rate cut for hospitals below 7 percent. A Medicaid budget that just shifts the state's costs to everyone else is not in anyone's best interests.

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