Sunday, October 03, 2010

Unwaivering support

Massachusetts last week received notice of federal approval of a Medicaid waiver that will provide $335 million for the state's safety net (aka, disproportionate share) hospitals. This is good news for the state in general and specifically for Boston Medical Center, Cambridge Health Alliance, and others who have seen a dramatic reduction in state support following the implementation of the MA health reform legislation.

I refer my readers to an excellent give-and-take on this issue here at the Heritage Foundation site. Josh Archambault claims such funds are a kind of unwarranted bailout given other options available to the state, but then Dennis Keefe, the CEO of CHA, provides a thoughtful rebuttal.

But the two writers talk past each other a bit. Here's Josh:

One, in order to make budget numbers work in a period of economic freefall, Governor Deval Patrick refused to make payment to BMC for Medicaid services already rendered. So the federal money possibly on its way to BMC could be another special deal to paper over Massachusetts’ budget woes.

Second, the budget gaps these hospitals face are reason for even more concern because of the President’s recently passed national health plan.

And here's Dennis:

You begin your piece by saying we are “turning to the feds” for a bailout to close our budget gaps. That simply isn’t true. We simply want and expect to be paid for providing important services for people who desperately need health care and have no place to turn.

It’s simple math; the greater the amount of care an organization provides to populations served by these programs, the greater the financial shortfall, and the greater concomitant need for additional revenue support.

Gentlemen, you are both correct. CHA, BMC and other hospitals absolutely deserve extra governmental help to help pay for indigent care because the new reimbursement system that was put in place by Chapter 58 and subsequent state budget actions systematically underpays them.

But the need for such funds is likely to expand nationwide under the new national law as poor people gain access to insurance plans that do not fully compensate hospitals. The difference at the national level is that the US Government cannot tap a higher level of government for the funds, the way Massachusetts can. Those funds will have to be generated by tax increases or reductions in appropriations. We are already seeing actions to reduce reimbursements from Medicare. That is a form of taxation on hospitals and doctors that is invisible to the public and the one that will be favored by the body politic.

The President promised access, choice, and lower costs in his health care bill. Only two out of three were possible. We will have access. The government will be reluctant to reduce choice. Lower costs -- but only for the federal government -- will be achieved by reducing appropriations.

1 comment:

Anonymous said...

Paul - This story should be getting much more press both locally and nationally. We were all promised that once everyone was insured that healthcare costs would come down. This is simply not happening. People in Mass now have state sponsored insurance so the providers bill the insurer AND ask for supplemental money from government. Provisions were made to make sure the "free care" hospitals (BMC and CHA) transitioned to serving people with insurance, they did not make the difficult choices to get their costs in line and are now getting bailed out. How much money did Elaine Ullian get paid while not making any of the necessary cuts during the transition period? Based on the Massachusetts plan, the feds are now going to roll out a massive expansion of Medicaid and other subsidized plans to millions of people without insurance and again are promising they can "bend the cost curve" once people are insured. ER use here in Mass has not declined, costs have not declined and the feds are quietly sending hundreds of millions of dollars to bail out the model they are copying nationally?? This is madness. Massachusetts hands out free insurance while doing nothing on cost or access and this is what we are going to copy nationally? I just don't get it.