Taking with one hand and taking with the other

The usual expression is "giving with one hand and taking with the other," but the Massachusetts Legislature and Governor sometimes act as though the version in the title of this post is the way to go, at least when it comes to the state's hospitals.  First, there are proposals in the health care reform legislation to impose new taxes on the hospitals.  Then, the various versions of the state budget take more away, to the tune of about $40 million.

The Senate, the last of the three branches to propose a budget, does not address any of the unjustified MassHealth (i.e., Medicaid) rate reductions the Governor initially recommended. These include doubling a penalty for "preventable" readmissions -- this notwithstanding that the measures used to track readmissions have been rejected by both the state's expert panel and the National Quality Forum.  There is also an outpatient policy that permits MassHealth to not pay for certain outpatient services if they are followed by an inpatient visit within three days, even if the visits are completely unrelated.  There are other technical changes, too, that are too abstruse to summarize here.

I know it is easier for public officials not to raise taxes to the general public, but this whittling away of the resources of the state's hospitals is inherently inequitable.  It is all the more galling when this same state Senate refused to act to alleviate the payment disparities among hospitals.  If you think about it, the kinds of changes summarized above act as an especially regressive form of taxation when the systems that have collected, and are collecting, hundreds of millions in excess revenues are treated with impunity.