Local hospitals can expect to lose hundreds of thousands of federal health care dollars next year.At the same time Florida senators and representatives were saying no to $500 million in federal dollars in Medicaid funding for health insurance for the poor, they said yes to their own cheap, state-subsidized health care policies.
That Medicaid money would have been paid for the care of uninsured patients under the national health overhaul if Florida Legislators had not rejected the Affordable Care Act.The Tampa Bay Times reported Monday that the House will pay just $8.34 a month for the next year, or $30 a month for their entire families.
That loss will hit hard in Florida and other states that decided against expanding Medicaid coverage. Cuts could jump to $4 billion in 2020, according to estimates released by federal health officials Monday.The Senate will charge its members $50 a month.
Hospitals that treat a large number of uninsured residents have relied on federal funding in the past to offset the cost.Representatives and senators are paid $29,697 per year plus expenses, and taxpayers pay about $600 a month to cover the health costs of legislators.
According to Florida’s Agency for Health Care Administration 2011 data, Florida Hospital Heartland, a 197-bed center between Sebring and Avon Park, collected $468 million in Medicare and Medicaid payments. Total patient revenues were $597 million.
Highlands Regional Medical Center, a 126-bed facility in south Sebring counted $230 million in Medicare-Medicaid against gross patient revenues of $302 million. The hospital declined to provide a spokesman for this story.
FHH President Tim Cook confirmed that 79 percent of all revenues come from federal dollars. Only $31 million came from private payers, $90 from commercial insurance companies.
But hospitals in states that declined to expand Medicaid – such as Florida, Texas and Pennsylvania – stand to lose the federal funding without a corresponding increase in Medicaid-covered patients to offset it, the AP reported.
“Medicare will continue to pay less,” Cook said. Since the April 2 federal sequester, the feds are already paying 2 percent less.
Other states that accepted Affordable Care Act money will make up that cut when Medicaid expands, Cook said. “We have nothing else to make it up.”
In Highlands, 40 percent of the population is 60 or older, meaning they are on Medicare or will be soon. According to president Roger Hood, the Heartland Workforce region is the lowest paid of Florida’s 26 regions, which is why the bills of 79 percent of hospital patients are paid with Medicaid-Medicare, Cook explained.
The Legislature’s decision not to expand Medicaid means potentially millions of residents in those states who would have been eligible will continue going to the emergency room when they are sick – and local hospitals will be stuck with the bill.
Some workers don’t make enough money to buy health insurance, but can’t qualify for Medicaid, Cook said.
As originally written, the Affordable Care Act required states to accept the Medicaid expansion as a condition of staying in the program. But a Supreme Court decision last summer gave each state the right to decide.
So far, 21 states plus Washington, D.C., have accepted the expansion, while Florida and 13 other states have turned it down. Another 15 states are still weighing options.
Among the states that aren't expanding Medicaid, Texas hospitals could lose more than $56 million next year, Pennsylvania’s could lose nearly $34 million, Missouri's could lose about $26 million, Alabama's may lose $17 million. Florida hospitals could stand to lose more than $10 million, according to rough estimates from the Department of Health and Human Services, a number Cook was unsure about.
“You have continuing high levels of uncompensated care, but the funding you had designated to address it is shrinking so the amount of unmet costs will grow,” said Bruce Rueben, president of the Florida Hospital Association.
Health experts are divided in their opinions of what will happen next. Judy Solomon, vice president of health policy for the Center on Budget and Policy Priorities, a liberal think tank, said the new regulations could mean that states that don't expand Medicaid will get a break and face smaller cuts compared to states that are expanding Medicaid. But even if that's true, she said hospitals will still be in trouble.
“In the states that don't expand Medicaid, even though the DSH cut may be relatively lower than had they had expected, they're still going to be worse off because of the large number of uninsured people who are still going to need services and the fact that the hospitals will still be receiving a cut,” Solomon said.
But Rueben said he doesn't think the feds will take pity on states that choose not to take them up on their generous offer to pay for Medicaid expansion. Under the federal health law, the federal government is offering to pay 100 percent of the coverage for newly eligible Medicaid recipients for the first three years and at least 90 percent after that.
“For those states that willfully deny their own citizens coverage when it was so substantially paid for…(the feds) will not protect those states from their own bad decision,” he said. “How does that make good policy sense?”
The American Hospital Associated has asked the feds to hold off on the cuts for two years until they have a better handle on what states are doing with their Medicaid programs.