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Law requires hospitals to care for poor; Legislature won't accept Medicaid money

SEBRING - Florida chopped the amount paid to hospitals for treating the poor on the theory that Medicare would reduce that loss, but then the Legislature refused to take additional the Medicaid money, a Florida Hospital official said Wednesday.

"Florida has already lost millions of dollars," said Richard Morrison, Adventist Health System vice president for governmental affairs. "Medicare was reduced nationwide by $700 billion over a 10-year period as a result of health care reform.

"The return for this," Morrison asserted, was that more uninsured patients would be covered by Medicaid to offset the loss.

"Extending coverage has already been paid for," said Sen. Denise Grimsley, R-Sebring. "It was funded by other cuts to hospitals nationwide from the federal government through the Affordable Health Care Act and other means. It is also important to remember that high levels of uncompensated care can limit any hospital's ability to maintain certain services and that ultimately someone pays the price for uncompensated care."

Although Gov. Rick Scott advocated taking the additional federal Medicaid money - which a study last week determined was about $5 billion by 2022 - and the Senate agreed, the House said no.

"I voted against it as well," said Rep. Cary Pigman, R-Avon Park. Although it put him into a disagreement with his employer - Pigman is an emergency room physician at Florida Hospital Heartland, which is owned by Adventist Health System - he said his first loyalty is as a "steward of hardworking Florida taxpayers' money."

"I think most hospitals would agree that Medicaid expansion should have happened," Grimsley said. "However, Florida was in a difficult position. The decision to expand Medicaid outright came at a time when the Agency for Health Care Administration was moving to managed care. I believe that the agency did not have the ability to do both and do them well.

"What the Florida Senate proposed in the 2013 legislative session was taking the federal dollars and purchasing health policies with those dollars so individuals that were unemployed could take those policies with them when they got back on their feet and returned to work," said Grimsley. "That passed out of the Senate last session (2013). The House, however, chose not to do that."

Grimsley said the Medicaid Disproportionate Share Hospital payments that Morrison referred to were reduced as part of the Affordable Health Care Act. "As you know, under the ACA, you are required to have health insurance. Because Florida did not expand Medicaid that does not eliminate that requirement on individuals."

The Disproportionate Share Hospitals program partially reimburses hospitals that treat a high number of Medicaid and uninsured patients. Payments were reduced by 75 percent, said Morrison, who develops and coordinates public and regulatory policy at the local, state and federal level.

"Again," he said, "on the expectation that more people would be insured. A significant number of the 'to be insured' were newly eligible Medicaid patients. But Florida will not see that increase because we did not accept the federal Medicaid money. Florida has taken the cuts and will continue to absorb the cuts, but will not see the expected benefits."

So who will pay for health care?

"If the person is working but uninsured and has insurance available through the employer but they haven't taken advantage of it, then they should revisit that option," Grimsley said. "Even if they decide to remain uninsured or go to the exchange, they still need to know what their insurance cost would be from their employer.

"If the person is uninsured and not working, they would want to explore the exchange," Grimsley said. "Medicaid rules have changed over the years, so even if they didn't qualify before, they may now. They can also apply for insurance or Medicaid in the exchange or through the Florida Medicaid program.

"Business owners who offer coverage and have qualified for the small business tax credit in the last few years and who want to continue to qualify for that credit must purchase their insurance through the exchange in order to keep those credits," Grimsley said. "If they renew their current policy, they will lose those credits. I would advise all small business owners to consult their CPA."

Pigman objected to accepting the Medicaid money for philosophical reasons, but one was tactical: many of the $50 billion in federal dollars that will fund Medicaid expansion over the next 10 years may be borrowed.

Another reason: "I wasn't convinced that the Medicaid delivery model was giving us good value. We would invest $50 billion and not get good results," Pigman said. Patients are getting episodic care, he said. "It's not part of a comprehensive care delivery method."

If the Legislature could fix its nurse practitioner system and the way the state delivers Medicaid, he would consider revisiting the issue, said Pigman, vice chair of the health care workforce select committee. Under physician supervision, NPs can write prescriptions and function like doctors. Instead, he said, Florida's NP laws are among the most restrictive in the nation."