Tuesday, March 29, 2011

San Angelo Hospitals Lead Advocacy on Medicaid Cuts

Shannon CEO Bryan Horner and Community CEO Brad Holland held a press conference on state budget cuts on the steps of the Tom Green County Courthouse.  They chronicled dire cuts that could cost thousands of jobs in the health and human services sector, responsible for 21% of  Tom Green County employment. This compares to 13% in other Texas counties.

Medicaid insures low income Americans, with the federal government historically picking up 60% of the bill and states 40%.  That changed under the Stimulus Bill, as the feds share rose to 78%.  The extra federal portion ends later this year.  This expiration contributes greatly to Texas' Medicaid shortfall.

The potential pain is great for 220 local heath and human service providers, employing up to 7,500 people.  The impact on Tom Green County includes::

-Risk of budget cuts of 35%
-Potential loss of 2,000 jobs
-Ripple impact costing another 1.000-1,500 jobs
-MHMR faces a cut of 45%
-Nursing homes, indigent care clinics and hospice programs could set cuts of 35%

Supporting Bryan and Brad were Lynn Rutland of MHMR, Mike Campbell of Esperanza Clinic, Eric Sanchez of ADAC and Wes Wells of Baptist Memorial.  Several City Council members were in attendance, Paul Alexander and Dwayne Morrison.  The City of San Angelo added to local hospital misery with their health insurance adjustments, which shed nearly 200 people from city sponsored health coverage.

Brad Holland cited increased local taxes and higher health insurance rates as a result of budget cuts in HB1.  I think it will be the later.  Local taxing authorities are the City of San Angelo, SAISD and Tom Green County.  The City has virtually no public health services left other than immunizations and an STD clinic.  City Council refused to raise taxes to cover longtime health insurance commitments to retired workers.  Instead, it passed increased cost onto workers and fixed income retirees.  Of the nearly two hundred dropping coverage, roughly 45 were employees/retirees and 147 dependents.

SAISD will eliminate 52 positions, formerly providing health insurance coverage.  They plan to decrease health insurance benefits in their basic plan by dropping pharmacy coverage.  SAISD is looking at increased premium sharing for employees, like the City of San Angelo.  The first two taxing entities have chosen to pass increased health care costs to employees, not to raise taxes.

Tom Green County is the only taxing authority providing health coverage for extremely low income residents.  It does so via the Indigent Healthcare Program.  The County sets aside 8% of its general tax levy, or over $2 million, for Indigent Health.  Last year it spent $69,400.  The County Indigent Health budget for 2011 is $458,579.  

Tom Green County contributes $1 million per year to the Upper Payment Limit (UPL) Program, which leverages state and federal Medicaid money.  County Commissioners front loaded this year's contribution of $800,000 to avoid expected UPL cuts.  The match is 3.55 federal/state dollars for every local dollar. 

Last fall I asked Judge Mike Brown to consider raising the income level to qualify for Indigent Health from 21% of federal poverty level.  He told me by phone that other counties have been slammed for taking such action.

Including UPL payments the county spent roughly half of the Indigent Health budget in 2010, with plans to spend about 75% in the current fiscal year.  The County successfully shifted budget responsibility for indigent care to the state/federal government, turning the program into a decade long cash cow

I don't see any local taxing authority raising taxes to make up for the state's disastrous cuts.  Citizens will pay through higher health insurance rates for ever-worsening coverage.  Access to health care will be restricted as hospitals and clinics cut services.   Those without insurance and a $100 cash deposit will traipse to area Emergency Rooms.  

Hospitals will have difficulty transferring patients to a nursing home, due to nursing home closures or reduced services.  Discharge planners should go wig shopping now.  After wigs return en masse, how long before leeches make a comeback?

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