Some counties have special taxes they collect to support their local hospitals that treat needy patients. The counties send that tax money to the state, which is able to pull down federal matching funds. That money then goes back to those 20 counties and ultimately to their hospitals. But a change in the Senate would require those districts to share with more than 40 others in the state that don’t have those extra taxes. And some say that “Rob Peter to Pay Paul” system isn’t fair:
“That policy would have the result of cutting reimbursements to our teaching hospitals, children’s hospitals and public hospitals, and move much of that money to the for-profit hospitals in the state" said Tony Carvalho, President of the Safety Net Hospital Alliance.
The safety nets are the main beneficiaries of those local tax dollars because many of them are located in the special taxing counties and treat large populations of poor, uninsured patients. Carvalho says the Senate’s plan requiring the counties to share their money statewide will result in a budget hit to those hospitals. For example, Miami’s cash-strapped Jackson Memorial hospital could lose an additional $14 million alone.
Hillsboro is one of the counties that collects the additional taxes to support indigent healthcare and it would lose $15 million under the Senate’s sharing system. Hillsboro officials say says it’s unfair that taxes paid by Hillsboro residents should go to other counties that don’t have refused to tax themselves.
“There are local taxpayer dollars that are used to take care of the vulnerable people in our community and we want to make sure that nothing happens to those precious taxpayer dollars,” said Hillsboro County Commissioner Sandra Merman
The fight over the fate of that local tax money is being caught up in a separate, but related issue: the way the state reimburses hospitals in general for treating low-income patients with Medicaid.
Under the new system a hospital in Tallahassee would get the same amount of money for treating a broken arm as one in Miami. The hospitals say they like the overall idea of the program, called Diagnostic-Related-Groups or DRG’s. But the Safety Net Alliance’s Carvalho says the Senate plan, doesn’t account for special circumstances that could raise costs over and above what it would normally take to treat patients.
“One example would be teaching hospital costs. Some of them have 500-1000 residents. These are your future doctors in the state of Florida. There are costs associated with that that impact the efficiencies in the hospitals," he said.
The Alliance estimates its hospitals could lose $112 million if the Senate refuses to take into account things like the population of people being served or, in the case of teaching hospitals—the amount of money it takes to train doctors. He says the House has been more accommodating putting an additional 100-million into the budget to make up for the money safety nets would lose. The Senate is getting closer to the figure. But neither side can get very far unless something is done about the local tax revenue money. Earlier in the week, Republican Senator Denise Grimsley said the chambers were getting close:
“We just need to keep working. There’s a lot of things we have to do to get it ready to make it public.”
So far the House has refused to go with the Senate when it comes to the issue of local taxing districts and how much safety-net and teaching hospitals should get to make up for funding drops under the state’s new reimbursement rate formula. The issues have been bumped up to each chamber’s head negotiator. If that fails, it will be left up to the heads of each chamber to resolve on or before next Tuesday’s deadline.
