The cruelest cut

Published: Tuesday, January 25, 2005 at 6:01 a.m.
Last Modified: Monday, January 24, 2005 at 10:07 p.m.
At the University of Florida-Shands, they are doing cutting-edge research in medicine and health care technology. They also are providing life-saving care to thousands of low-income Floridians who cannot afford it.
Pushing back the frontiers of medical science and caring for the poor are flip sides of the same UF-Shands mission. One cannot and should not be sacrificed for the other.
But if UF's hospitals and clinics lose millions of dollars this year because of cuts to the state's Medically Needy and Medicaid programs, the university's ability to fulfill its mission will be severely impaired.
Teaching hospitals are the care centers of last resort for many low-income Floridians. And if Gov. Jeb Bush's proposal to eliminate hospital coverage under the state's Medically Needy program is embraced by the Legislature, it will put teaching hospitals like Shands in a fiscal and ethical bind.
"Other (health care) participants, if the world gets bad, they can walk, pharmaceutical companies don't have to provide the drugs if (compensation) is too low," Tony Carvalho, president of the Florida Teaching Hospital Council, recently told reporters recently. "But we're going to provide the care."
It is too soon to pass judgment on Gov. Bush's ambitious plans to slow runaway Medicaid spending by essentially turning it over to the private sector.
But in a year when the governor is proposing yet another round of tax cuts, eliminating a program that provides life-sustaining hospital care to about 36,000 low-income Floridians who suffer from catastrophic illnesses seems like a particularly cruel fiscal expediency.
The good news in that regard is that legislative leaders are reacting warily to the prospect of eliminating the Medically Needy program.
And well they should; two years ago, lawmakers made deep cuts in the program, only to have to reverse course in the wake of an angry public backlash.
"When you push people out of that program, they present themselves somewhere else, perhaps in an emergency room, which is the most expensive setting," Senate President Tom Lee, R-Brandon, said last week of the Medically Needy program.
It is estimated that Shands' hospitals and clinics provide about 30 percent of all the charity care in Florida. And it is doubtful that UF's hospitals will begin to turn away the poor even if its budgets are slashed.
But make no mistake; deep cuts in compensation for indigent care will have negative ramifications.
Either the quality of care must suffer under the crunch of staff cuts and lost resources, or hospitals will be forced to charge insured patients more in order to cover the costs of treating those who have no insurance.
When the Legislature goes into its annual session it will not be facing a looming budget crisis. And bringing Medicaid spending under control likely is going to be a long-term process; immediate, drastic cuts are simply not justified.
Under the circumstances, Gov. Bush's assault on the Medically Needy program is bad health care policy.
And it is unfair to expect hospitals, especially public teaching hospitals, to provide more and more indigent care for less and less money.

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