An elusive solution to indigent medical costs in Manatee County

March 23, 2014 

Manatee County commissioners in April 2013 set an election on whether to implement a sales tax increase to pay for indigent health care. Voters rejected the referendum. FILE PHOTO/TIFFANY TOMPKINS-CONDIE/Bradenton Herald.

Clarification: Manatee County's fund to pay physicians for indigent care will be exhausted within days but payments to hospitals from the health care fund will continue into next year.

The day of reckoning has arrived far sooner than expected. Manatee County's fund to reimburse medical providers for treating indigent patients will be depleted within days.

Even as recently as last summer during the heated debate over a sales tax increase referendum designed to replenish the fund, the monies were forecast to last until 2015.

Now what?

One partial solution remains an enigma. Certain Florida legislative leaders continue to be hard-hearted about accepting federal expansion of Medicaid under the Affordable Care Act -- even with the Obama administration allowing options acceptable to other Republican-led states.

So Manatee County's poor will continue to visit hospital emergency rooms and exact a higher price on society. Hospitals will likely be forced to write off more of the cost of indigent care. The community's private physicians already provide free care for the poor, and cannot be expected to bear additional costs.

In 1984, the county sold the then publicly owned Manatee Memorial Hospital, raising $45 million solely dedicated to health care.

Payments to the Manatee Memorial Hospital, Lakewood Ranch Medical Center, Blake Medical Center and dozens of physicians will cease soon.

On an annual basis in recent years, the hospitals divvied up some $9 million with up to $1 million for doctor reimbursements.

How can Manatee County come up with a reasonable solution now that those monies will disappear?

This dilemma has been a major topic of community discussion for many years, and a sales tax increase has been on the table for a long time, too.

Tough political options

Since voters shot down a sensible half-cent sales tax increase (only bringing the rate on par with Sarasota and Hillsborough at 7 percent), will the commission revisit this idea?

We suspect not.

With a county commission election coming up next year and three of the seven seats open with each contested, a property tax increase proposal is highly unlikely to gain any traction.

Could Manatee County pay for indigent care out of current revenue? If so, how much damage would be inflicted on other budget items, like parks, libraries and other quality-of-life programs?

The problem of paying for charity care is not unique to Manatee County. Around the country, counties have been grappling with this issue for years.

Some found answers, including Hillsborough County. Its award-winning health care plan -- funded by a half-cent sales tax -- offers comprehensive managed care. The average monthly cost per indigent enrollee has plunged by more than half in recent years, even as most health care costs soared.

Federal law guarantees access to emergency medical care irrespective of ability to pay, but does not provide financial support for hospitals and physicians. Florida law obligates local taxpayers to compensate hospitals and physicians for indigent care.

Manatee County has studied the health care situation in this community for years, issuing report after report -- including an in-depth analysis in 2008.

Numerous improvements in the health care delivery system have come about, but the issue of uncompensated medical services for the poor remains elusive. The community must unite to find a solution.

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