Manatee County found a reasonable road forward on the intractable and knotty issue of partially reimbursing health care professionals and hospitals for the cost of indigent health care. This coming fiscal year will be the first that county commissioners will decide whether to commit millions in tax revenue to medical services required under federal law.
The only option is to let private enterprise, i.e. hospitals and physicians, absorb that cost; the likely outcome of that would be an increase in medical care for patients who can afford treatments through insurance, co-pays and other out-of-pocket bills. The negative impact on recruiting doctors to open practices here is also a major fear.
Thanks to sensible community-driven strategic proposals, commissioners now can finally face this issue head-on -- without the tired complaint that the county lacked any plan. There are two on the table. The most pressing case -- for fiscal 2015-2016, which commissioners must finalize next month -- could only be a stopgap solution.
These new proposals address major issues that dogged county and community discussions on indigent health care as the trust fund established years ago to pay this cost evaporated under rising costs and slumping investment returns. County staff recommends spending $7.5 million on this care for 2015-2016 with commissioners giving preliminary approval last week. The so-called transition plan features two components vital to the public interest: greater transparency and accountability.
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One important point bears repeating as the community digests these proposals: The county only covers Medicare reimbursement rates for the health care for residents earning less than 200 percent of the poverty rate who do not qualify for Medicaid, Medicare or any other health insurance. "We are the providers of last resort," Brenda Rogers, the county's community services director, told commissioners at last week's workshop.
At that time, the United Way of Manatee County presented a second plan also conceived by community activists and leaders, a three-year pilot project that should resonate loudly with opponents of any county funding of health care for the working poor. This second plan aims to fund working-poor health care through a grant from the Centers for Medicare & Medicaid Services instead of county dollars. That would be huge relief for local taxpayers.
This is clearly an end-run around the state Legislature's and the governor's opposition to Medicaid expansion under the Affordable Care Act. Florida continues to reject billions in federal money to provide health to the working poor making between 133 percent and 200 percent of the poverty rate, the gap that is not covered by Obamacare insurance policies or traditional Medicaid. The U.S. Supreme Court allowed states to opt out of Medicaid expansion under ACA. So Manatee County citizens hope to short-circuit Florida's political opposition to everything connected to the Affordable Care Act by proposing a county acceptance of those funds.
We hope the federal agency views this as a wise strategy to side step the state's ill-advised position, promulgated by the Florida House and Gov. Rick Scott.
The state Senate has voted overwhelmingly to accept Medicaid expansion. Frankly, the federal agency's approval of a Manatee County grant request could set a national precedent for piecemeal Medicaid expansion in states that reject ACA's benefits, should CMS approve this potential request.
Manatee's community-conceived plan has other strong components, including the sharing of patient medical records so health providers can avoid any duplication of services -- though confidentiality is a concern that must be addressed. Eligibility only lasts six months before patients must reapply to qualify. Case management would be implemented for frequent patients.
Consultants would advise an advisory board on health care data and provide recommendations. The public would regularly be able to peruse expenditures on indigent health care and patient numbers.
The county examined the best practices at other jurisdictions, too, since neighboring counties and others across Florida contribute local tax dollars on this type of care.
Manatee County would be ill-advised to abandon this essential public service and place all of the responsibility on the private sector. Commissioners now have a framework for deeper discussions and fine tuning, progress indeed after floundering too many years in seeking a solution.