We tax ourselves, but others get our money


Imagine being a high-school freshman. Your grandparents believe it’s important for teenagers to have part-time jobs, so they make an offer: For every dollar you earn at work, they’ll give you another dollar toward college.

After a year, though, your parents intervene. Even though your little brother doesn’t want to get a job, they decide to take part of your grandparents’ matching funds for his college fund. Now you’re getting an extra 75 cents for every dollar you earn. The next year, they decide to also share some of grandma and grandpa’s gift with the neighbor kids, who also didn’t feel like getting jobs. You’re down to a 50-cent match.

Why would you complain, your parents ask — you’re still getting a little something extra. So what that the other kids didn’t have to put in any sweat equity for their share?

It sounds unfair, of course, and that’s exactly what’s happening with the public healthcare dollars that taxpayers generate in Miami-Dade and Broward counties — hundreds of millions of dollars.

The federal government rewards communities with matching grants if they put local public dollars into healthcare systems like Jackson Health System, Broward Health and Memorial Healthcare System. But those federal funds pass through the state government, which insists on sharing larger and larger chunks of the money with counties whose own residents refuse to tax themselves for public health. We get the part-time job, and they get a share of grandma’s college dollars.

South Florida is known for exporting goods all around the world, but few people realize that we’re also exporting our public healthcare dollars to the Panhandle and Southwest Florida. In Miami-Dade alone, taxpayers’ commitment to Jackson Health System is rewarded with $566 million in federal funds but only $229 million goes back into Jackson Health System.

Another $129 million goes to private hospitals across Miami-Dade — some of which are for-profit systems, and none of which are owned by the taxpayers. Even more jarring, the remaining $207 million is exported to other Florida counties. That means Miami-Dade taxpayers are only keeping 40 cents of every dollar our federal “grandparents” are sending us for working.

In Broward, the two public systems combine to earn $457 million in federal matches. But they only get to keep $184 million. A little bit is redistributed within Broward, but a staggering $267 million — nearly 60 percent — is shipped right out of the county.

To make matters worse, changes to the Florida Medicaid program happening this year could make it almost impossible for taxpayers to watch what happens with this money. Unless the Legislature takes action to keep this accounting public, it could disappear into the confidential financial data of private insurance companies.

As the CEOs of South Florida’s three public hospital systems, we understand the bigger picture of community wellness. We’re not opposed to seeing some of the federal matching dollars used at private hospitals in our counties, and there’s even an argument for allowing a bit to be shared in communities that don’t generate their own public healthcare funds.

But what’s been happening for the last few years is an insult to the Miami-Dade and Broward residents who have spent decades building a strong and lasting system of community-owned hospitals and clinics.

And it could get worse. Under a new Medicaid payment formula for hospitals known as “tiering” that takes effect in state law July 1, Tallahassee would take even more of Jackson’s money and give it to other hospitals, while the net benefit Jackson receives for sharing its public healthcare dollars would decrease by $142 million.

We need to bring some sanity to the formulas through an honest and public discussion of how the federal funds are used.

Healthcare is entering a new era with increased competition and increased need. All three of our systems expect to continue providing best-in-class medical care.

The Miami-Dade legislative delegation has already embraced part of this issue as one of its top priorities for 2014. We need our taxpayer-owners to stand with them — and with us — to oppose the further redirection of dollars designed to care for our neediest neighbors.

Carlos Migoya is president and chief executive officer of Jackson Health System. Frank Nask is president and chief executive officer of Broward Health. Frank Sacco is president and chief executive officer of Memorial Healthcare System.

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