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Pending Medicaid cuts raise concerns

State and federal cutbacks in the Medicaid program would have dire consequences for both the healthcare industry and poor people who depend on the services, according to leaders of Florida's hospitals, nursing homes, doctors, the healthcare union and spokesmen for the poor.

The Bush administration has announced plans to cut federal contributions to this healthcare program for the poor, and the Legislature is considering several ways of cutting the portion it pays.

''Florida is already at a breaking point,'' said Lisa Margulis of the consumer group Florida CHAIN. ``It can't be cut any more.''

''It's a real scary time,'' said Betsy Marville of the SEIU Florida Healthcare Union. ``You don't want to take budget cuts off the backs of the patients or the workers.''

Even without the cuts, many complain about the services that Medicaid provides now, particularly in Broward County, where a pilot project puts poor patients into managed-care programs.

''It's extremely poor as it is,'' said Howard Mallinger of Sunrise, who has two sons in the Medicaid pilot project.

''They've established Medicaid mills,'' Mallinger said. ``My sons go to mental-health clinics where there are 30 to 70 people in the waiting room. They get two to four minutes with a doctor or nurse practitioner who charges Medicaid $125. Two weeks later, they can't get their medicine. One of my sons has ended up in the hospital at least eight times because he couldn't get his medicines.''

Among the gloomy news, hard-hit nursing homes are clinging to one ray of hope: strippers.

Two Tampa Bay legislators have proposed that a $1 fee be added to admission charges at strip clubs to boost Medicaid funds for nursing homes.

The word taxes has strongly negative connotations in Tallahassee, and Ed Towey, spokesman for the state's nursing homes, said an amendment calls the charge a ``surcharge, not a tax.''

Nursing homes are particularly dependent on Medicaid because Medicare does not fund extended nursing home stays.

''Instead of a modest increase in the daily rate Medicaid pays for its nursing home patients,'' Towey told The Miami Herald, ``on Jan. 1, facilities received an actual dollar cut in rates compared with what they were reimbursed in July.

'This is in addition to the $169 million removed from the nursing home line item in October 2007 and $91 million vetoed by Gov. Jeb Bush in May 2006. Gov. Charlie Crist's proposed budget eliminates another $192 million in inflation-related funding. The Legislature is also likely to cut Medicaid funding for `extras,' such as Medicaid-paid eyeglasses, dentures and hearing aids for nursing home patients.''

Some political leaders counter that tax-financed healthcare is not affordable. The Bush administration's new budget proposes cutting $17 billion from Medicaid nationwide.

Perhaps worse, the Government Accountability Office issued a report in January saying the federal government is overpaying Florida $6.9 billion over five years as part of a demonstration project, suggesting that the federal government will be looking for ways to reduce its payments to Florida in particular.

On the state level, Rep. Marco Rubio, R-West Miami, the speaker of the House, recently e-mailed colleagues: ``Our current Medicaid system is unsustainable. It is currently 22 percent of the state budget, and is projected to 27 percent in just the next three years.

``Florida simply cannot afford to continue doing business like we are currently. In order to save the Medicaid system, continuing reform is vital. Expanding Medicaid Reform into Miami-Dade County is an important step in creating a system that can survive and is a step that we should enact this session.''

Consumer advocates for the poor reply that this would be a mistake. ''There are many, many problems with the so-called reforms now in Broward,'' said Margulis, of Florida CHAIN. ``People can't make informed choices. Access to specialists is reduced.''

Hospitals, meanwhile, are concerned that the pressure to reduce state and federal expenditures on healthcare will inevitably mean less money for them.

''This is a huge problem,'' said Linda Quick of the South Florida Hospital and Healthcare Association. ``The state is facing a $2.4 billion shortfall, and they always look to healthcare as a cost-containment alternative.''

Since Medicaid pays less than the hospital's costs for each patient, ''you can't make that up in volume,'' Quick said. That means hospitals have to attempt to shift costs onto those with private insurance. That increases the premiums, which in turn causes more employers to drop coverage, increasing the number of uninsured.

Meanwhile, the Florida Medical Association, which represents the state's doctors, says one reason that Medicaid patients have a hard time getting care is that many physicians don't want to treat them because of the low reimbursement rates.

Florida's Medicaid fees for doctors are only 65 percent of what Medicare pays, according to the FMA. Even by the low standards of Southern states, Florida is well behind Georgia (81 percent of Medicare fees), South Carolina (89), Alabama (90), Mississippi (91) and North Carolina (97).