Regaining its health

IN SURGERY: Doctors and nurses in one of Jackson Memorial Hospital’s operating suites.
IN SURGERY: Doctors and nurses in one of Jackson Memorial Hospital’s operating suites.

It’s heartening news that one no longer has to add the qualifier “troubled” when talking about Jackson Health System. As the Miami Herald reported this week, JHS closed the books in the black for the third straight year.

That’s a testament to the smart business leadership in which administrators made hard choices, while continuing to deliver high-quality healthcare to unfunded patients who most often had no other choice than Miami-Dade’s public hospital.

Jackson saw an almost $51-million surplus, closing out the fiscal year with more than 41 days of cash in its pocket, up from about 27 days the year before. This, too, is a sign of the institution’s improved condition.

Credit CEO Carlos Migoya and his team for turning around what was a listing ship, and steering it in the right direction. They tackled challenges head-on, cutting costs, renegotiating contracts, going after bad debt, leveraging charitable donations. This year, more than half of the surplus came from operations, plus a boost from robust sales-tax revenues.

Where there were challenges, Mr. Migoya & Co. confronted them. Still, challenges remain. The most onerous are beyond management’s control and will cost the health system millions, undermining its mission to treat the indigent and unfunded — at least a million of whom fall into the health-insurance gap needlessly created by the state Legislature, aided and abetted by Gov. Rick Scott, by refusing to expand Medicaid as outlined by the Affordable Care Act.

Mr. Migoya estimates that Medicaid expansion would mean about $50 million a year for JHS, to say nothing of the ability of thousands of Miami-Dade residents to get healthcare when they need it, as opposed to when they are so ill that they absolutely, positively have to seek treatment through Jackson’s emergency room, the most expensive route.

Next year, as per the Affordable Care Act, Jackson — and other other hospitals across the country — will lose funds from the federally funded Low Income Pool program. States that have created Medicaid exchanges will have the funds to make up for the loss. But not Jackson. Florida has rejected those funds time and again. So JHS takes a double hit — no Medicaid, no LIP, which accounts for about $200 million annually.

JHS has also seen a decline in the number of patients served, which isn’t necessarily as dire as it sounds, but, again, presents challenges. Mr. Migoya told the Editorial Board that many of JHS’ previously unfunded patients have obtained coverage through the ACA, and are able to seek treatment at other facilities. That’s a good thing. One, they’re covered; two, they are no longer a negative on Jackson’s books.

But Jackson now has to work harder to attract paying patients. Because of the $830 million bond issue voters approved in 2013, JHS is doing just that, so far renovating its maternity suites and planning a new organ-transplant facility, among other upgrades.

It’s past time for the Legislature to do its part. Mr. Migoya says Florida continues to leave federal healthcare funds — not just Medicaid — on the table because it hasn’t created the proper mechanisms to draw them down. It’s a long-standing lapse that predates Mr. Scott’s tenure. Next session, lawmakers would be wise — and responsible — to pursue untapped funds to replace what will be lost, and to seek compromise over Medicaid expansion, as opposed to outright rejection again. We know what that looks like, and it’s neither pretty nor smart.