http://www.oaklandtribune.com/Stories/0,1413,82~1865~1159371,00.html
Medicaid reforms could be devastating to California Hospitals fearful of state options to create their own programs By Lisa Friedman and Suzanne Bohan STAFF WRITERS WASHINGTON -- California's hospitals could face "devastating" impacts from President Bush's plan to reform Medicaid, state and Bay Area officials said Tuesday. Specifically, advocates said they worry that a $1.8 billion program within Medicaid that helps hospitals make up the cost of treating the poor and uninsured could take a massive hit if states decide to take the White House up on its offer of a fixed amount of federal cash. Last year, California health care facilities like Children's Hospital Oakland and others that serve large numbers of uninsured patients, received about $900 million from that program. State officials said hospitals need every dime they can get with an estimated 6.3 million uninsured children and adults and another 6 million enrolled in the state's Medicaid program -- called MediCal -- which often does not cover the full costs of hospital care. "That is of grave concern to us, because those are the safety net hospitals. When you don't have insurance, those are the hospitals you go to," said Jan Emerson, spokeswoman for the California Health Care Association. Under Bush's plan, "That money could end up in a whole lot of other places," she said. Low-income patients in California already are feeling the pinch of an estimated $35 billion budget shortfall with Gov. Gray Davis proposing to roll back benefits, forcing a potential 200,000 people out of MediCal. Under President Bush's plan for overhauling Medicaid, states could choose to stay with the status quo and receive federal reimbursement for each patient based on a per capita income funding formula. Or, they could opt into the new version of Medicaid and receive a greater portion of the $3.25 billion extra the administration plans to add next year. States would then receive a fixed sum of money to design an insurance program however they like -- be it adding, reducing or even eliminating benefits for low-income, elderly and disabled residents. The federal government would increase its Medicaid contribution under the new plan by $12.7 billion over seven years, but after that states would receive less money. "If I were still a governor, I would absolutely jump at an option like this," said Health and Human Services Secretary Tommy Thompson, the former governor of Wisconsin. "The old Medicaid rules are a straitjacket, restraining creative new approaches that could preserve coverage and expand it to more Americans in need," he said. But state and local officials said they fear that if states will chose the immediate extra money behind door number one, Medicaid and the disproportionate share hospital program will suffer down the road. "My fear is that this proposal would involve cuts to disproportionate share funds," said Mary Dean, senior vice president of Children's Hospital Oakland. "And any cuts that come to disproportionate share hospitals are devastating." Bush's proposal made her "very uneasy" Dean said. Emerson also said the changes could have "a devastating impact on disproportionate share hospitals." Rep. Pete Stark, D-Fremont, had even harsher words. He called Bush's plan "pernicious" and said ultimately poor patients and the hospitals that serve them will have to compete with roads, schools, prisons and everyone else who wants a piece of the California budget, since unused money from federal block grants could be funneled into a state's general fund. Dean was hoping for the best but cautious about Bush's plan. "How is this going to help us provide care, badly needed care, for children?" she said. "My hope is that I'm missing something and that there is some good news. But my fear is it will not be good for children." _______________________________________________ http://www.mccmedia.com/mailman/listinfo/brin-l
