Deal wants extension of hospital ‘bed tax’

But some lawmakers unhappy with decision not to expand Medicaid

mlee@macon.comJanuary 17, 2013 

ATLANTA -- Some of Georgia’s hospitals breathed a sigh of relief when the Legislature took its first step toward renewing a state tax that attracts matching federal health care dollars, but they face a murkier picture with Gov. Nathan Deal’s decision not to expand Medicaid eligibility.

Republicans insist the tax is a provider fee, while Democrats call it a bed tax. But no matter what it’s called, the state collects between 1.4 and 1.45 percent of most hospitals’ net patient revenue, which triggers additional federal matching funds.

And this year it’s set to expire unless the state Legislature takes action to renew it.

Julie Windom, vice president of government relations for the Georgia Alliance of Community Hospitals, a lobby for its nearly 100 hospital members, said those funds disappearing would be “devastating.” The combined loss of state and federal dollars, she said, would cause a 32 percent cut in the Medicaid reimbursement rate to her hospitals, big economic engines in many communities.

On Thursday at his State of the State address, Deal urged lawmakers to renew the collections. Hours later, the state Senate seconded him with a 46-9 vote on the measure, Senate Bill 24.

State House of Representatives consideration could come when the Legislature reconvenes at the end of January.

“We’re fairly confident we have the votes to pass it,” Windom said, due in large part to the governor’s support and the support of leadership in both chambers.

Matt Caseman also said the loss of the money would be “devastating.” He’s executive director of the Georgia Rural Health Association, which counts as its members hospitals, health centers, physicians and others.

“They’re running such thin margins right now,” he said of hospitals across the state.

Hospitals with a higher Medicaid-patient caseload fare better than those not under the formula. For the year ending in June 2011, the latest available state data, The Medical Center of Central Georgia netted about $1.8 million on the transactions. For Houston Medical Center the sum was about $200,000, and Coliseum Medical Centers, nearly $61,000.

By contrast, Tift Regional Medical Center lost about $322,000.

But another Deal decision will be tougher for hospitals: Georgia will not opt in to the federal initiative to expand Medicaid -- insurance for the low-income Georgians -- to more people.

“I did not judge it prudent to expand the eligible population of an entitlement program by adding an additional 620,000 new enrollees,” said Deal, “since our state is already spending approximately $2.5 billion in state taxpayer funds annually” on Medicaid.

Georgia has slightly more uninsured residents than the national average, according to the U.S. Census Bureau. It estimates that in 2011, some 19 percent of Georgians had not been covered by any insurance all year, be it private, Medicare or Medicaid. The national uninsured rate was nearly 16 percent.

Caseman argued in favor of an expansion of the Medicaid rolls because it “would allow thousands of people to finally see a primary care doctor and receive preventative medicine.”

But Windom, acknowledging the budget constraints the state is under, said her community hospital alliance is concerned that if Medicaid is expanded, it may actually result in less access to doctors.

In its management of Medicaid, Georgia is not allowed to roll back eligibility or services, Windom said, so the only way to trim the cost is to trim the amount the state pays doctors to take care of low-income patients.

“We already have too few physicians treating Medicaid patients,” she said, attributing it to the program’s reimbursement rate and the paperwork burden.

But optometrist and state Rep. James Beverly, D-Macon, called the decision not to expand “a huge mistake,” because people without insurance will continue to go to emergency rooms.

“It drives up the cost. They don’t have the money, so who pays the burden of it? Taxpayers pick it up,” he said.

People without insurance “get the most expensive primary care,” state Sen. David Lucas, D-Macon, said on the Senate floor. “They end up in the emergency room.”

Coliseum Health System spokeswoman Robin Parker declined to comment on the measures, and efforts seeking comment from Houston Medical Center and The Medical Center of Central Georgia were not successful Thursday.

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