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Ellen Belcher is the Dayton Daily News opinion pages editor. She writes about state government, education, the environment, higher education and all things Dayton.
Martin Gottlieb is an editorial writer and columnist for the Dayton Daily News opinion pages. He focuses on the political process itself and does such national issues as war, the economy, taxes and Social Security, as well as a hodge-podge of local and state issues.Home > Blogs > A Matter of Opinion > Archives > 2009 > April > 30 > Entry
Editorial: Not fixing Medicaid costs everybody
Ohio’s hospitals and nursing homes are ticked about Gov. Ted. Strickland’s budget. They can take a number.
With the exception of some schools (which believe that the governor has set them up to get much more money in the future, though not so much now), nobody is happy.
State employees (who won’t get raises for the next three years and must take five-day furloughs this year and next), people who feed the hungry, local governments — they are all disappointed.
Specifically, the health-care providers are mad that Gov. Strickland wants to increase a tax that only they pay. The proceeds from it are used to tap federal Medicaid dollars that must be matched by the state.
(Medicaid is the government program that provides medical care for the needy, and nursing home care for the poor and those who became poor after paying their nursing home bills.)
Historically, both industries have paid the tax willingly because Ohio has paid the money back — dollar-for-dollar — to offset the cost of providing charity care.
In this Strickland budget, the governor would increase the tax to bring in about $600 million, but the providers would only get $187 million back. Thus, they’d pay $400 million in new taxes.
That opens up a door that hospitals and nursing homes don’t even want to go through.
As compared to other industries, it’s hard to fret about hospitals.
Many say they’re losing money, and across the country, many have closed. Still, many others are buying and building like gangbusters. They also have created all sorts of work-arounds that move money off their books.
Meanwhile, executive compensation is beyond generous.
As for the nursing home industry, in Ohio, it has had a great gig going, almost always getting most of what it wants from the Legislature in reimbursements and with regard to regulations.
Knowing these realities, Gov. Strickland — when he looked at a $54 billion two-year budget that is being patched together mainly with $6.7 billion in one-time federal stimulus money — decided hospitals and nursing homes could be hit up to pay more than in the past.
This week his budget proposal was worked over in the Democratic Ohio House — with the hospitals and nursing homes getting more, but not all of, their money back.
Now the legislation moves to the Republican-controlled Senate. Who knows what will happen there.
The complaint from hospitals and nursing homes about their taxes is important less on its merit and more because of the point it makes about the crushing cost of refusing to make enough Medicaid reforms.
After all, if hospitals can legitimately complain about their financial problems, it’s because Medicaid is fraught with inequities and crazy rules that drive up costs.
However, what’s not well understood is that that fact affects everybody — not just poor people and health-care providers.
Consider:
—Because Medicaid reimbursement rates are low, hospitals, doctors and nursing homes charge more to people who have insurance, driving up their rates.
—When hospitals or medical providers cut services and employees because Medicaid shortchanges them, the quality of care for all patients suffers.
—The more of your tax dollars that the state spends on Medicaid, the less money there is for other things (or the more your taxes go up). Today almost 40 percent of the entire state budget goes for this program.
The most pressing and vexing issue is not that Gov. Strickland wants to ding the health care industry. It’s that Medicaid, as it exists in Ohio, is unsustainable.
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