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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 > 2011 > May > 16
Monday, May 16, 2011
Guest column: Budget puts health care safety net for kids at risk
This commentary was written by David Kinsaul, president and CEO of Children’s Medical Center of Dayton.
Ohio’s children’s hospitals are facing Medicaid changes that could be devastating to our ability to provide the highest quality of care, regardless of a family’s ability to pay.
While Dayton Children’s Medical Center and the other children’s hospitals across the state focus on ensuring that children receive the best care for the best value, we also collectively provide more than 28,000 Ohioans with jobs — good-paying jobs that serve as economic engines.
Our researchers and medical professionals are leading the nation in innovation, product commercialization and technology development — all of which lead to more jobs and top-notch, groundbreaking health care for children.
Here in Dayton, our hospital has delivered $340 million in economic impact to the region.
As the economy has suffered, however, our Medicaid rolls continue to increase, placing more pressure on an already burdened system.
We are the health care safety net for Ohio children, and, in fact, more than 50 percent of the patients in our hospital rely on Medicaid, up 8 percent in the past three years.
This is staggering, given the fact that for each 1-percent patient shift from commercial insurance to Medicaid, our institution loses more than $1.6 million a year. Medicaid reimbursement does not cover the real cost of care.
We’re not alone in these losses. Statewide, Medicaid losses for children’s hospitals continue to grow — from $202 million in 2008 to $225 million in 2009.
Even when you consider Medicaid reimbursements and other programs for high-Medicaid hospitals (like the children’s hospital line item that is in jeopardy under the proposed budget, and the Hospital Care Assurance Program), we are still faced with a more than 20-percent gap between our Medicaid costs and state funding to provide for that care.
More than 1.2 million Ohio children — one in three Ohio children — rely on Medicaid for health care coverage, and yet Ohio’s current Medicaid spending for children is 22 percent below the national average, according to the administration’s reporting.
Without changes to the proposed budget, our Medicaid losses will increase, the gap will widen, and, I fear, Ohio’s most medically fragile children will be left without the high-quality safety net that they need in Ohio’s children’s hospitals.
Specifically, there are two key changes that need to be made to the budget. We hope that the Ohio Senate will make these changes.
• While we appreciate the amendment in the Ohio House appropriating $2 million each year to the children’s hospital line-item, it is important to remember that we are losing more than 100 times this amount annually. Fully funding this important program at $6 million in general revenue funds in each fiscal year will allow us to draw in approximately $9 million in federal matching funds.
• Medicaid managed-care plans — corporations that make money providing administrative oversight for most of Ohio’s Medicaid recipients — are attempting to gain an advantage through language that forces Ohio’s hospitals into non-negotiable relationships with these plans.
This language is not only unnecessary, but it will compound our Medicaid losses and stifle the innovation that the governor and Office of Health Transformation are envisioning to reform Ohio’s Medicaid program. This language needs to be removed to maintain a level playing field.
With the hundreds of millions of dollars in annual Medicaid losses we collectively incur, we can’t expect that Ohio will make us whole. However, we are hopeful that the losses we already shoulder will be considered as the Senate debates the most challenging state budget we have seen in our lifetime.
It is important for all of us to make sure our state senators know how important it is to invest in the health care of children and to protect the safety-net providers who care for them.
Children don’t vote, so we have to speak for them.
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Editorials: Extra elections do nothing to help voters
The bipolar course of American politics during the last few years has shown even the most thickheaded denier that elections matter. A lot.
If Barack Obama hadn’t been elected in 2008 — along with big Democratic congressional majorities — universal health care coverage would not have happened, period.
If John Kasich had not been elected in 2010 with a general Republican tide, collective-bargaining changes and more wouldn’t have happened, period. This list goes on.
The changes being made are in the structure of things — if not the most basic structure, then the next level down. Walls are being torn down, new rooms built, old ones eliminated. In the new structure, people who haven’t been around for a while could easily get lost. And the construction and reconstruction never seem to end.
It was not always so, when the political parties were more like each other.
Whether the new situation will cause more people to vote isn’t clear. What is clear is that the elections that matter most have bigger turnout than the others. When multiple high offices and big issues are being hotly contested, more people turn out than, say, when there’s only one matter on the ballot.
Ohio has long had the practice of allowing local entities to call special elections for February and August. Most typically, the votes are about school levies, but municipal levies and other issues come up, too.
The schools often say they need this option, in part because, if they lose on the first attempt, they can try again after addressing concerns of critics, possibly by lowering the levy proposal.
In truth, though, other political considerations are often at play, including the calculation that low turnout might improve the odds of passage, given that many teachers and many parents of students are likely to vote, even if overall turnout is only 20 percent.
Superintendents and school boards are trying to do right by the organizations they serve, which are made dependent on levies by Ohio law. But something feels wrong about taking advantage of low turnout.
One result of special elections is that people can be called to the polls several times a year, given that every year has either federal/state/county elections or municipal elections.
If there’s any way to consolidate some of these elections, that should be done, in the name of efficiency, consideration for voters and higher turnout.
It’s not easy, because most elections are built into some constitution or other. But the state Senate is now looking at eliminating February and August elections, as part of a large bill about election law. Sponsored by Sen. Keith Faber, R-Celina, chair of the government oversight committee, the special-elections provision ought to find bipartisan support.
Election reform has moved in recent times toward including more people in elections: early voting, no-fault absentee voting, massive get-out-the-vote campaigns, easier registration.
There has also been backsliding, including efforts to narrow what kinds of identification may be used at the polling place.
Eliminating special elections needs to be seen as part of the effort to increase participation, by having more people vote on the issues in question and by loading up the major elections so as to draw attention and more people to them.
If the case that elections matter is overwhelming, the case that special elections matter is obviously not. It’s a tough sell. Given that there’s a good alternative, they should be eliminated.
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