TALLAHASSEE · Financially strapped hospitals serving large numbers of uninsured patients, like St. Mary's Medical Center in West Palm Beach and Jackson Memorial Hospital in Miami, could find themselves in a tougher pinch under Gov. Jeb Bush's Medicaid reform plan, legislators warned Wednesday.
Bush has proposed that the state's 2.3 million Medicaid recipients be allotted money like a voucher to buy their own health care coverage from managed care organizations and other private medical networks. If enacted, the program would make Florida the first state to allow private companies, not the state, to decide the scope and extent of services to the elderly, disabled and the poor, half of them children.
As part of the plan, Florida would put an annual cap on per-patient Medicaid spending. The goal of the cap, Bush aides say, is to create a financial incentive for private companies to enroll the state's vulnerable population in their health care networks.
But several legislators, including Senate President Tom Lee, R-Brandon, have begun publicly questioning whether the strategy will only shift health spending from the federal and state governments onto the shoulders of local governments and private hospitals.
They said they envision scenarios in which large numbers of Medicaid patients reach the spending cap but continue seeking health services from doctors and hospitals that are obligated to treat the patients.
State Rep. Mary Brandenburg, D-West Palm Beach, launched a similar strike at the Bush plan during opening day of Florida House hearings into Bush's Medicaid revamp proposal.
"My concern is that this is going to be reform on the backs of hospitals, which by law are required to treat anybody who shows up at their door regardless of whether they have insurance or if they have exhausted this proposed maximum Medicaid benefit," Brandenburg said. "Are we really just telling every private and public hospital that they have to provide free medical care?"
Brandenburg, who serves on an oversight board of St. Mary's Medical Center in West Palm Beach, said that hospital, like others in Florida providing a substantial amount of indigent care, can't shoulder a greater burden.
The worries about cost shifting to the counties and local hospitals are disputed by aides to the governor and aren't shared by all hospital administrators.
Several hospital officials in South Florida, instead, say it's too early to know exactly how they will be affected by the governor's Medicaid overhaul.
William Scherer, general counsel of the North Broward Hospital District, said the tax-assisted system may benefit in one regard, by gaining many new patients as the state forces Medicaid recipients to switch from private physicians to managed care entities. The north district, the South Broward Hospital District and Jackson Memorial Hospital in Miami have a network that could offer discounted drug prices and experienced health managers, Scherer said.