Sharing the Pain in Florida?

There were more than a few sighs of relief when Florida House and Senate members came to an agreement on health and human budgets this week.

There was also some welcome news. 

But not everyone is happy, and there will still be plenty of pain to go around.  People like me won’t feel it, but millions of others will.

First, let’s get to the good news. 

After weeks of uncertainty, funding for adult mental health services will not be eliminated or cut.  Senate and House leaders, led by Rep. Denise Grimsley, came to the conclusion that asking people with mental illness to shoulder this much more pain this year was just too much.  This is a tremendous relief to everyone affected by mental illness.  Though we may not be able to quantify “things that don’t happen,” we know that legislators saved many people from harm, and prevented scores of crises down the road.

The Medicaid “medically needy” and “aged and disabled” programs in Florida also remain intact.  If they had been eliminated, over 81,000 elders and people with disabilities would have been left with no more health care and no money.  These are all people either living in poverty already or who have monthly incomes too high to qualify for Medicaid – even though they have no savings and have to spend most of their income on medical care.    

Legislators deserve credit for making these choices in the face of surprisingly strong headwinds.

Now let’s get to some of the bad news.

Hospitals will take a 12% cut in state Medicaid payments, and nursing homes will take a 6.5% hit (on top of a 10.5% cut this year).  Home care providers will also be cut.

It’s always a little easier to cut from providers than it is to cut from people, but these cuts to providers affect real people, too.

For example, many hospitals already lose a lot of money providing care to the Medicaid population because reimbursement rates are low.  There are only two ways they can absorb another 12% reduction in payments.  Either hospitals will be forced to cut back on services to everyone, or private health insurance rates will have to increase to offset the reduction.

Nursing homes are often the last home many people with chronic illnesses will experience in life.  60% of nursing home residents rely on Medicaid to pay some or all of their bills, making Medicaid the largest payer of nursing home care.  Cutting Medicaid rates another 6.5% means further constraining care for some of our oldest, sickest citizens.

People relying on home and community based services as an alternative to nursing home care also weren’t spared.  The compromise appears to reduce funding for home-based services by over $36 million, by reducing provider rates by 4%.

Medicaid managed care will also move forward.  This is an unsettling prospect for many.  It will mean months of testy negotiation with a federal government that will be reluctant to approve Florida’s waiver.  If Florida reaches a compromise with HHS, it will then mean years of transition to a managed care program that could still result in less care for almost 3 million Floridians.

In commenting on proposed cuts before the final votes were cast, a State Senator noted that “everyone is going to have to share in the pain.”

But is that what really happens in this budget?

It doesn’t look like I’ll be feeling any pain when this Florida state budget gets put to bed.  My health insurance will be there when I need it, my physician will still make enough money to cover his cost when he treats me, and I probably won’t need hospital or nursing care this year.

Looking at the bigger budget picture, my youngest son graduated from our local public high school a couple of years ago, so I won’t feel the effects of school funding cuts.  My daughter is in an out-of-state university, so I won’t notice the tuition increases here in Florida.  My mother died a decade ago in Connecticut, so she won’t be affected by cuts to a Medicaid program that allowed her to live her final years in the comfort of her own home.

For me and people like me, there are $308 million in tax relief in this budget - far less than the $2 billion the Governor wanted.  Some of it may even lower my property taxes again.  They have already been cut by 41% this year – largely because of the odd methods we have of determining the taxable value of property in this state.

It’s nice to know that I won’t have to live with any pain this year.  While I’m grateful that some people with mental illness and impoverished elders won’t either, I can’t help thinking at least a little about those who will – and wonder why.

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