NEWS ANALYSIS: Outcome Puts Services for the Poor on Uncertain Ground

By Koehn, Donna | Sarasota Herald Tribune, June 19, 2013 | Go to article overview

NEWS ANALYSIS: Outcome Puts Services for the Poor on Uncertain Ground


Koehn, Donna, Sarasota Herald Tribune


MANATEE COUNTY -- For many years, Manatee County's $45 million Health Care Trust Fund seemed fit to carry poorer residents to better health for decades to come.

But a stumbling economy helped undermine that plan and, with the fund expected to run dry by 2015, Manatee voters on Tuesday overwhelmingly rejected the idea of adding a half-cent sales tax increase to replenish it.

The options now are limited as Manatee faces a struggle increasingly common to governments across the country -- how to shoulder the cost of health care for the working poor.

Doctors and hospitals will have to absorb more of the costs, at least initially, while possibly charging more to those with insurance. Some residents could go longer before getting treatment, making their ultimate care more expensive.

If the situation persists, Manatee facilities may find it harder to recruit and retain physicians. Eventually, the impact on lower- income patients could result in medical conditions that worsen or are left untreated.

Federal health care reform will not offer an immediate solution in Florida. The Legislature this year considered expanding Medicaid coverage under the Affordable Care Act to include the working poor. The expansion would have extended coverage to the needy in Manatee as the local Health Care Trust Fund ran out of money. But while the Senate and Gov. Rick Scott supported the Medicaid expansion, lawmakers in the House said no -- this, despite the offer of full federal funding for the first three years of expansion.

Several groups, including area hospitals, are continuing to lobby lawmakers to reopen the debate.

Local health care facilities that previously used the Manatee funding to provide specialized services to those without insurance will no longer be able to take these needy patients. More of those patients will end up in already-crowded emergency rooms.

Because ERs are required by law to take in all patients who come to their doors -- whether or not they have the ability to pay -- the costs will be written off, the burden shared by those with insurance.

Or, according to Manatee County Administrator Ed Hunzeker, the Manatee Board of County Commissioners might revisit the issue next year as another sales tax referendum. The county also might opt to increase property taxes.

The big idea

Back in 1984, it seemed like a great idea, both innovative and clever: Sell ailing Manatee Memorial Hospital and put the proceeds into a trust fund, using the interest to provide health care for the poor. Manatee became a model of ingenuity.

The Health Care Trust Fund soared with the stock market. Manatee kicked in $23 million, and $9 million was contributed each year from the fund.

But rising medical costs, an expansion of the program to Blake and Lakewood Ranch medical centers, and a swelling of the ranks of the poor and uninsured in the recession have nearly depleted the funds. …

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