This should concern us all. Gov. Malloy has demonstrated his willingness to confront hard situations such massive storms, prolonged economic duress and the Newtown tragedy. But the proposed budget's impact on health care is either extremely cynical or extremely ill-advised (bordering on incompetent).
Bruce Cummings, CEO of Lawrence & Memorial Hospital, highlighted the financial numbers in a fiery letter to the
The governor must be aware that Medicaid only pays a fraction of the true cost of care. So the burdens on hospitals to absorb what will be a 50 percent to 100 percent increase in Medicaid patients will only deepen their debt.
Or something will give.
There is already a presumption that patients receiving Medicaid enjoy a reasonable standard of care. That is simply false.
A colleague, Andre Sofair, and I published a study demonstrating that in Connecticut's teaching clinics — where the lion's share of Medicaid patients receive care — roughly one-third of patients' subspecialty needs are not met. I know of a 40-year-old woman who used a wheelchair for 10 years because she needed a hip repair, but couldn't get it because, even before the governor's cuts, Medicaid doesn't pay doctors or hospitals enough to do it.
Medical professionalism aside (must we depend upon philanthropic doctors to donate services?), Medicaid is now underfunded and can't provide its patients with subspecialty services that other citizens take for granted; that impact their ability to live normal and productive lives. This is no myth; it is happening just down the street from most of us. But the poor have no advocates, they have no legal standing to require our state to provide a minimal standard of care, and this issue is out of the line of vision of most politicians and taxpayers.
For those who aren't so concerned about poor people not getting routine subspecialty care, there's something in the budget for you too.
Medical care is a zero-sum game. Hospitals are required by law to take all comers in need. So when Medicaid rolls swell and hospitals must absorb the underpayment of their bills and $650 million of Malloy-cuts, where do you think hospitals will make up the difference?
Quality care is administered by people; and highly skilled people cost money. Appropriate nurse-to-patient ratios, which promote safety and quality, and hospital safety programs will surely be targeted early as hospitals seek to remain solvent. Yes, services and staff will be cut; educational programs will be scavenged, and the net result will be erosion of the safety and quality of care for everyone.
Is this really what the governor intends? I am willing to bet him a free physical exam (not that his health insurance wouldn't cover it) that every hospital leader in the state would agree that his proposed cuts will impact the quality and safety of care provided in our hospitals.
The promise of the Affordable Care Act was that more citizens would have health care, but if the governor wins the day, it will have the opposite effect, binding more citizens to an underfunded Medicaid system of substandard care. This will affect everyone else because hospitals will have no choice but to cut all but essential services.
When other states' conservative governors postured on ideological grounds that they would refuse federal affordable care money for Medicaid, I smugly thanked God for living in an enlightened state. If the governor's cynical plan – or simple mistake – is implemented, I won't feel so smug, or proud.