The mood was dark and the rhetoric dire at the annual conference of the National Association of Public Hospitals in Florida late last month.
Speaker after speaker alluded to the disaster that will hit public hospitals, and their constituents, the urban poor and labor unions, if Medicaid and Medicare cuts are enacted as proposed by the Republican Congress.
`There's no way to hit a $132 billion (spending restraint) target without reducing healthcare services and making dramatic changes in giving care," said Douglas M. Cook, director of the Florida Agency for Health Care Administration.
Cook suggested going back to give healthcare reform a second look. "You cannot control costs unless you expand coverage," he said. Otherwise, "we're going to have to restrict access in healthcare. This shouldn't happen in America. This is not Costa Rica. This is a rich country."
Medicaid reform is off on the wrong track, Cook said. "Sixty-nine percent of Medicaid goes to (the) elderly, blind and disabled. Is anyone seriously talking about reforming elderly, blind and disabled (programs)?"
As a group, public hospitals had a lot of political capital invested in the Clinton healthcare reform package. Last November, they lost their powerful allies on Capitol Hill. Now, they are nonplused by the change in tone of the healthcare debate.
Only last July, Cook reminded the group, the subject of discussion was whether universal coverage should be defined as 95% or 92% of the population. "What a difference a year makes," he said.
NAPH lobbyists and three Democratic congressional staffers advised public hospitals to educate their members of Congress, preferably by September, when key votes will take place.
"Whether you're a Democrat or Republican," said Bridget Taylor, a Democratic staffer on the House Commerce Committee, "it's important to be fiscally responsible. It's important to tighten your belt. But we're talking about not breathing."
Robert Sillen, executive director of the Santa Clara Valley Health and Hospital System in California, vowed that he would never allow authorities to close any hospital he was in charge of for financial reasons. Such a closure has been proposed for LAC-University of Southern California Medical Center in Los Alamitos. On the other hand, he acknowledged, "going down in a blaze of glory is not necessarily a quick death."
The hospitals are not the only ones worried about their future. Labor unions have taken up the banner and hope to use what clout they have to dissuade Congress from draconian spending cuts.
John J. Sweeney, president of the Service Employees International Union, had been scheduled to address the conference but did not appear, as he is campaigning to become head of the AFL-CIO.
He sent in his place Carol Regan, SEIU state health issues director, who said the pace of change in healthcare is "putting a squeeze on healthcare workers." The SEIU is having to do a lot of re-education of healthcare workers, she said, to acclimate them to the new environment.
The SEIU wants to preserve the public health mission of public hospitals and to participate in restructuring. "We will fight for the rights of healthcare workers and their unions," Regan said.
Apart from the anxiety about funding cuts, the theme of the conference at Amelia Island Plantation near Jacksonville was Medicaid managed care: how to deal with it when your institution has largely been bypassed by the commercial managed-care revolution. Attendees heard a series of primers from consultants and other public healthcare groups on organizational strategy and contracting mechanisms.
How to mine existing structures for new sources of revenues was a repeated theme. Bruce Siegel, M.D., president of the New York City Health and Hospitals Corp., described the rapid growth of his system's own managed-care plan, MetroPlus, which enrolled 11,000 new patients last month.
Patricia A. Gabow, M.D., chief executive officer of the Denver Department of Health and Hospitals, explained how her agency is setting up a Medicaid managed-care plan for Colorado. The department has used an entrepreneurial model to increase its revenues and improve public health and welfare in that city, she said.