The federal government’s proposal is a devastating blow to Florida’s healthcare

Medicaid is at a critical time. As they work on the federal budget, Washington lawmakers are considering massive, unfair reductions in programs that destabilize the world-class healthcare system that Florida has built and have intense outcomes for the most vulnerable people in our state.

Don’t get the wrong nature of the cut. They are not accounting tactics. They’re not tax cuts. It is also not a way to make Medicaid more efficient or cost-effective.

They are already an extreme blow to the underfunded care system, with about one in five Florida residents, mostly pregnant women, low-income children, individuals with disabilities, and frail and vulnerable elderly people. In some of our rural communities, Medicaid covers more than a third of all residents.

Based Medicaid payments cover less than 60 cents of the $1 cost of providing care to Medicaid enrollees, and are lacking every time care is provided to pregnant mothers, children with special medical needs, or low-income citizens with cancer.

Hospitals rely on supplemental payments to make up for some of this shortfall. Florida, like almost every other state, uses the flexibility provided by the federal government to fund the state’s required share of these payments. One way is through a provider tax on the hospital itself. These taxes are tallied and combined with federal Medicaid funds, and then paid to hospitals through Medicaid managed care organizations based on their use of Medicaid.

Congress is considering both reducing the use of these widely used provider taxes and limiting the amount of payments hospitals pay in the direction they receive. Results: More supply care costs and tough decisions.

If hospitals must take on additional unreimbursed costs, they must make a sincere choice in reducing or eliminating resource-intensive services such as trauma, pediatrics, labor and delivery, psychiatry, and burns. It can reduce or eliminate community-based services such as mental health clinics. The reduced availability of these community services forces Medicaid enrollees to rely heavily on the emergency department, the most expensive entry point to the healthcare system.

In our small community, hospitals may need to be closed completely.

And the results are not only evident in financial statements.

The consequences of these harsh cuts are seen in the lack of staff nursing home beds for low-income seniors who can no longer live independently. They are seen with potentially life-threatening delays for children who need chemotherapy. They can be seen on 30, 40 or 50 miles drives to go to a hospital where mothers can safely deliver babies. They are seen in an ongoing cycle of crisis and despair for young people with schizophrenia alternate between prison and hospital emergency departments.

Florida is already the last dying of per capita Medicaid spending. As a non-expandable state, Florida only covers Medicaid at levels required by the federal government, except that there has been some enhanced eligibility for children, pregnant women and new mothers. Florida Medicaid has no fat to trim, no bloating to remove, or no waste to minimize.

Congress believes it is nothing more than starving and enveloping the already grown system of care, a lifeline for so many Floridians. Lawmakers still have the opportunity to reverse courses and pursue other policies. Our children, our elderly, and our most vulnerable people, we expect it.

Mary C. Mayhew is president and CEO of the Florida Hospital Association.