A number of constituents have been in touch with me regarding a recent $64 million cut in scheduled state payments to the Boston Medical Center. Many health care professionals who live in my district work at the BMC.
I fully understand the essential role that the Boston Medical Center plays in providing health care to the indigent in the region’s poorest neighborhoods.
I also fully understand that a cut of this magnitude is virtually impossible to absorb suddenly without impacting the quality and availability of necessary care.
Finally, I feel that when agreements have been made between the state and private parties, the state should make every effort to honor those agreements.
Over the past week, I have inquired about and expressed concern over this cut to members and staff of the House Ways and Means Committee and the Health Care Finance Committee. The BMC sits in Representative Rushing’s district and I have also been in touch with his office to offer my support. (Please note — this issue part of the supplemental budget, not the main budget conference, which I have limited my further comment on.)
For those who are less familiar with the issue, here is some background. The cut cut came in sections 14-16 of a supplemental budget that moved quickly through the House earlier this month. The Senate did not include the cut in its version of the supplement. So, the issue will be resolved in negotiations between the House and Senate budget committees.
The cut originated with the Governor as part of the package of cuts that he proposed last October to respond to the fiscal crisis. The legislature did not act on that cut and the Governor apparently largely backed off his plans to cut the payments (and a similar cut to the Cambridge Health Alliance).
The BMC cut appears to have come back on the table recently as the legislature and the Governor struggle to close the books on Fiscal 2009 without completely depleting the Commonwealth’s reserves.
Historically, the state and, indirectly, the federal government, have subsidized the state’s “safety net” hospitals that care primarily for indigent clients. These hospitals are reimbursed primarily through Medicaid, which pays low rates. Unlike most hospitals, they have few clients with private insurers whose higher reimbursements can cross-subsidize the Medicaid clients. Prior to the state’s universal health insurance reforms, the safety net hospitals also handled many clients without insurance and were reimbursed for these clients through a fund known as the free care pool.
As part of health insurance reform, the state and federal government are seeking to eliminate subsidy payments. So, in the long run, the Boston Medical Center and Cambridge Health Alliance need to expect changes in their funding stream. But the transition needs to be reasonably paced and needs to be combined with fair reimbursement policies.
We can expect that the next few years will involve continuing negotiations on these issues as the state’s overall revenue weakness compounds the pressure created by rising health care costs. I do believe that we should think of health care as a right and work to assure the quality of care provided to the most vulnerable in society.