There’s still time, though not much, to preserve hundreds of millions of dollars that pay for the medical care of poor Illinois residents. But without a push from U.S. House Speaker J. Dennis Hastert, the last-minute surgery will fail.
The issue is federal Medicaid dollars to reimburse hospitals, public and private, for the health care they provide to people who can’t otherwise afford it.
That sounds noble enough. But, truth be told, it hasn’t been. Illinois and 16 other states have been exploiting a loophole that lets them bill Medicaid for more money than it actually costs hospitals to treat poor patients. The federal Health Care Financing Administration (HCFA) has long permitted that trick, which brings $500 million a year into Illinois. Illinois has used the money to reimburse its hospitals for indigent care, and also to provide dental care and other services to the poor.
But some state governments have abused the privilege. They’ve used parts of their federal reimbursements for non-medical projects like roads. HCFA has said “Enough!” and proposed a much skimpier formula that would strip Illinois of $426 million a year.
Given how some states have taken advantage of HCFA, it’s not unfair for the agency to close the loophole. But doing so also penalizes states that–remember, with HCFA’s approval–spend the federal money wisely. If it’s implemented, the new formula would be a severe blow to public hospitals (like Cook County) and privates as well (like Mt. Sinai, which treats many poor patients on Chicago’s Near West Side). Chopping off so many federal dollars would likely put more hospitals at risk of closing.
Sen. Dick Durbin has drafted legislation to keep the $500 million coming to his state. But with the session waning, Durbin’s proposal will die unless Hastert uses his influence as speaker to push it through the House.
If Hastert does rescue the bill, it could then go to end-of-session negotiations. There, leaders of the House and Senate will, along with the White House, decide the final shape of lingering legislation. And the people who rely on well-spent Medicaid dollars to care for themselves and their children might breathe easier.
Hastert’s aides say he is committed to keeping the whole $500 million coming to Illinois. But he thinks there’s a better legislative path than Durbin suggests.
Hastert, a Republican, has a right to be peeved that this mess has landed in his lap. Why didn’t the Democratic White House browbeat HCFA to protect states like Illinois?
Good question. But at this late hour, it’s Hastert who can be a hero in the ER.
