Posted by Post-Standard Editorial Board November 28, 2008 5:02AM
Gov. David Paterson has laudably taken on the difficult but necessary task of cutting a state budget that is billions of dollars out of balance. But the size of his proposed cuts in Medicaid payments to hospitals could end up doing more harm than good.
The governor wants to cut more than $500 million in Medicaid in the 2008-09 budget alone, with more cuts predicted for the following budget year. Those cuts would take their toll on hospitals.
As the CEOs of Crouse, Community General, St. Joseph's and University hospitals pointed out at a Post-Standard editorial board meeting last week, hospitals serve as the primary medical safety net in the region. They are bound by the law to provide care for whomever comes through their doors -- and the numbers continue to climb as people lose jobs and health insurance and the local elderly population increases.
Patient volume already has increased 22 percent between 2003 and 2007 at the four hospitals, and the hospitals are feeling the strain. If things get much worse, one CEO said, he could foresee patients waiting up to 15 hours for care in the emergency rooms.
Yet hospitals are left to figure out how to absorb the growing numbers of patients -- a problem that can be traced back to the nation's inadequate health care delivery system -- while dealing with million-dollar cuts in their budgets. The four Syracuse hospitals stand to lose nearly $17 million over the next two years under Paterson's proposed cuts.
Hospital executives say they have managed to get by -- they don't have a choice -- but can't continue to operate with fewer funds and more patients.
New Yorkers who have health insurance may mistakenly believe that inadequate Medicaid reimbursements only affect low-income patients. But as one CEO explained, hospitals don't have "insured beds" and "Medicaid beds." They don't have a system that allows people with health insurance to skip the line in the emergency room. If an ER is backed up because it cannot handle all of the incoming patients, or the hospital doesn't have enough beds, insured patients will be just as affected as those without insurance. People who don't think so need only visit an emergency room.
The governor said that when it came to budget cuts, nothing was off the table. But the governor has consistently left one revenue-raiser off the table: He won't consider a millionaire's tax that would be temporarily placed on those with higher incomes -- as was done successfully under Gov. Pataki in 2003. The Assembly has passed such a measure, but it was rejected by the Senate.
Wealthy people would feel a pinch from such a tax. If a disproportionate share of the burden falls on hospitals, every New Yorker will eventually feel the pain.
