Budget cuts mean county health clinics will be unable to fill hundreds of jobs, leaving smaller staffs to serve low-income people in state that declined to expand Medicaid despite pleas from its hospitals and business leaders.
To state officials, it’s streamlining and finding efficiencies. To healthcare advocates, it’s another blow to providing adequate services in a state that has already declined to expand Medicaid and was sued in federal court over inadequate access for children who currently receive Medicaid.
What viewpoint one has, the numbers in the budget presented by Gov Rick Scott are not in dispute: it eliminates 1353 positions, and healthcare workers represent 758, or 60%. The fact that roughly 500 are currently vacant did not appease patients who spoke with the Tampa Bay Times about long waits in health clinics. County health clinics in Florida provide low-cost care to the poor, nutritional assistance for children and work to limit the spread of infectious disease.
Gov Scott’s spokesperson, Tiffany Cowie, told the Times that “no department services or radiness capabilities will be interrupted.” Positions eliminated include nutritionists, health counselors and family support workers, including 470 at the county level. These front-line workers provide care for those who might lack the ability to seek primary care elsewhere.
It is unclear yet what effect the proposed cuts could have on Florida’s hospitals and emergency rooms, which are already feeling financial strain. A coalition of hospitals and business groups tried but failed earlier this year to convince the legislature to expand Medicaid to consumers earning between 100% and 138% of the poverty level.
Under the Affordable Care Act (ACA), hospitals have already sustained cuts in payment for treating the uninsured, and those cuts scheduled to escalate later this year. The thinking at the time the the ACA passed in 2010 was that as Medicaid expansion progressed, fewer uninsured would seek routine care in emergency rooms, where care is less appropriate and more expensive. But in Florida and 21 other states, that has not happened.
Florida recently surpassed New York as the third-largest state and its population continues to grow. Its 2012 diabetes rate is 9.9%, above the US average of 9%, and rates are significantly higher in the northern and central counties, according to CDC data. Diabetes rates will be important indicators of the ability of healthcare institutions to receive reimbursements from Medicare going forward, as CMS is pursuing a program of linking payment to quality measurements. At present a 5-part diabetes measure is included in the Medicare Shared Savings Program for accountable care organizations.
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