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BILL MINOR: Too little attention given to Barbour hospital tactics
14 months ago | 782 views | 1 
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Now five years later, that pledge is forgotten and recently he's been engaged in a down-to-the-wire battle with lawmakers not over whether to raise taxes, but how much.
Both Barbour and the Legislature agreed several months ago on raising the cigarette tax. He wanted less, and lawmakers wanted more. They settled for something in between.
But the big brouhaha at session's end came over putting a bed tax on hospitals, both private and public. Barbour pulled the hospital bed tax idea completely out of the blue earlier in the 2009 session as his answer to the ever-present problem of funding Medicaid, the longstanding federal-state program that now provides the only health care coverage for 600,000 poor or disabled Mississippians.
Barbour leaned heavily on lawmakers to tack $90 million in bed taxes on hospitals. After initially wanting no bed tax levied on hospitals, legislators eventually gave Barbour $60 million, which would escalate to $90 million in three years.
Somehow, in the last minute scramble, the question of whether or not to reauthorize the Medicaid Division became a big issue. Traditionally, the Medicaid program has contained a three-year "sunset" provision.
But, never before in its long history has reauthorization been made an issue.
The amount of the Medicaid-hospital bed tax actually took a back seat to Barbour's unprecedented targeting of the Mississippi Hospital Association - MHA president Sam Cameron in particular - as the devil blocking Medicaid funding. Doubtless, Barbour forgot that when he pushed his tort reforms through the Legislature in 2004, he depended on the MHA as one of his major allies.
In the dying moments of the session, Barbour strong-armed Cameron into endorsing the hospital tax deal by threatening to run the Division of Medicaid by executive order. If he were to run the division, Barbour warned Cameron, the hospitals would face more drastic measures from the governor's office.
Cameron says some hospitals will be unable to pay the bed tax without reducing services and staff. Hospitals, he added, are the largest employers in some cities and towns.
The MHA leader had a final warning that although the $60 million bed tax infusion was hailed as a permanent source of funding for three years, the Medicaid Division "in the near future" will ask for more taxes or threaten cuts.
After Cameron's experience, it's no wonder that House Speaker Billy McCoy, Barbour's Democratic nemesis, recently called the governor a "dictator."
McCoy knows about gubernatorial style: He served under seven previous governors, but never before used that term to characterize any of them.
The amazing thing is that there's been no outrage in Mississippi news media about Barbour's heavy-handed tactics to put a bed tax on hospitals, since the bottom line is a tax on sick people.
Some newspapers have rationalized that many hospitals need to be punished because they don't take Medicaid patients. What about the doctors? Lawmakers who keep up with such things say that only 30 percent of the doctors in Mississippi accept Medicaid patients.
The thought of Haley Barbour, the ultimate professional politician, running Medicaid by executive order and dealing out misery to the hospitals is frightening enough, but not to be overlooked is the existing Medicaid Division under the Barbour administration.
In his June 30 statement, Cameron made a point that got no attention: that the existing Medicaid Division "has yet to demonstrate its ability to plan, project and administer any budget."
I remember that when public health doctors Alton Cobb and Clinton Smith headed the division with no political interference, it ran well. Maybe that's where Medicaid reform should start.
Bill Minor is a syndicated columnist who has covered Mississippi politics since 1947. His address is Box 1243, Jackson, MS 39215. Send e-mails to Minor through edinman@earthlink.net.
Bill wrote, "In his June 30 statement, the MHA's [Sam] Cameron made a point that got no attention: that the existing Medicaid Division 'has yet to demonstrate its ability to plan, project and administer any budget.'" The aspersion cast concerning the capability of this (or any other) Medicaid administration's ability to balance the books is a lie by omission. What's omitted are indisputable facts.
Fact #1: When any given manager is prevented from having control over revenues or expenditures there is no way to accurately "plan, project, and administer any budget."
Fact#2: State law and Federal law control the funding of Mississippi Medicaid as well as the rates paid to providers.
Fact#3: Beneficiaries and Providers, MANY OF WHOM ARE FRAUDULENT, WASTEFUL OR ABUSIVE, control the amount of Medicaid products that are utilized.
Fact #4: Providers control rate setting through LOBBYISTS AND OTHERS WHO DIRECTLY IMPACT state legislation.
Fact #5: Because Medicaid is an entitlement, if you're eligible, you get coverage. This adds another layer of difficulty to estimating the Medicaid budget. There is no completely accurate measure by which to estimate additions to the program. Once someone fails to meet eligibility requirements their coverage, by law, should be terminated; yet Medicaid is
Fact#6: Medicaid Rates X Medicaid Utilization = Medicaid Expenditures. Mississippi Medicaid has no control of either. Medicaid is usually intentionally underfunded or funded with some degree of smoke and mirrors.
Fact#7: Mississippi Medicaid budgets are projected two years in advance which makes it difficult to accurately predict the degree and direction of movement of a host of variables.
The columnist goes on to say, "I remember when public health director Alton Cobb and Clinton Smith headed the division with no political interference, it ran well. Maybe that's where Medicaid reform should start."
Fact#8: In 1970, Dr. Alton B. Cobb reported to the State Medicaid Commission and was given control over the program. He could make all cuts necessary to stay within the budget, and he did just that. By doing this he had the total support and backing of the then Mississippi Legislature to do what was necessary to stay within his $38 million budget. Alton Cobb was and is a good administrator and a fine person.
Fact#9: Today's Medicaid program is a $4 billion program which has the future potential of financially devouring us all. Funny how the legislators talk from both sides of their mouth. One side espouses the need for greater service coverage while the other beats DOM about the head and shoulders trying to restrict funding at the behest of MHA, irrespective of the needs of beneficiaries.
Fact#10: On many occasions Medicaid Executive Directors have been sternly reminded by the Mississippi House of Representatives Leadership that political control over the program was not only favored but a matter of pride. Mississippi’s Medicaid program is among the most codified in the entire country. Legislation controls what Medicaid can do, can pay, can provide for, service recipients, services to be provided, etc.
Fact#11 Most Mississippi Medicaid programs have been designed through the political "squeaky wheel" approach and are highly inefficient.
Fact#12 Ninety-six lobbyists are working on legislators both day and night for more money to be paid to their clients through Mississippi Medicaid. It must be remembered that House leadership stated “We will not agree to anything unless the MHA is ok with it. Who are the legislators working for; the State of MS or MHA? The evidence is clear…….and it “ain’t” the State..
Perhaps the real reason "that we hear no outrage in the Mississippi news media about "[Governor] Barbour's heavy-handed tactics" is Mississippians are finally getting both sides of the story and can see through this columnist's spin.