Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, June 4, 1990 TAG: 9006040209
SECTION: EDITORIAL PAGE: A6 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
A ruling is expected soon. Whatever the outcome, there will be no winners.
If the state's appeal is upheld, that presumably would snuff out the prospect of judicial takeovers of the Medicaid programs of Virginia and other states. That's good: Health-care policy ought to be set and overseen by presidents and Congresses, governors and legislatures - not by the courts.
On the other hand, if Virginia hospitals continue to be repaid only 71 cents on the Medicaid dollar, as the Virginia Hospital Association says they are, victory for the commonwwealth would prove empty indeed.
Hospitals these days don't get much by way of charitable donations. Greater efficiency - the merger in Roanoke, for example, of non-profit Memorial and Community hospitals - can help, but not forever.
Ultimately, only three things, or a combination of them, can happen if hospitals aren't reimbursed for treatment that is supposed to be funded by Medicaid:
Rates must be raised so that non-Medicaid patients - directly or via higher insurance premiums - will subsidize the shortfall. Hospitals must make up the deficit with money that ought to be spent on updating equipment and facilities, threatening the hospitals' survival. Or the poor simply must do without adequate medical care, because hospitals can't afford to serve the roughly 10 percent of the population who rely on Medicaid.
The last may already be happening, if indirectly; Virginia's relatively stringent rules for Medicaid eligibility may be discouraging some people from seeking care in the first place.
Virginia's appeal to the U.S. Supreme Court is ultimately a detour. The more important appeal is to executive and legislative responsibility. Clearly, Medicaid should be funded to cover more of the costs the program claims to provide. Just as important, the health-care system has to be made more efficient and equitable, and less costly.
If the Supreme Court rejects the state's appeal, and if the courts subsequently require higher Medicaid reimbursements to Virginia hospitals, there'd be little cause to rejoice. Not only would it mean judicial takeover of a responsibility best left to policy-makers. It also would do nothing to solve the underlying problem of escalating health-care costs.
Medicaid in Virginia now costs $1.3 billion annually, including the federal share. That is double what the program cost in 1985, and the spiral shows no sign of slowing.
To solve one set of problems by simply mandating increased Medicaid reimbursements is to create another set. Other good and necessary programs already have been hit by cutbacks in the face of a state budget crunch - due in part to escalating Medicaid costs.
The problem of health-care inflation is close to intractable as it is. Abdication of responsibility by a Congress and president unwilling to forge a national health-care policy, and by a governor and General Assembly unwilling to confront the hospitals' grievances head-on, transforms the difficult into the near-impossible - and invites judicial intervention.
by CNB