Kirk Long, chief executive officer of NeuroMedical Center Hospital in Baton Rouge, predicts this year's thwarted battle merely sets the stage for a future one. "Health care providers can't rely on found money to continue financing gaps in Medicaid funding," he says.
Long, who helped build Park Place Surgical Center in Lafayette, also is the executive director of the Louisiana Association of Focused Care Facilities, which represents the state's 16 specialty hospitals.
The original bill, proposed by Rep. Sidney Mae Durand of Parks, called for a one half of 1 percent tax on gross revenues gathered by most health care providers in the state. The bill was proposed on behalf of Gov. Kathleen Blanco's administration.
The state hospital association, however, countered with a proposed bill that would have taxed only small "boutique" hospitals, facilities that concentrate on providing specific care. Under that plan, rural and community hospitals that treat indigent patients would have been exempt from the new tax.
In Lafayette, there are four specialty hospitals, including Park Place, Heart Hospital of Lafayette, Lafayette General Surgical Center (operated in partnership with Lafayette General Medical Center) and Lafayette Surgical Specialty Hospital. The recently opened hospitals compete for patients with the large hospital providers, including Lafayette General Medical Center, Our Lady of Lourdes and Medical Center of Southwest Louisiana.
And they are succeeding.
The infighting over the proposed tax highlights a growing enmity between the large hospital health providers and the doctor-owned specialty hospitals. The large hospitals argue that the specialty centers are siphoning off profitable procedures, like heart surgeries, that help pay for loss leader trauma units and burn wards. And since the specialty hospitals don't accept indigent patients, they avoid the cost of absorbing care for the uninsured.
Long says Durand's bill, by her own admission, was introduced to jumpstart a discussion about self-taxation of the hospital industry.
"It's obvious there is a need for hospitals to solve revenue problems," Long says. He equates the problem to challenges faced by nursing homes in the 1990s; the nursing home industry responded by taxing itself and placing the money in a trust that receives matching funding from the federal government. "The feds have restricted many of these matching fund programs," Long says, but they are still available for health care. "It's a big opportunity for hospitals and other health care providers to raise revenue."
The large health care providers might be wary of a tax that would raise matching funds, says Joe Donchess, executive director of the Louisiana Nursing Home Association. The industry in 1992 was a "reluctant proponent" of a bill passed to tax the nursing homes, but only because the matching funds were supposed to be funneled back to the nursing homes.
That happened for a couple of years, Donchess says, before the Foster administration began diverting the money to other health care programs.
He estimates that the nursing home industry alone raises $67 million a year, money that is matched by the federal government. The tax also applies to the mental health care and pharmacy industries, which raise a collective $30 million annually that's matched by the feds.
"We are what is called the cash cow of state government," says Donchess. The nursing home industry has paid some $770 million in taxes, generating $1.8 billion in federal matches.
A bill proposed this year would return those matching funds to the nursing home industry, Donchess says.
On the other hand, he adds, he does not think the federal government will allow Louisiana to tax only one segment of the industry ' like specialty hospitals ' in order to receive matching grant money.
He says the large hospitals might be more agreeable to a provider tax, but only if the Blanco administration will promise in the language of the law that the money collected goes to the hospitals that provide indigent care.
Long argues that an LSU study shows that only 2.1 percent of the total cost spent on providing health care in this state is spent on indigent care at the largest community hospitals. That study, conducted by Donald Smithburg, chancellor of the LSU hospital system, shows that the national average is 6 percent.
"The charity hospitals take care of the vast majority of indigents [in Louisiana]," Long says, noting that the for-profit Medical Center of Southwest Louisiana currently accepts no Medicaid patients, while the non-profit Our Lady of Lourdes pays no taxes.
He adds that the focused care association had no problem with Durand's broad-based hospital tax, agreeing that it was time for hospitals to help fill in funding gaps.
Under the state association plans, money raised through a hospital tax would be returned to the community hospitals to help pay for the treatment of the uninsured and to raise their Medicaid rates, says Burton Dupuis, chief executive officer of St. Martin Hospital. His facility would have been exempt under the hospital association plan.
The debate is just getting started. After multiple requests for comment, John Matessino, state hospital association president and CEO, would only say, "We are still discussing positive health care reform with the administration and are optimistic."
Struggling to preserve their Senate majority, Democrats are attacking Republicans over Medicare and Social Security in Louisiana, spending cuts in Arkansas, off-shore jobs in New Hampshire and women's issues in Colorado.
Saints safety Kenny Vaccaro says he "can't wait" to play against Green Bay quarterback Aaron Rodgers.
The heat keeps rising for Iberia Parish Sheriff Louis Ackal as a new slate of corruption allegations surfaced this week, adding even more fuel to a fire that started burning with the suspicious March 2 death of Victor White III in the back of a deputy’s patrol car and the federal investigation that has since ensued.
If opposing defenses sell out to stop the Packers' passing game, they risk being gashed by powerful running back Eddie Lacy, a New Orleans-area native.
At the horn the officiating crew trotted to the tunnel and left security personnel to clean up after them.
Friday's Blogs from the Bog!
Sign "ninjas" cleaning up clutter; NYC doctor positive for Ebola; Ferguson grand jury decision nears; and more national and international news for Friday, October 24, 2014.
We can safely assume incumbent Chief K.P. Gibson isn’t too worried about this challenger.
Nationally, Republicans must gain six seats to win Senate control. The most competitive races, many in states where Obama lost in 2012, remain too close to call.
The Baton Rouge Republican has repeatedly battled a perception within his own party that he perhaps wasn't the best choice to carry the GOP banner.
Even if Jimmy Graham's production dips while the star tight end recovers from a shoulder injury, it looks like Drew Brees won't have much trouble finding other targets.
A former campaign manager for Senate candidate Rob Maness is striking at the Republican contender's tea party support, saying Maness only sought to appeal to conservative organizations because he needed money for his campaign.
Ninety-two percent of public school teachers were rated either effective or highly effective in a report the state issued marking the second year of a new statewide evaluation process.
School board members Mark Babineaux, Hunter Beasley and Tehmi Chassion can vote to fire Cooper — because we all know that’s exactly what they’ll do.
District 2 school board candidate Simon Mahan is hoping to unseat first-term incumbent and former Carencro Mayor Tommy Angelle in the Nov. 4 election.
District Attorney Mike Harson is showing his desperation by falsely attributing quotes to his opponent and blocking journalists from his social media.
The governor is traveling the country laying the groundwork for a possible 2016 presidential campaign, but his approval ratings at home hover well below 50 percent.
State District Judge Bob Downing extended the order and delayed a planned Wednesday hearing about a permanent injunction while negotiations continue between Attorney General Buddy Caldwell and the waste disposal site operator.
New Louisiana higher education commissioner Joseph Rallo will be paid more than his predecessor.
Elijah McGuire and Alonzo Harris each had four rushing touchdowns, and Louisiana-Lafayette rolled to 419 yards on the ground in a 55-40 victory over Arkansas State on Tuesday night.
Bill and Hillary Clinton are the validators-in-chief for Democrats struggling through a bleak campaign season in states where President Barack Obama is deeply unpopular.
President Barack Obama is turning to black radio listeners to plead for midterm votes, a targeted approach to drum up Democratic support at a time when many candidates don't want him around in person.
"I am extremely disheartened by the political machines that are attempting to hijack my efforts along with others that advocate for children."
Landrieu, who is fighting to keep her seat for a fourth term, said that Ebola is serious and precautions should be taken, but she accused Republicans of using the virus outbreak in West Africa to "create fear" here at home.
Law enforcement agencies are participating in a "Louisiana Heroin Summit," designed to address the recent rise in heroin use and drug-related deaths around the state.