Unpopular bed tax spurs debate
Wednesday, February 17th, 2010Georgia lawmakers, health-care advocates and business leaders are united in opposing a proposed “bed tax” on hospitals to shore up a financially struggling Medicaid program.
What they don’t agree on is where to find $247.8 million to replace the revenue the tax would raise, money Gov. Sonny Perdue is counting on to help balance a recession-ravaged fiscal 2011 budget.
“There’s no consensus on what to do to fill the hole, it’s so big and bad,” said Rep. Ben Harbin, R-Evans, chairman of the House Appropriations Committee. “Medicaid is in such bad shape, we’ve got to come up with revenue for that.”
The governor is recommending a 1.6 percent tax on hospitals’ net revenue to help plug a projected $506 million Medicaid shortfall driven by growing demand for services and the impending loss of federal stimulus funds.
Rhonda Medows, commissioner of the Georgia Department of Community Health, gave lawmakers an either-or choice last month: approve the bed tax and accompanying fees on managed-care organizations or slash Medicaid reimbursements to all health-care providers by 16.5 percent.
But opponents see that as a false choice. Rather than offsetting the bed tax revenue with spending cuts, they would prefer to replace it with other taxes, more aggressive tax collecting or with savings from other areas of the Medicaid budget.
One possibility is raising Georgia’s tax on cigarettes and other tobacco products.
Perdue pushed a 25-cents-per-pack increase in the tax through the General Assembly in 2003 during a milder recession than the current downturn. That brought the tax per pack to 37 cents. Now, health-care advocates are calling for an additional $1-per-pack tax.
Kevin Bloye, spokesman for the Georgia Hospital Association, said there’s logic in scrapping a tax on hospitals and replacing it with a higher tobacco tax because smoking contributes to health-care costs.
“Why are we taxing organizations that make us well and not products that make us sick?” he asked.
Bert Brantley, a spokesman for Perdue, said the governor considered raising the tobacco tax when he developed his budget recommendations late last year.
But Brantley said a higher tobacco tax would have diminishing returns for the state because it would reduce smoking and, thus, tobacco tax revenue. “You end up collecting less than anticipated because demand goes down,” he said. “That’s good public policy, but you end up with a hole.”
Harbin said the only way to sell a tobacco tax hike to a tax-averse legislature would be through tieing it to health care. But he said he’s not convinced that argument would sway enough lawmakers.
While the tobacco tax doesn’t appear to be gaining traction, legislative leaders are giving a better reception to bringing in more tax revenue by giving the state more tax-collecting tools.
The House version of the amended fiscal 2010 budget includes $342,000 to hire more investigators and auditors for the Department of Revenue.
Also, House Republican and Democratic leaders have introduced bills to let cities and counties share information with the state agency, making it easier to identify and go after businesses that aren’t remitting sales taxes to the state.
“(Consumers) are paying the taxes, but they’re not being collected. We’re talking about cheating,” said House Minority Leader DuBose Porter, D-Dublin, chief sponsor of the Democrats’ bill. “It (also) would ease the pressure in this budget.”
But Brantley warned that relying on a sales tax crackdown would be risky because it’s uncertain how much additional revenue could be collected.
He said there’s also no guarantee that additional sales taxes brought in through more aggressive collecting would go toward Medicaid and not other cash-strapped state agencies.
Proposals put forth by the Georgia Chamber of Commerce would directly affect Medicaid because they would generate savings inside the program.
Chamber President George Israel, a former managed-care industry executive, said more serious efforts to prevent Medicaid fraud and abuse could save the state $100 million.
Israel also suggested big savings could be had if the Department of Community Health got more aggressive with its disease management programs.
“Seventy to 80 percent of the cost (of Medicaid) comes right out of chronic disease,” he said. “They haven’t exhausted the options.”
In response, the Department of Community Health issued statistics showing that the agency’s Medicaid fraud-and-abuse program has generated millions in savings in recent years.
Brantley said a key advantage to the hospital tax is that the revenue would be plowed back into the Medicaid program.
He also noted that the state revenue would be matched by larger drawdowns from the federal government.
Because of that federal match, hospitals serving large numbers of Medicaid patients – including Atlanta’s Grady Memorial – would be net gainers.
The hospitals that would lose money typically have more paying patients.
by Dave Williams, Atlanta.bizjournals
