Déjà vu’ on Balancing Federal Budget on Hospitals


I have been in this business a long time and I am considered by many to be an archivist. I think it means I am old.

In any event, I feel like we are going through déjà vu’ all over again. Our friends in congress, as they did back in 1997, have decided to balance the budget on hospitals’ backs. I am in no way saying we shouldn’t shoulder our share of the burden, but what is being discussed is just down right frightening and not right.

Under the recently passed healthcare reform law, hospitals are expected to put up $155 billion in cuts, which already are in place. Of course, that was to be offset by increased coverage. Various proposals endorsed by the Republicans would repeal the mandate, but keep the cuts, devastating enough. However, now there are reports that the administration and congress are talking about a deal to take literally trillions out of the budget, with the bulk of it coming from Medicare and Medicaid.
An analysis by THA shows the dramatic impact of the $155 billion reduction, which has me shaking my head to figure out how hospitals will be able to deal with those cuts. Now, with congress and the administration piling on more cuts, I know we will see some hospitals close and surely we will see services curbed and layoffs aplenty.

What has me scratching my head is this is similar to 1997 when the Balanced Budget Act (BBA) was passed. For three years, hospitals endured the cuts through layoffs and curbed services. Congress finally saw the light and restored many of those cuts. Why congress and the administration would call for these drastic cuts is beyond me, knowing Tennessee hospitals will have to cut quite a few of their 98,000 jobs while safety net hospitals will struggle to stay open and keep losing money in an effort to provide needed services.

Is this déjà vu all over again? Will congress cut and then restore funding a few years later when the damage is done? I, for one, am not waiting to see if that happens.

THA has been working hard to convince Tennessee’s congressional delegation to be prudent in its cuts to providers. There is only so much that can be cut before we see the Armageddon I described above. What hospitals need to do is to make more noise and tell their elected officials just what the impact will be on their individual institutions. If everyone stays quiet, they surely will think hospitals can handle these draconian cuts.

I may be the archivist, but I am not too old to know what these proposed cuts will do to hospitals and the people they serve.


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