Lawmakers face sacks of facts on hospital tax

Published 12:00 am Sunday, May 31, 2009

It was about 17 years ago, so memories of the details have faded, but the gist is this: Lawmaking would be a lot easier if every topic had just one set of objective, provable facts.

The late Grey Ferris, who went on to be Senate Education Committee chairman, was in his first term representing Warren County. A hot topic was collection of court-ordered child support payments. An out-of-state company, Maxis or Maxus or something, won a contract from the Legislature for a pilot program in 10 or so of the 82 counties. The company was to report its results so lawmakers could decide what to do.

If the private collection workers did better than the collections staff at the Department of Human Services, the presumption was that the state would expand the contract, reducing the number of public employees and increasing the efficiency of collecting cash from absentee parents. If the DHS staff did better, the company would be sent packing.

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There were political calculations, too. Kirk Fordice was governor. A conservative’s conservative, he was of the view that anything a government employee could do, a private sector employee could do better — given the profit motive and all. Ferris was a Democrat and thus vulnerable to accusations of being in favor of big government, expanding public jobs and catering to state employee unions.

Well, for statehouse regulars it was predictable what would happen when the numbers came in. The company showed it was hustling, doing a bang-up job — far better than those entrenched chair-warmers at DHS. And then the DHS numbers came in. To no one’s surprise — except newer members of the Legislature — the state employees’ performance was just as good as the private company, if not better.

Ferris was that rare member of the Legislature who cared little for appearance or alignments or party labels. It would not have hurt his feelings in the least to vote with the Fordice camp if it meant more money collected for children.

His consternation was real. “I guess it comes down to whose facts are more factual,” he said.

As it turned out, the experiment in contracting out child support enforcement, similar to the experiment in contracting out law enforcement to traffic camera companies, was short-lived.

The relevance of the story today is this “hospital tax” thing.

The word from the House, where Democrats hold sway, is that the mean old Senate and Gov. Haley Barbour, unfeeling Republicans that they are, have wanted to “tax the sick” to extract $90 million to use in obtaining matching federal Medicaid dollars. (Leading into last week’s debate, the House was only half-mean, willing to “tax the sick” $45 million or so.)

The story line from the governor and the Senate has been that the irresponsible members of the House want to gobble up all the stimulus dollars from Washington in one bite and, not only that, deplete the state’s stashed cash, about $360 million. Besides, the Senate conferees said, participating hospitals themselves came up with the idea of these “voluntary fees” years ago and paid them until 2005.

Lots of truths, lots of facts and lots of political overtones.

Medicaid, which pays the health-care and nursing home bills of about 600,000 people in Mississippi, is a federal-state program for the poor and disabled. Matching money is required. Mississippi’s match has been about three federal dollars for every state dollar. Via the stimulus legislation, the match will approach six federal dollars for every state dollar, at least for a year or two.

Follow the bouncing ball …

Before 2005, some hospitals did devise a plan to lend the state money, which was accepted by the Division of Medicaid like a short-term loan. The money was posted as state dollars to draw federal dollars. In turn, hospitals got their money back along with their payments for treating Medicaid clients.

Federal regulators, at first, said this was OK. Then they said it wasn’t, so the hospitals stopped doing it.

Along came Hurricane Katrina, and the state got some grants to cover Medicaid shortfalls. Then, last year, an accounting error was discovered by the feds that generated enough money to do what the hospital money previously did.

It’s on this background that House members and the hospital industry have been able to call the approach by the Senate and Barbour a tax. And the same background has the Senate and Barbour saying there’s nothing really new in their proposal (except the tax would be a tax, not a loan).

Yep.

The situation has plenty of facts to support almost any position.

That’s what makes legislating not as easy as it looks.