Taxes on health professionals targeted in Medicaid reform bill

Washington States no longer would be able to leverage taxes to health care professionals and intergovernmental transfers to boost federal matching funds artificially under a proposal to overhaul Medicaid’s financing.

Rep. Bill Cassidy, MD (R, La.), on June 20 introduced a bill aimed at achieving more accountability and efficiency for Medicaid funding by instituting a formula that caps and more evenly distributes federal Medicaid dollars among the states, while taking steps to improve patient outcomes. “As a practicing physician in a safety-net hospital, I know firsthand that a Medicaid card offers the illusion of access without the power of care. Medicaid is one of the major drivers of America’s debt crisis, yet the financing of the system has not been updated since 1964,” Dr. Cassidy, an associate professor of medicine at Louisiana State University, said in a statement.

Rep. Bill Cassidy, MD (R, La.)

The legislation would save money by separating the Medicaid population into four groups that are deemed more representative of the costs associated with certain patient populations: the elderly, the blind or disabled, children, and adults, according to a summary of the bill. For each of these populations, a per-person capitated payment would be made to the state to address their health care needs.

Quality bonuses would be awarded to top-performing states in each of those categories according to patient outcomes.

Dr. Cassidy also is proposing to reduce the portion of the Medicaid bill that states must pay to the lowest rate required under the federal matching assistance program, or FMAP. Mississippi currently contributes at the lowest rate.

In return for this consideration, states no longer would be able to leverage taxes to health care professionals and intergovernmental transfers to increase the amount of federal funding they receive for Medicaid. Such taxes on doctors, hospitals and others often are paid back in the form of higher pay rates, or they can be used to avoid implementing pay cuts that otherwise might be necessary.

The National Conference of State Legislatures reported in February that in fiscal 2011, “the number of states with some type of Medicaid-related provider taxes has increased to 46 states” plus the District of Columbia.

In the event states no longer were allowed to use taxes to health care professionals for this purpose, “it would certainly limit funds available in the program,” said Stacey Mazer, a senior staff associate with the National Assn. of State Budget Officers.

It’s difficult to predict whether the discontinuation of provider taxes would manifest in reduced health professional pay rates, benefits changes or other events, Mazer said. “It’s certainly a resource that states have been relying on and continuing to rely on. Clearly it’s an area that has been under scrutiny and potentially one that could be affected by deficit reduction plans.”

President Obama has proposed saving money for the federal government by restricting the ability of states to use provider taxes. Obama and congressional Democrats, however, generally have opposed Medicaid block grant proposals or other bills that, like Dr. Cassidy’s, would cap federal contributions to Medicaid.

The American Academy of Family Physicians plans to have its Commission on Governmental Advocacy study Dr. Cassidy’s legislation before issuing a position on it. The legislation was referred to the House Energy and Commerce Committee.