Fox smears Dems with insinuations of shady special deals

From the March 19 broadcast of Fox News' Special Report with Bret Baier:

BRIAN WILSON (correspondent): Deals still alive for the moment? Well, Republicans claim that Democrat Bart Gordon changed his vote from “yes” -- from “no” to “yes” after he got $100 million for Tennessee hospitals that treat the poor. Other deals still in play? Yes, the Louisiana Purchase: $300 million in Medicaid money is still alive; Connecticut hospital handout -- $100 million sought by Senator Dodd.

From the March 19 edition of Fox News' Hannity:

HANNITY: Retiring Congressman Bart Gordon is doing a 180 as well. Now he voted “no” in November, but after securing millions of dollars in Medicaid funding for low-income patients in his home state, well, he's now in the “yes” column.

CT isn't only state eligible for hospital funding

Connecticut would reportedly have to compete for the hospital funds. The Hartford Courant reported that Connecticut would have to compete for the funds. Also, Dodd reportedly said that at least 14 other states could apply for the grant.

Funding for health care facilities would be decided by Health and Human Services secretary. The text of the Senate health care bill as passed states that the $100 million grant for “infrastructure to expand access to health care” “may only be made available by the Secretary of Health and Human Services upon the receipt of an application from the Governor of a State” that meets certain requirements:

(b) REQUIREMENT.-Amount appropriated under subsection (a) may only be made available by the Secretary of Health and Human Services upon the receipt of an application from the Governor of a State that certifies that-

(1) the new health care facility is critical for the provision of greater access to health care within the State;

(2) such facility is essential for the continued financial viability of the State's sole public medical and dental school and its academic health center;

(3) the request for Federal support represents not more than 40 percent of the total cost of the proposed new facility; and

(4) the State has established a dedicated funding mechanism to provide all remaining funds necessary to complete the construction or renovation of the proposed facility.

Proposed UConn hospital part of Republican Gov. Rell's health care proposal. Connecticut Gov. M. Jodi Rell, a Republican, has reportedly proposed a $352 million University of Connecticut Health Center that would rely on $100 million in federal funds that Connecticut would have to compete for under the provision inserted by Dodd.

Tennessee currently shortchanged on hospital funds; bill would fix that

Under health care bill, $100 million would go to “disproportionate share hospital payments” that Tennessee would otherwise be deprived of. Changes proposed to the Senate health care bill included a section that, in part, gives Medicaid disproportionate share hospital (DSH) payments to states that otherwise would receive no payments after FY2011. The House Rules Committee summary of the changes describes Sec. 1203:

Sec. 1203. Disproportionate share hospital payments. Lowers the reduction in federal Medicaid DSH payments from $18.1 billion to $14.1 billion and advances the reductions to begin in fiscal year 2014. Directs the Secretary to develop a methodology for reducing federal DSH allotments to all states in order to achieve the mandated reductions. Extends through FY 2013 the federal DSH allotment for a state that has a $0 allotment after FY 2011.

Entire TN delegation asked Congress to deal with the fact that TN is “one of only two states with no DSH payment.” As reported by the Nashville Business Journal, a May 2009 letter from Tennessee's entire House delegation -- consisting of both Democrats and Republicans -- to the House Energy and Commerce Committee requested DSH funding. According to the letter, Tennessee had given up DSH funding in 1993 when it created a special state insurance program, TennCare, in lieu of traditional Medicaid. The letter added that, since March 2006, Tennessee hospitals have “returned to a traditional Medicaid population,” but are not getting DSH payments, unlike almost every other state. From the letter:

As you may know, with the onset of the TennCare waiver in 1993, the state agreed to eliminate the DSH payment for Tennessee, using the rationale that the majority of the uninsured and uninsurable would have the opportunity to enter the new TennCare program and, consequently, hospitals would be getting TennCare reimbursement for the majority of the patients that would have been charity care patients. Although there was an initial 25 percent-decline in charity care under the program, the cost of charity care in Tennessee hospitals returned to pre-TennCare levels by 2000 and has continued to grow at a pace consistent with hospitals across the country. As of March 2006, the state Medicaid program began to disenroll adults who were eligible for TennCare as uninsured or uninsurable previously. This leaves Tennessee hospitals in the dilemma of having returned to a traditional Medicaid population covered by a Medicaid program with no DSH payment. Tennessee is one of only two states with no DSH payment. The other state is Hawaii.

Tennessee reportedly got temporary fixes in the past. The Nashville Business Journal article also reported:

The imbalance has existed since Tennessee gave up its payments when it created TennCare in the 1990s -- and it has been similarly addressed by lawmakers in the past. Early last year, a $32.8 billion bill to insure poor children included a provision extending DSH payments to Tennessee hospitals by $30 million a year for two years.

TennCare spokeswoman Kelly Gunderson said the majority of Tennessee hospitals receive some level of DSH payments.

Provision affecting Louisiana fixes Medicaid gap caused by Katrina, Rita

Funding would fix FMAP rates for “certain states recovering from a major disaster.” The Senate bill as passed includes a provision -- often referred to as the “Louisiana Purchase” by conservative media -- that would adjust the Federal Medical Assistance Percentage (FMAP) rate for “certain states recovering from a major disaster.” The bill requires that it only apply to states “for which, at any time during the preceding 7 fiscal years, the President has declared a major disaster” and “determined as a result of such disaster that every county or parish in the State warrant individual and public assistance or public assistance from the Federal Government.”

The Department of Health and Human Services states that FMAP is “used in determining the amount of Federal matching funds for State expenditures for assistance payments for certain social services, and State medical and medical insurance expenditures. The Social Security Act requires the Secretary of Health and Human Services to calculate and publish the FMAPs each year.”

Times-Picayune: Temporary post-Katrina spending “spiked” per capita income “long enough” to skew Medicaid funding formula, causing state Medicaid funding shortfall. The Times-Picayune reported on January 22 that “FMAP refers to the percentage of a state's payments under Medicaid that are covered by the federal government. Louisiana usually gets a higher match because of how poor the state is, but because of all the recovery and rebuilding money that poured in after Hurricanes Katrina and Rita, state per capita income spiked long enough to throw the formula out of kilter and threaten to blow a hole [in] the state budget. [Sen. Mary] Landrieu's fix was, according to state officials, only the beginning of a solution for a huge Medicaid shortfall the state is facing.” The article stated that Landrieu said “attaching the Medicaid provision to a health-care bill made sense, and there is no obvious and feasible legislative alternative.”

Jindal: “If not corrected in Washington, D.C.,” FMAP problem will cost $500 million a year. Louisiana Republican Gov. Bobby Jindal's fiscal year 2010-2011 budget proposal states that the “Louisiana state government faces significant, multi-year budget challenges, compounded by a faulty federal FMAP formula that, if not corrected in Washington, D.C., will cost the state approximately $500 million a year in Medicaid funding, impacting services for the poorest in our state, and often those who need care the most.” The proposal also says that "[w]hile there is discussion in Washington about extending the enhanced federal Medicaid match rate for six months for all states, without a permanent fix to Louisiana's faulty FMAP calculation, combined with the loss of federal stimulus funding, Louisiana will still face a projected $1.7 billion shortfall for FY 12."

This item has been edited for clarity.