In other words, if — as in the last fiscal year — the Med should provide some $90 million worth of charity medical care, all $90 million worth in federal compensation would go back to the Med under a Governor Wamp, who said yes when asked at his Memphis press conference if he would have absolute authority over the allocation of such funds, which are paid to the state, not directly to the generating hospital.
At present, all such payments for the indigent care generated by the Med and other Tennessee hospitals are routed, via TennCare, Tennessee’s version of Medicaid, on a pro rata basis to some 20-odd hospitals in the state.
Both Wamp, a Republican, and the Shelby County Commission members ,both Republican and Democratic, who had sought such a pledge of all active candidates estimate that changing the formula to pay out the funds on a one-to-one basis would net the Med an additional $50 million per year.
With that, says Shelby County Commissioner Mike Ritz, who has been prominent in local efforts to pry more money for the Med out of the state, the institution’s long-running financial woes would be “over.” In fact, says Ritz, it would be possible to amortize the bonds for a new, smaller, more efficient facility for the Med; that’s another consummation the hospital’s supporters devoutly wish.
Whether the federal government would approve a change in the Medicaid waiver it has granted Tennessee is one potential obstacle to the proposed new arrangement — though the feds normally are agreeable to whatever distribution formula a state proposes.
Other, more formidable problems would issue from the politics of the affair, from regional rivalries, and from within the state’s hospital bureaucracy. Greg Becker, president of the Tennessee Hospital association, was quoted at the Chattanooga Times-Free Press as objecting: "if you do this, then you're going to take away CPE (certified public expenditures), which will take away matching dollars for the TennCare program which will then be taken away in rates (cuts) to the Med."
The reference to CPEs indicates one of the complex auxiliary formulas whereby federal matching funds augment state expenditures. TennCare Director Darin Gordon also made reference to CPEs and suggested that a deviation from the current distribution formula would result in the state receiving fewer federal funds overall.
But no one, not Becker or Gordon and not one of the three other gubernatorial candidates — Knoxville Mayor bill Haslam and Lt. Governor Ron Ramsey of Blountville, both Republicans, or Jackson businessman Mike McWherter, a Democrat — has disputed that indigent care provided by the Med results in the Memphis institution generating a disproportionate share of federal paybacks, nor that the state’s allocation to the Med from all sources combined is less than the total amount of these Med-generated funds.
In short, as virtually all local officials have maintained, regardless of party or their position in the sphere of government, the Med is being short-changed. Not even the recently enacted bed tax passed by the General Assembly would do anything to redress this perceived imbalance. Nor would the Med’s hanging-by-a-thread status be much affected.
Already the other gubernatorial candidates have reacted to Wamp’s bold move by proposing a variety of summits and further discussions to find some other formula for the Med than the one-to-one payback method. But both interim Shelby County Mayor Joe Ford and Memphis Mayor A C Wharton, as well as various other Memphis and Shelby County officials, have been down that road.
Talks with Governor Bredesen and other representatives of state government have been strained at best and unproductive at worst, except for the fact of the bed tax, which would stabilize the current fiscal status of the Med and other institutions receiving money via the TennCare network.
Ritz admits to a cynicism about the bed tax and other proposed solutions short of the one-to-one formula, and he sees the influence behind the scenes of private hospitals as being formidable. “They don’t want the Med to fail, because that would mean they’d have to take over too much indigent care themselves,” said Ritz, who extended the argument to include Nashville General and Chattanooga’s Erlanger, two other charity-care hospitals. “But they don’t want such hospitals to get too comfortable, either, because that would make them too competitive. Starvation rations is something they’ll settle for.”
Whatever the realities, Wamp stands to gain politically in Shelby County, which by some estimates generates a fifth of all Republican primary votes. Last Wednesday’s press conference, which was attended by Democratic commissioners Sidney Chism and Steve Mulroy as well as several Republicans, was deemed non-political, but a move is afoot among the GOP commissioners to endorse Wamp as a body.
That may or may not come to pass — and one Republican commissioner, George Flinn, would have to measure the impact of something like that against his own bid for the GOP congressional nomination in the 8th District — but no one disputes that Wamp has gained significant political collateral in Memphis and Shelby County.
If nothing else, he has made a decisive response to the widespread suspicion, whether justified or not, that Memphis and Shelby County are orphans to state government and don’t get either the funding or the respect that other regions do. (In particular, Governor Bredesen’s several remonstrations to local officials to get the Med’s house in order before seeking more funding has been a source of local discontent.)
“Memphis matters” is a slogan lately adopted by candidate Wamp. One way or another, his gubernatorial rivals will henceforth be challenged — by thought, deed, or concrete proposal — to match it.
UPDATE: Germantown Board votes 4-0 to approve agreement.