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Cover Story: The Anticipated Impact
Coral Gables Hospital Celebrates
Halloween Game of Thrones Style of the Election on Healthcare
Continued from page 1.

Let’s start at the state level. With the One issue that has not been addressed
state legislature maintaining its by either party but is coming at us like a
Republican majority, and with a new freight train is the fact that the Medicare
Republican governor who is closely system is expected to go broke in the year
aligned with President Trump’s political 2026, this as indicated by the Trustees of
views, we may anticipate that there will be the Medicare Trust Fund, themselves.
no Medicaid expansion in the state of Having said that, it may be anticipated
Florida over the next two to four years. We that Medicare will not be allowed to go
may also expect that there will be no broke. Baby boomers have a loud voice in
enhanced eligibility in the state. As such, American politics, bolstered by the power
there will be people who will continue to of the American Association of Retired
fall between the cracks in terms of insur- Persons (AARP) which represents
ance coverage. Americans over the age of 50. Individuals
People earning 133 percent of the in Congress every so often mention the
Federal Poverty Level (FPL) or above will concept of reevaluating entitlements …
be eligible for the federal subsidies the code word for Social Security and
The leadership team at Coral Gables Hospital transported themselves to anoth- through the Federal Exchange under the Medicare. But this is the third rail in
er time by dressing up as characters from the hit TV show, Game of Thrones, to Affordable Care Act. But parents who American politics and would tend to
celebrate Halloween. The team wished all employees and patients a Happy make more than 30% of the FPL, individ- haunt the House or Senate members who
Halloween by passing out goodies around the hospital. “We wanted to bring the uals without children and undocumented bring up the concept in earnest.
spirit of Halloween to everyone who is hospitalized during a holiday, and help immigrants will be ineligible for Medicaid. Given that cutting benefits of retirees or
brighten their day,” said Cristina Jimenez, Chief Executive Officer of Coral Without any insurance coverage, these raising the age of eligibility will tend not to
Gables Hospital. categories of individuals will be dependent happen and given the fact that Medicare
Pictured (l-r) are Madison Workman, Henry Capote, David Araya, Jessie upon Emergency Departments for their will not be allowed to go broke, there are
Miller, Cristina Jimenez, Peter Iriarte and Patty Vila. care, the highest cost, lowest quality of only two variables left … increase taxes on
care given the discontinuity of care. the employed and self-employed popula-
Further those individuals without insur- tion and/or cutting reimbursements to
ance coverage will be charged full list providers. Indeed, the trend has already
St. Mary’s Medical Center Celebrates price. With an inability to pay , this patient occurred. Hospitals are operating on an
average operating margin of under 2.8%
population will continue to place a bad
a Decade of Comprehensive debt burden on health care providers. and we may anticipate further reductions
Looking at the federal level, the in reimbursements to hospitals
Stroke Care in the Community Democratic majority in the House and the systems. Physicians have seen reductions
Republican majority in the Senate will in reimbursement for clinical services
tend to assure that there will be no major under Medicare. For example, the conver-
change in current health care policy sion factor for calculating clinical servic-
except, perhaps as it pertains to pharma- es reimbursement for a Medicare patient is
ceutical pricing and policies. The recur- actually lower today than it was 10 years
ring theme of “repeal and replace” of ago and more cutbacks may be expected in
Obamacare will now be a mute point as the future. One of the other hidden aspects
the various attempts to reverse the law in is that Medicare is the major funder of res-
the past were initiated in the House. And idency training programs, a policy that
whereas Florida will not be expanding began in 1965. There will be increased
Medicaid, we are and will continue to see questioning as to whether Medicare is the
additional states expanding their Medicaid appropriate source of funds given the need
programs. It is interesting to note that for CMS to control costs. The result would
when Medicaid was initially passed in be costs of residency programs,
1965, the number of states that signed on absorbed by teaching hospitals, fewer resi-
were approximately the same number as dency programs, and a result in increased
those that initially expanded their shortage of physicians. It should be noted
Medicaid programs with partial federal that in the not too distant past, there were
funding in 2011. Over time, the number of 133 residency positions for every
St. Mary’s Medical Center recently celebrated the 10 year mark of providing states that adopted Medicaid or Medicaid 100 medical school graduates. Today there
community members with award-winning stroke care. As a comprehensive equivalent programs expanded to all 50 are fewer residency program openings
stroke center, the hospital offers the highest level of care for stroke patients, and states and the District of Colombia, much than there are graduates from medical
has performed more than 3,100 neurointerventions throughout its history. like what we have seen with the number of school.
During the celebration, Dr. Ali Malek, the stroke center’s medical director, states adopting Medicaid expansion con- So one can anticipate that issues that
and his team were presented with the American Heart Association/American tinuing to increase. One of the unknowns have been on the forefront of the health
Stroke Association’s Stroke Gold Plus Quality Achievement Award. This desig- will be the extent of rule changes by the care debate, issues dealing with access and
nation, along with the stroke center’s various other awards, is a testament to the Department of Health and Human efficiency , will continue to be the subject
high level of stroke care the community has been able to rely on for 10 years Services, the Center for Medicare and of continued conversation and debate.
and counting. Medicaid Services, and the President him- Certain aspects are relatively certain, and
self in terms of Executive order, as they other aspects are unclear in terms of out-
affect Medicare and the Federal govern- come. Indeed we will continue to realize
ment’s role vis-a-vis Medicaid. that, as per President Trump, “health care
There are two areas of apparent consen- is complicated.”
Snapshots Democrats that appear to be forthcoming: Chair, Department of Health Sector

sus between the Republicans and
Dr. Steven Ullmann is Professor and
assurance of insurance coverage for those
individuals with preexisting conditions
Management and Policy,
and the monitoring and regulation of at the University of Miami.
pharmaceutical companies.

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30 December 2018 southfloridahospitalnews.com South Florida Hospital News