The staggered Republican governor didn't see it coming but quickly regained his footing. He responded with a biting commentary on the deep-pocketed nursing home industry and vowed not to be intimidated by special interest groups.
"For them to get their way would continue a precedent of bullying, intimidation and the power of special interests in our state," Kasich said in an interview at his office.
The governor, whose own hard-charging style has drawn comparisons to bullying, sees a bigger issue here than just a budget debate. He sees potential sea change in how policy is set in the state of Ohio, one where the power of special interests is limited. But this is the test case: Can he stand up to a group big enough to launch public relations warfare on him?
The governor has proposed chopping Medicaid reimbursement rates for nursing homes by $420 million over the next two years. The plan would give more money to home-based care programs. Nursing facilities complain that they are being unfairly targeted.
The ad literally implied Kasich was pulling the plug on the sick and elderly. It was the first salvo in the battle between one of the most powerful and best-funded lobbying efforts in Columbus and the newly minted and strong-willed governor bent on shaking up the status quo.
"What we were trying to do is educate the public about what the governor propose cuts would do," said Peter Van Runkle, executive director of the Ohio Health Care Association. "There is going to be significant job loss and it will have an impact on care, and it is going to be a negative impact."
The Ohio Health Care Association -- the largest of the three nursing home lobbying groups was behind the commercial.
By the end of the week, Van Runkle announced he was pulling the ad because it was scaring off lawmakers who felt they were being forced to publicly choose a side. But he warned this commercial, and others already in the works, would return if negotiations do not go well soon for nursing homes.
Kasich said he will not back down because the outcome of this fight will affect how policy is shaped in the state.
"This notion of laying in the weeds until the end to try to get your way and beat people up, this is a culture we cannot afford to have in Ohio," he said.
The nursing home lobby and Kasich are essentially vying for the attention of the public and of the Republican-controlled Ohio Senate, which is now considering the budget bill.
Kasich's aim is to remake the entire Medicaid system, the most costly expenditure in the state's $55 billion budget proposal. He plans to do it largely by changing how the system operates. Too often, the governor said, nursing homes are the default for patients with no other options. He wants at-home care to eventually emerge as a viable choice.
Medicaid is the state and federally paid healthcare system that serves about 2.1 million poor, elderly and disabled Ohioans. About 50,000 people live in nursing homes under Medicaid while another 30,000 are receiving assistance at-home.
Kasich has proposed cutting nursing home payments by 7 percent while spending 15 percent more to ramp up home care.
"The big shift is that the old way of payment is the political process picks the winners and losers by provider: Did the nursing homes win or did the hospitals win?" said Greg Moody, director of Kasich's Office of Health Transformation.
"What we've done is put all that money together and then give people the choice of setting so that individuals are choosing the setting they prefer," Moody said.
Moody said he would like for Ohio to achieve a 50-50 balance in the number of people living in nursing homes as compared to at-home care. He also said that nursing homes currently spend 50 percent on care and 50 percent on operations and salary. He wants that to shift to a 60-40 ratio in favor of care.
Moody said Ohio has more nursing homes per capita than any other state, and that the state's nursing homes on average have a 15 percent bed vacancy rate. He suggested nursing homes consolidate to fill empty beds and cut down on operational costs.
"I've heard the association say it doesn't matter to Medicaid because we're not paying for empty beds," Moody said. "Just intuitively if you are 15 percent empty, there is inefficiency."
Geoffrey Webster, an attorney for the Ohio Academy of Nursing Homes, another state lobbying group, said the administration is making a critical error in judgement by assuming that cutting payments won't have a detrimental affect on quality of care.
"You got to understand, there are 80,000 meals a day served to people who can't feed themselves, there's tens-of-thousands of people who can't get bathed unless someone helps them," Webster said. "And the only place left to cut is staffing."
Nursing homes have been hit with rate reductions and a bed tax over the past six years, Webster said. They estimate the proposed cut could mean a loss of $250,000 per nursing facility on average.
The AARP Ohio, which represents the state's senior citizen population, applauded the governor for wanting to increase at-home services and said the ultimate goal should be for more people receiving care at home versus a nursing home.
But Bill Sundermeyer, of the AARP, said the concern is whether Kasich is allotting enough money in the program to increase the pay of aides who care for patients in their homes. Workers make as little as $8 an hour.
"We are finding that anywhere from 40-to-50 percent of the people who are actually doing the care face-to-face, many of them stand in food lines to provide for their own families because the money they are making is below poverty lines," Sundermeyer said.
Sundermeyer worries Kasich's administration is overlooking this issue. It's possible Ohio could increase at-home options but there would be too few qualified people willing to take the jobs because the pay is too low.
"One of the downsides then could be having waiting list for at-home services," he said, which then could revert back to making nursing homes the default choice.
Kasich said pay will be addressed in due time.
"As the demand goes up, the pay will go up," the governor said, though without a specific plan for backing up that promise. "They're not going to have problems finding people to do this. If we get out there and find we have a problem, we'll figure it out."
Both Van Runkle and Webster, of the nursing home lobby, said Ohio has a large enough elderly population that they do not fear competition from at-home services. In fact, they say one is not a threat to the other because nursing homes tend to care for people who are too sick to live at home.
"So what they are saying is we're going to pay you less to care for those people who are left, those who are most sick," Van Runkle said. "That's what we can't understand."
Still, Webster said he did not agree with Van Runkle's decision to run the attack ad against the governor to get attention.
"If John Kasich wants to have a press conference, he stands up and (media) gather around," said Webster, who prefers the quiet, backroom chats with lawmakers. "That's not a good guy to pick a fight with in my view."
The AARP also issued a statement denouncing the ad.
The Kasich administration said it met with the three nursing home groups, the Senate president and House speaker on May 5 and had a cordial conversation.
The ad ran the next day.
"There was agreement on process for having a policy-oriented discussion. And then the ad ran the next day," Mooney said with disbelief.
Van Runkle said the administration knew a new ad was coming. He is unapologetic but did acknowledge getting blow back from some senators and the administration which affected talks this past week.
The Senate is expect to complete its work on the budget by early June. By law, the governor must sign the next biennial budget by July 1.
Source http://www.cleveland.com/
No comments:
Post a Comment