Hospitals Against Norquist; For Renewal Of Bed Tax

October 5, 2012 9:57 am

by Charlie · 41 comments

Rare to see it, but this should help us at least understand how broken our tax system and health care business model is broken.  A group of hospitals have slammed Grover Norquist and are advocating for the renewal of a tax on their industry.  Georgia Health News frames the debate:

Now, some major Georgia hospital organizations have fired back at Norquist and come out strongly in support of the tax, which expires in July.

Children’s Healthcare of Atlanta, Grady Health System in Atlanta, Memorial University Medical Center in Savannah and HomeTown Health, an association of rural hospitals, delivered a letter of their own to leading Georgia officials Tuesday. It said that not renewing the provider fee could double Medicaid’s already sizable financial shortfall.

If the fee is killed, “the burden of funding Medicaid and caring for the most vulnerable Georgians would fall entirely on the backs of state and local taxpayers,’’ said the hospital group, called the Coalition for Medicaid Payment Equity.

A rejection of the hospital tax, the coalition letter said, would probably cause Medicaid patients to lose access to health care; endanger the finances of safety-net hospitals; and raise costs to the state.

They noted the hospital fee is not levied on individual patients or on hospital beds, but is based on hospital net patient revenue. More than 40 states use such provider assessments to help cover the costs of their Medicaid programs. With bad economic times battering state budgets, some states in the past five years have increased taxes already in place or approved new ones on hospitals, nursing homes or managed care plans.

This remains to be perhaps one of the most contentious issues that the legislature will face in the upcoming session, and the rules aren’t as clear as one would think.  I was against the tax when it was originally issued.  I’m going to have to spend a lot more time understanding the real implications of not renewing before I weigh in on the renewal.  This one is complex.

mountainpass October 5, 2012 at 10:12 am

It’s not complex at all, “we the people” are paying the tax right now……. some how, some where, some way.

Charlie October 5, 2012 at 10:20 am

True. But are we the Georgia people going to pay more, less, or the same tax if the hospital tax is or isn’t renewed? And will we the Georgia people recieve better, worse, or the same hospital care at the same, higher, or lower prices if it is or isn’t?

Simple answers to complex questions often aren’t the right ones. This one needs details.

Calypso October 5, 2012 at 10:32 am

And are those slated to pay the tax the ones who actually should be paying the tax or is that burden placed on them wrongly?

Charlie October 5, 2012 at 10:33 am

Which is another sub-question: Who is actually bearing the burden of this tax?

Calypso October 5, 2012 at 10:49 am

My guess is that those of us who pay health insurance premiums to private insurers are paying the tax.

Charlie October 5, 2012 at 10:51 am

I’m not sure that’s actually the case. Given that this seems to affect medicaid reimbursements, I’m not sure those of us with health insurance wouldn’t be paying even more if the tax were removed, but that would mean the federal government would also be spending less on Georgia. It seems very circular, and again, I have yet to be able to really try and break it down.

John Konop October 5, 2012 at 10:24 am

Ironic, Norquist is for forcing the mothers to have the kids, but if they get sick let them die. WOW as I said before, many are pro birth, not pro life.

Charlie October 5, 2012 at 10:33 am

John, that kind of comment is inflamatory and doesn’t do anything to add to the actual discussion of the bed tax, and frankly is a borderline thread jack. Dial it back on occasion from an 11 to about a 7 please.

John Konop October 5, 2012 at 11:16 am

The bed tax goes to pay for Medicaid which is kids, seniors and special needs. We already know that close to 75% of unwed teenage mothers end up using the service at one point in time. The combination of birth control policy and abortion rights would be major contributors to the problem of needing the tax revenue. Norquist is against both insurance companies required to allow women to have the choice about using birth control if their employer said no, and is against abortion. In my book it would be rather hypocritical to be against both policies and take away tax revenue for Medicaid. What am I missing? BTW if you really want to lower abortion how can you be against promoting contraception, especially in schools with high teenage pregnancy rates?

…..Contraceptives lower Abortion rates 62 to 78%….

AMB October 5, 2012 at 10:59 am

Single payer is looking pretty good, right now.

Charlie October 5, 2012 at 11:11 am

That really is the whole point of Obamacare, isn’t it?

ryanhawk October 5, 2012 at 11:36 am

It would be interesting to hear from former Rep. Roy Rowland on this. He and Mike Bilirakis (R-FL) had a great deal of support for a bipartisan alternative reform approach to HillaryCare in the 1990s. As I understood it way back then a lot of what they intended to accomplish would have improved public health access while controlling costs. Might be time to revisit that, and it would be nice to hear from an old warhorse anyway….

Chris Huttman October 5, 2012 at 11:53 am

Look if you care to read that bill it is here…

It has a lot of features similar to…Romneycare/Obamacare, though some differences. The point being – I don’t see how a rational person could look at the current political scene and conclude that ANY alternative to what passed could have passed. I take that back – I could see different version of Obamacare passing, but there’s just no way a true Republican alternative could have passed. You are kidding yourself.

Just remember the actual reality of the situation. The Republicans in the Senate had all of the power – they could have forced through a very conservative compromise due to the filibuster (just look at what they did on the stimulus). And they decided to make it Custer’s last stand instead.

So while it’s tempting and interesting from a historical perspective to talk about an alternative to a debate from 1994 – it isn’t very helpful.

ryanhawk October 5, 2012 at 12:30 pm

“Obamacare” was the Republican alternative — they simply denied parentage when Obama adopted it. The rhetoric has been politics, not policy. Going forward I believe we are going to need to consider a lot of new ideas, and reconsider some old ones, since anyone who can count knows funding Medicare and Medicaid as they exist today simply is not a viable option.

Chris Huttman October 5, 2012 at 3:35 pm

Oh I definitely agree – I’m just saying it’s hard for me as a Democrat to take Republicans seriously on this stuff when they say hey there’s a funding problem for Medicare, our solution to fix it is to delete $716B from Medicare advantage. And then when Obama does the same thing, they make it the centerpiece of their campaign.

Now obviously, they use the $716b to lower taxes, Obama used it to finance expanded coverage thru Medicaid and the exchanges – but if it’s wrong for Obama to use that $716b for spending, I don’t see how it’s right for them to use it for something else.

rrrrr October 7, 2012 at 6:28 pm

Charlie revealing endings like this you must be a lot fun around book clubs…

AMB October 5, 2012 at 11:20 am

The whole point of healthcare should be that children should be treated and made well. Families shouldn’t be bankrupted because their child got sick. Elders shouldn’t have to spend into poverty to live in assisted living.
Single payer puts the emphasis back where it belongs-medicine and recovery. Costs for hospitals and doctors would be predictable making regional healthcare planning easier.
Unless you are an insurance company, it makes the most sense.

Dave Bearse October 5, 2012 at 6:39 pm

“Elders shouldn’t have to spend into poverty to live in assisted living.”

The current system could perhaps be improved, but if they don’t it’s simply foisting their healthcare costs on the public in order to leave their assets to heirs.

Noway October 5, 2012 at 8:22 pm

“children should be treated and made well.” (Yes, they should. Pay for their care yourself.)
“Elders shouldn’t have to spend into poverty to live in assisted living.” (They should pay for their own needs.)
Spoken like a true leech!
It’s the parents’ job to pay for and care for their own kids as well as the care of their elderly parents.
It’s is not the responsibility of anyone else to get you, your sick kids or your elderly folks through life. That is why this country is effectively dead. Paying for the responsibilities of others has crippled us. Thanks a lot!

Dave Bearse October 7, 2012 at 3:33 pm

There won’t be a Republican in the White House until the GOP puts those with with your sentiments in check.

There is a general public responsibility for the welfare of children. It’s pre-sumptious to think that security in old age ought to be dependent on living children.

The twin GOP actions of obstructionism, and policies of undermining the middle class and middle class security are currently what is killing the country.

John Konop October 7, 2012 at 6:09 pm


Help me understand how my comment is out of line when the Norway comment is the view of the Norquist side of the GOP?

Harry October 5, 2012 at 11:39 am

Meanwhile we’re spending ourselves into third world status.

Chris Huttman October 5, 2012 at 11:54 am

Wow poor hospitals. If only some mechanism existed to get them billions of dollars from the federal government.

Stefan October 6, 2012 at 1:51 am


bowersville October 5, 2012 at 11:55 am

Here’s an article that might as well be thrown into the debate as well. As baby boomers age GA is facing a shortage of doctors.

While there are more medical students, there aren’t enough residencies — the final phase of training required to become a full-fledged doctor. The bottleneck in the doctor pipeline persists as medical schools and elected officials struggle to find a way to pay for more residency slots at teaching hospitals across the country.

ryanhawk October 5, 2012 at 12:38 pm

Much of the problem is that it is illegal for nurses and PAs to deliver care they are perfectly capable of delivering. Doctors like it that way, but there is no reason taxpayers or poor patients who are denied access to care by these laws should accept it.

Three Jack October 5, 2012 at 2:42 pm

When will government start looking at the other side of this equation, the freeloaders who consider healthcare their right despite no contribution to the funding of their healthcare. We can keep taxing productive citizens until eventually there will be nothing left to tax and still not keep up with handout demands. It is past time for tough love, taxpayers cannot be the compassionate source of all welfare in a sustainable society.

Harry October 5, 2012 at 9:16 pm

The Yiddish song Dana Dana expresses the sentiment of one who exists under the constraint of false security:

On a wagon bound and helpless
Lies a calf, who is doomed to die.
High above him flies a swallow
Soaring gaily through the sky.

The wind laughs in the cornfield
Laughs with all his might
Laughs and laughs the whole day through
And half way through the night

Now the calf is softly crying
“Tell me wind, why do you laugh?”
Why can’t I fly like the swallow
Why did I have to be a calf,

Calves are born and soon are slaughtered
With no hope of being saved.
Only those with wing like swallow
Will not ever be enslaved.

rrrrr October 7, 2012 at 6:24 pm

Please pass the A1 sauce

Calypso October 8, 2012 at 10:01 am


Scott65 October 8, 2012 at 11:36 am

feelin the yiddish

Scott65 October 8, 2012 at 11:28 am

oy vey … lots of gornisht maven around here…feh
Now THATS some yiddish

Scott65 October 8, 2012 at 11:25 am

back to topic… As I’m reading this, it seems the ones BEING taxed want it. They are asking to be taxed, because they know what a bad situation we will be in if they are not.

Harry October 8, 2012 at 11:53 am

Nisht gefloygen. The bed tax is paid by the insurance company or patient not the hospital. The hospital benefits from having services paid for that they provide to their welfare patients.

Scott65 October 8, 2012 at 5:12 pm

Nit ahin, nit aher. You pay one way or another. A shandeh for those who let the poor go without medical care at all.

Harry October 9, 2012 at 7:42 am

Do you think government is responsible for or even capable of providing the same level of medical care for everyone?

John Konop October 9, 2012 at 8:03 am

No, Harry that is one of the problems. Public or private, healthcare is a resource that cost money. We need to look at the must efficient manner to deliver the service, but we cannot afford to give everyone Cadillac care. And both parties avoid that reality for obvious reasons……..The moment any side uses the word or concept of rationing via services it becomes about death panels and killing grandma.

Self_Made October 9, 2012 at 7:14 am

Why do we get into these discussions and people are railing about EITHER revenue OR cost…never the two as components of a larger picture. The bed tax IS paid via pass-through by the (insured) private payer, but that’s not a boon to the hospitals…who must cover the costs of non-paying patients with FEWER tax dollars from other sources. You also have other providers who MUST accept a lower rate of payment from MedicAid for services. The bed tax is essentially a “public/private engineered solution” that does minimal damage to the sacrosanct “marketplace” and keeps the safety net somewhat viable.

Harry October 9, 2012 at 7:45 am

Having a safety net doesn’t mean it’s realistically possible for welfare patients to receive the same level of medical care as paying patients. Maybe doctors are required under their ethics to do so, but government isn’t.

AMB October 9, 2012 at 12:38 pm

Okay Harry-you get the only slightly used band aids.

Harry October 9, 2012 at 1:38 pm

Could I be allowed to put my personal funds together to get new ones?

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