Unleashing An Epidemic: Florida Gov Rick Scott Shows The Folly Of Cutting Safety Net Hospital Funding

When Florida voters elected Rick Scott back in 2010 they may have thought they were getting a health care expert. After all, his claim to fame was building the largest for-profit hospital company. Boy were they wrong.

The list of Scott’s public health missteps are vast–such as trying to gag doctors from discussing guns with patients, taking credit for refusing to perform abortions at his old company, trying to shut down a monitoring database that would keep pain pill addicts from getting more prescriptions, and pushing the sale of the state’s public hospitals to buyout funds to raise money to close the deficit.

But this latest one may be the most tragic. In March Governor Scott moved to close A.G. Holley hospital, a small 100-bed safety net institution specializing in tuberculosis. The Palm Beach County public hospital had operated for 60 years. Closing it saved only $5.4 million, which is what its costs were last year. Scott justified the closure saying that TB cases had dropped by 10% in recent years.

Yet in April the CDC notified the state that a major TB outbreak was unfolding among homeless people in Florida, linked to 99 cases and 13 deaths, according to this report in the Palm Beach Post. Another 3,000 people had been exposed to the disease, mostly at shelters. The state kept the CDC report hush-hush, instead announcing in June a plan to transfer quarantined patients at A.G. Holley to TB wards in Miami and Jacksonville. This month it went ahead with the plans to permanently close the A.G. Holley TB facility.

While the closure of the hospital did not directly cause the outbreak–after all, TB is caused by bacteria–having a dedicated hospital to house patients who are contagious may have been contained it sooner.

Scott’s cavalier approach to public health is dangerous. He’s already proven, through his actions, that health care is less important than the hurt feelings of gun rights extremists, private equity funds’ returns, and manufacturers of pain pills. And now added to that list are the lives of vulnerable TB patients and those who are exposed to their disease.

Across the country, states are contemplating similar decisions. It’s easier to cut a safety net hospital, which has little voice in state capitals, than it is to cut payments to pensioners or teachers that have strong constituencies. But these facilities are still needed. Even with the ObamaCare’s imminent implementation, there will still be 25 million uninsured people (see table 3 in this CBO report), many concentrated in states like Florida and Texas that have large immigrant populations. De-funding these institutions–or forcing them to be sold to private investors, as Scott has recently been advocating–is very short-sighted. And it shouldn’t take tuberculosis epidemic to recognize that fact.

David Whelan is a contributing editor at Forbes, where he was a staff writer for 8 years covering health care payers, providers and policy. He’s currently studying and working in hospital administration. Follow him on Twitter @WhelanHealth

10 replies »

  1. Now you’re thinking like Lee Atwater. I wonder why Alex Sink didn’t think of that back when she was running?

  2. Given that everyone knows that there were 2 sets of books at Columbia/HCA and everyone knows it came from the top (read Maggie Mahar’s book), wouldnt a vindictive political opponent think about reopening criminal investigation into what is still one of the biggest ever Medicare Fraud settlements (Columbia/ HCA on Scotts watch).

    OK wont happen here, but Scott better be glad Vladimir Putin isnt President here!

  3. Yes please Joe, be specific. Not sure how subsidies to buy insurance incentivizes a move away from low income – any more than Republicans want to move away from it now. Rick Scott’s refusal to expand an already underfunded Medicaid to the poorest of the poor is not coming from a “liberal”. As a so-called “lefty” I’m not sure if I like the ACA as the mandate forces people to buy the most expensive system in the world. I don’t like the meek provider cost controls, but providers pay lobbyists, not so for the poor.

  4. He was never convicted of anything so we should be careful here. But his company did pay a huge settlement for actions that took place when he was in charge.

  5. I think you should write that up. Get away from attacking “the left”–but show in factual terms how the ACA incents providers to leave low-income areas.

    One way that’s happening is that by tying HCAHPS scores to Medicare reimbursement the hospitals operating in less affluent areas may get punished–by not having the same nurse ratio as in the fancy suburb. (Cleanliness is a HCAHP category–which is important, obviously, but who’s going to do better? St. Inner City Hospital–or St. Suburb?)

    The other parts of the ACA are not as obviously anti-low-income as you say. But I’d be curious to read your whole take.

    Thanks for the comment

  6. David- look at the incentives in the ACA.

    Every incentive encourages states and hospitals and providers to move away from low income, minority areas.

    While this was a trend already in the works, the ACA is putting the process into overdrive.

    It is being said that the best way for inner city hospitals to survive is to close their doors and reopen in more affluent areas.

    But, since the President let the insurance industry write the ACA, not too surprising.

    What is pathetic is that so many on the left– who would have brought pitchforks and torches if Republicans had offered a similar bill (and no projection- all Rs voted against this bill, they have zero responsibility)- are defending the law.

  7. Yes, going back to the 19th century will save us. But, our bankers will be richer for it.

  8. I think you’re absolutely right–unless the economy starts growing again.

  9. While I have watched with shock and horror at the election of Rick Scott – remembering Columbia HCA’s profit focussed slash and burn M&A days, I have to say, the overall economic state of the country is going to make this TB hospital closing an unfortunate recurrent event in the next many years.

    The US Economy doesn’t have the money to pay for many of the social services it has provided in the past – healthcare, education, prisons, pension commitments, medicare, medicaid and the list goes on.

    The government will put pressure on individuals and states, and the state governments will make cuts across the board. Yes, it will be about lobbies and which groups can prevent cuts to their group, but the bottom line is that cuts will happen. The rest of it is just a question of where.

    The economics just don’t support our ability to get out of this tailspin any time in the near future.