A Critical Juncture for the State's Health Care Safety Net

Boston Medical Center is preparing for layoffs as early as this week and Cambridge Health Alliance will likely close one of its three hospitals and some health centers early next year. The state’s two largest safety new hospitals claim they are bearing a disproportionate share of state budget cuts…but the Patrick administration say it is time to rebalance the state’s health care spending.

(story transcript)

MARTHA BEBINGER: For decades, Boston Medical Center and Cambridge Health Alliance have made it their mission to care for Massachusetts residents who fall through the cracks of the health care system. They’ve created comprehensive programs of care for the uninsured, immigrants, drug addicts and the mentally ill. Representative Alice Wolf of Cambridge is leading a group of state and local elected officials worried about how her hospital will cope with 55 million dollars in state budget cuts this fiscal year.

ALICE WOLF: If there is a reduction in services, if an emergency room had to close or part of a hospital had to close, that would make a real difference. There isn’t any other place for those visits to be taken care of.

BEBINGER: Cambridge Health Alliance includes hospitals in Cambridge, Somerville and Everett as well as 20 community health centers. Administrators have not announced any changes …but the uncertainty is having an effect.

Some doctors who work with psychiatric patients are leaving Whidden hospital in Everett, forcing the hospital to rearrange services. Cambridge Hospital physician Steffie Woolhandler says staff has been warned about the full impact if none of the 55 million is restored.

STEFFIE WOOLHANDLER: We would have to shut down half of the facilities, lay off about 20% of the workforce, cut back the services a great deal. If you destroy that much of the public sector it takes decades to build up the services that we have at Cambridge Hospital.

BEBINGER: Woolhandler says Cambridge also offers care at a cheaper rate than many hospitals and emphasizes primary care…which the state needs more, not less of. The Patrick administration is negotiating with Cambridge to keep essential services open and boost the network’s reimbursement rates. Cambridge loses money on most of its patients because they are in government insurance programs that pay less than private insurance plans. The network was working on an reorganization and savings plan before the state budget cuts hits. The state is not talking about restoring those cuts. Massachusetts Health and Human Services Secretary JudyAnn Bigby says meetings with Cambridge Health Alliance are frequent and intense.

JUDYANN BIGBY: We are working very closely with Cambridge, we are going through all of that data, we are going to guarantee that people have access, but there are no final plans for them to close anything and that’s why we are working with them.

BEBINGER: The state is not in such active negotiations with Boston Medical Center, which faces more than 100 million dollars in state budget cuts. There is a sense in the Patrick administration that BMC will be OK this year…that it can weather cuts by tapping its endowment. But the hospital is preparing layoffs, considering a lawsuit against the state and telling staff to identify about 40-million dollars in cuts for next year. BMC is working with union and community leaders on a campaign to pressure the Patrick administration with letters, phone calls and at least one public event next month…as Governor Patrick begins planning his re-election campaign. The message…

CELIA WCISLO: This is a Draconian cut on those 2 institutions on a level that other hospitals aren’t facing.

BEBINGER: Celia Wcislo with the Service Employees International Union, 1199, is also critical of the Patrick administration for not explaining how displaced patients will get care. Boston Mayor Tom Menino says the mission of Boston Medical Center is under threat.

TOM MENINO: BMC is always a hospital that says that anybody who comes through these doors will be able to get health care. Well it’s questionable if they’ll be able to do that in the future so. I think there are some people out there who don’t understand the mission of BMC and that’s very unfortunate.

BEBINGER: But how BMC, Cambridge and other safety net hospitals fulfill that mission was always supposed to change under the state’s health coverage law. For years, the state collected a pool of money to pay for care for the uninsured. BMC and Cambridge Health Alliance received the lion’s share. Now the state is using a growing share of that money to subsidize health insurance. Administration and Finance Secretary Leslie Kirwan says Boston Medical Center and Cambridge knew that special payments they received to care for the uninsured would be phased out.

LESLIE KIRWAN: We understand that there are some growing pains as part of that, but that change was definitely contemplated as part of health care reform and I think what we’re seeing in some of the strains the health care system is feeling is a direct result of that.

BEBINGER: The phase out is happening faster than planned. But Kirwan says the state can’t avoid major cuts for BMC and Cambridge. Together, these two institutions receive two and a half Billion dollars…or just under 10-percent of the state’s total budget.

LESLIE KIRWAN: The governor and the governor’s whole team understands the importance of the safety net hospitals. They receive a good deal of the budget and had to have a share of the cuts as well. And I would point out that we are not done with this.

BEBINGER: Kirwan says there will be more cuts next year across the state budget. She will listen today as a team of economists advises State House leaders that the economy and the state budget gap is expected to get worse before it gets better. As the budget vice tightens, there are growing calls for more scrutiny of state money for Boston Medical Center and Cambridge Health Alliance. Nancy Turnbull is at the Harvard School of Public Health and an advocate for low income patients on the Connector board.

NANCY TURNBULL: Even if we weren’t in the middle of a fiscal crisis, it’s absolutely essential and imperative for the state to be looking very, very carefully at all of the money that is flowing to BMC and Cambridge to be sure that it’s being spent appropriately and carefully in furtherance of the critical mission of these two organizations.

BEBINGER: That mission will get a public hearing if Boston Medical Center or Cambridge decides to close any service considered “essential” under state law. They must give the state notice 90 days in advance…a step Cambridge is expected to take as early as next month. That will put the Patrick administration in the position of scrutinizing the impact of its own cuts on thousands of patients.