Perspective from the 19^th Hole is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf.  Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon (Les AuCoin), as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist.  This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.  I could have called this blog “Middle Ground,” for that is what I long for in both politics and golf.  The middle ground is often where the best public policy decisions lie.  And it is where you want to be on a golf course.

It’s interesting to see how a current event prompts memories of the past.

Such was the case for me last week as I noticed that legislators at the State Capitol in Salem, Oregon were considering special taxes on hospitals and health insurers.

Why?

Well, the money that would arise from those taxes would then be used by the state to generate more “matching funds” from the federal government under the Medicaid program (about 60 per cent of the funds for Medicaid come from the federal government and 40 per cent from Oregon).

In theory then, the “new money” – a combination of the tax revenue and the federal matching funds – would be devoted to increase funding for Medicaid, which serves low-income Oregonians.

Sounds good, right?

Well, again in theory, it is.

But there is this tension, which I recall from my days as a state lobbyist when the special taxes on hospitals and health insurers first were proposed:  How do you insure the “new money” goes to fund health care programs, especially Medicaid, and is not siphoned off to go to other programs.

It’s almost impossible to achieve because, once new money arrives in Oregon, it is just that – new money, which is available for legislators to dispense as they wish.

What happened back in my days could be called “supplanting.”  By that, I mean that the new health care money was devoted to health care programs, but then money already in health care budgets (and not arising from the new taxes) could be taken out from behind the new money and used elsewhere.

Thus, “supplanting.”

Back in the day, lobbyists like me tried to forestall the problem, but we were not able to do so, no matter how hard we tried.  Especially on budget issues, it’s tough “to cut a deal with the Legislature” and have it stick, given all the other demands on state government money.

I hope current lobbyists can find a way to be more successful.

From the Oregonian newspaper story, here is more background:

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“The Oregon House voted Thursday to renew a tax on hospitals and health insurance plans to help increase funding for the state’s Medicaid plan.  House Bill 2010 would adjust and extend taxes on hospitals and health insurers, which the state uses to bolster federal funding for the Oregon Health Plan, the state’s Medicaid program that provides health care to low-income individuals and those with disabilities. 

“The taxes are expected to raise $2.1 billion to support the Oregon Health Plan, which covers 1.4 million Oregonians, including more than half of children in the state.

“The Oregon Health Plan is funded by a mix of state and federal funds, including the assessments on hospitals and insurance providers. 

“The hospitals support the taxes, though, because they unlock billions in federal matching dollars.  The federal government funds the majority of the state’s Medicaid spending.  According to Georgetown University’s Center for Children and Families, the federal government contributes $1.37 to Oregon’s Medicaid coverage for every $1 Oregon spends.

“The hospitals essentially get much of the money back in the form of larger reimbursements for the care they provide to low-income Oregonians, and it reduces the amount care provided to people without insurance that goes uncompensated.”

Again, this caveat from me, not from the Oregonian newspaper:  All this sounds good as long as the “new money” goes directly to health care and is not “supplanted.”

On that, to use a time-worn phrase, time will tell.