While the president and Congressional Republicans negotiate how much to cut out of Medicare, Medicaid and Social Security in exchange for raising the nation’s debt limit, one of the biggest losers could be the system of privately owned hospitals, clinics, and health centers that provide service to the 600,000 residents of the nation’s capital.

Although budget negotiators remain huddled in the White House and on Capitol Hill hammering out the details of legislation to raise the debt ceiling, and possibly, also balance the federal budget, some predict cuts to health spending that could mean financial ruin for hospitals, medical practices, and other health care providers.

According to the DC Hospital Association, hospitals in the District are already overburdened in light of the amount of unreimbursed care to those needing services that cannot pay.

“Cuts are not good for patients, the health delivery system, nor physicians; they make no business sense,” said Dr. Leonard Weather, a practicing gynecologist and president of the National Medical Association (NMA). Dr. Weather’s group, the nation’s largest association of African-American physicians, is sounding the alarm about the impact of the federal debt negotiations on the eve of its national conference starting this weekend at the Washington Convention Center (Click here for full details).

From a business sense, any cut in payments to health providers is completely “illogical,” asserted Dr. Weather, who has managed a gynecological health care practice for 28 years. According to Weather and his group, physicians and hospitals in D.C. and around the country are barely remaining afloat. “Physicians are lucky to make ends meet, often working without pay. Further reductions may cause medical practices and hospitals to reduce hours, lay off employees, and even close their doors,” Dr. Weather said.

Spending cuts that reduce access to care and compromise the quality of the care delivered will help neither patients nor the economy, Dr. Weather predicted. “Fewer doctors would mean that more people will be forced to utilize emergency rooms, which may result in poorer health outcomes and more expensive care,” the NMA’s president said.

Ultimately, the proponents of “balancing the federal budget” through cutting health spending are merely shifting the unavoidable burdens of public health to states, businesses and average Americans, contends the NMA.

Businesses and health practitioners like Dr. Weather have cause for alarm as nearly all the proposals being seriously discussed for raising the nation’s spending limit call for deep health care spending cuts.

The president favors a “balanced” deal to increase the debt cap by reducing government spending and increasing tax and other revenues. This “shared sacrifice” according to President Obama’s recent Weekly Address “means spending less on domestic programs,” like Medicare and Medicaid. In fact, the president has suggested a 3:1 formula for balancing the budget—$3 in cuts to federal health and other programs (along with interest costs) for every $1 in taxes and other “revenue increases.”

Republican Congressional leaders have differing ideas for addressing the debt-ceiling crisis. The plan (Click here to read) favored by House Budget Committee Chairman Paul Ryan (R-Wis.) would balance the budget through $30 billion in Medicare cuts, transforming Medicaid into a program of block grants to the states (that some fear could be used by the states for other non-health purposes) and slashing funding by over $250 billion for elderly, disabled, and poor.

If House Majority Leader Eric Cantor (R.-Va.) had his way, he would impose staggering reductions of federal DSH funds (reimbursements to hospitals that care for poor patients who cant pay), reduce support for state Medicaid programs, and slash federal programs supporting nursing homes and rural hospitals.

Many—mostly newly-elected—Tea Party Republicans oppose any debt cap deal, instead they are pushing a systemic solution proposing a “Cut, Cap and Balance” budget amendment (Click here to read). This measure would require a supermajority vote of Congress for the federal government to raise its debt ceiling and/or implement other major budget changes such as deficit spending, increasing taxes, and spending more than 18 percent of the nation’s GDP. While not detailing cuts to Medicare and similar programs, according to the White House, the bill could result in severe cuts to health education, Medicare and Social Security.

All these cuts would be disastrous according to NMA’s Dr. Weather. To prevent a tsunami-like financial catastrophe to the health system here in the District and nation, Weather and NMA leaders are exploring “creative” means of communicating their concerns to the president and other budget negotiators.

With nearly 7,000 doctors, nurses, and other supporters arriving into town for the NMA conference, Dr. Weather is even gauging support amongst his fellow physicians for a sit-in (like that led by District Mayor Vince Gray) at the White House gates to convey their opposition to cuts jeopardizing their patients and businesses. “We have to do something,” said Weather.

Talib I. Karim

Special to the AFRO