RICHMOND, JAN. 26 -- A vigorous three-week campaign by Virginia's powerful hospital lobby has killed all but token support for a proposal by Gov. Gerald L. Baliles' administration to assess hospitals and nursing homes to pay for indigent health care, key legislators said today.
The success of the lobbying effort by the Virginia Hospital Association, which included personal appeals by several Northern Virginia health care executives to their lawmakers here, represents an unusual setback for an administration that prides itself on a near-perfect record of winning legislative approval for its initiatives.
Even before the formal introduction of the fee proposal that state Human Resources Secretary Eva S. Teig had been circulating for weeks, Baliles' traditional allies in the General Assembly and pivotal lawmakers have walked away from the idea.
Under the plan, hospitals would be charged $5 a day for each bed and nursing homes would be assessed $1 a bed to help defray the cost of health care for the needy.
"It was almost 'no-sale' from the start," said state Sen. Dudley J. (Buzz) Emick Jr. (D-Botetourt), who was regarded by both Teig and the industry as a crucial player in the forthcoming health care debate. "It's impractical as a solution."
Del. Leslie L. Byrne of Fairfax County, one of several Northern Virginia Democrats who have been among Baliles' strongest supporters, said the proposed bed fees are "in deep trouble and as more and more attention is focused, they'll be in deeper and deeper trouble."
The idea behind the plan is to pull into the state's general fund new money that would be available for the joint federal-state Medicaid program. The federal government is expected to match state Medicaid spending, thus every new state dollar would generate a total of $2 for Medicaid. Those funds would be targeted for health care for the poor.
Several legislators said that while they endorsed the goal of Teig's proposal -- ensuring quality care for those least able to afford it -- they were unwilling to endorse the fees. They cited the burden the fees would impose on hospitals and said the complicated financing mechanism raises questions about whether the federal government would match the funds gained from the fees.
Emick, for example, said the theory behind the fees "breaks down because it assumed that the feds are stupid and they will let us get by with that kind of financing. It is fraught with 'ifs.' "
While refusing to concede defeat this early in a 60-day General Assembly session that began Jan. 13, administration officials acknowledged that the fee proposal faces widespread opposition. At the same time, the officials stressed the fees were but one possible proposal to deal with the problem of indigent care.
"We knew from Day 1 that the proposal was not going to make everyone feel warm and fuzzy," Teig said in a telephone interview tonight after a 90-minute meeting with a dozen hospital executives and two lobbyists from the industry association.
But, she added, "We've always said that this proposal was a concept that represented our best thinking. The concept of fees is going to be alive, though perhaps not in the format we've talked about here.
Meanwhile, Baliles' office backed away from the proposal.
Chris Bridge, the governor's press secretary, said Baliles may recommend a variation of the current fee proposal when he sends a formal proposal on indigent care to the legislature.
"She's out there with a proposal that could be an option," Bridge said of Teig.
"The governor intends to pursue a solution. What form it takes will be determined by him later."
In a related development, Emick filed bills today that could kill or derail the fee proposal. Emick called for a moratorium on new hospital and nursing home beds, which he said would help limit the rising costs of the state-federal Medicaid program.