Op Ed: INADEQUATE HEALTHCARE FUNDING FOR LOCAL RESIDENTS

PART 4: SUBSIDIES

Now that we have seen some of the differences between MediCARE and MediCAID, and what implications those differences have in terms of maintaining funding for the comprehensive healthcare of the residents of AS, I would like to dig a little deeper into that murky well of U.S. taxpayer dollars that American Samoa so heavily relies upon… so that people will know where to look for the truth.

With electronic medical records, inadequate billing and claims submission, poor compliance with CMS and their requirements, and even just failing to take maximal advantage of the few residents who do have outside health insurance, we have seen several ways in which basically everyone loses.

And when it comes to whatever reduced funding that LBJ does actually get (or recover) from the U.S. Govt., there still remain some very serious questions as to how and when that money arrives does it make its way through to be used for the care of patients at LBJ.

For example, is money budgeted for MediCAID matching actually used only for that purpose? Or is it as I strongly suspect, always at risk of being diverted in total or in part (“reprogrammed,” as politicians like to call it), to other priorities of spending for ASG?  Just name your favorite cause or concern here, but paving roads, buying fleets of new vehicles, and even just having Departmental parties come right to mind as some of ASG’s priorities that I think we can agree we’ve seen very highly publicized in the past.

I know for instance that I repeatedly heard past Administrators at the Hospital (both Executive-types and on occasion, even certain individual Board Members) loudly bemoaning ASG’s tardiness with their legally-mandated monthly subsidies. They didn’t all do it in public mind you, but I’m sure I’m not the only one who often heard many of these horror stories in private.

Here again, we need to remember that the local law in AS requires these payments to be disbursed according to a Governor's Office-generated (and Fono-approved) annual budget for the hospital!  Then there should be even more income coming from that ugly and onerous 2% Wage Tax as well, right?  I mean the one that is legally earmarked strictly for LBJ!

Yet for a vast majority of months over the years (and going back to previous ASG Administrations as well), the money simply never reached LBJ.  The subsidies were either not paid in full, not on time, or in a number of cases, just not paid at all.

Now as I understand it, ASG is required to pay out 10% of LBJ’s annual operating budget (that it has approved) in monthly installments. So for about a $50Million Budget, that'd be roughly $5Million divided by 12, or a little over $400K/month.  And apparently, most if not all of that money looks to the Feds like "local" funds coming from ASG (regardless of wherever they actually get it from).

Which means of course, that AS’s Medicare/ Medicaid Office should be able to go right back to CMS with that approx. $5Million per year from ASG, and immediately DOUBLE IT!  Essentially mind you, with no serious questions asked. The money is truly “there for the taking…” provided of course that the leaders only do their due diligence in keeping up with all of the requirements and mandated payments.

Now if ASG would just do that, we'd be talking about $10Million per year, which would be roughly 20% of the overall hospital budget lately, am I right? That's a pretty big number... Many, many years I remember shortfalls of less than that alone in LBJ's bottom line, when all was said and done.

 So, to the kind and conscientious and well-meaning people of American Samoa, in my humble opinion what you should be asking yourself (and your Governor, and The Fono, and the Office of Medicare/Medicaid, and of course, your LBJ Board and Administrators) is, "May we please follow the money?"

If these nebulous and potentially dangerous politically driven “shell games” with healthcare funds are better exposed, it should certainly at least give everyone a better idea about where to start in fixing the hospital’s shortcomings. 

And remember that it should also better inform the Territory’s residents about whom they can trust with their votes (not to mention their lives, and families’ wellbeing)!

Bottom line: There simply must be better, more honest and fully transparent management of all public funds which are intended for healthcare in AS. After all, these funds come primarily from everyone’s hard-earned tax dollars, right? Doesn’t everyone want, and need that money carefully watched over and preserved for future generations?

The people of AS simply cannot afford ANY subjective reprogramming of healthcare funds, and EVERY LAST DOLLAR of available funding must be captured, protected, and properly accounted for so that it can be renewed (or even increased) year after year. 

That shouldn’t be so hard now, should it?  But then again, maybe it is…  Especially when one considers all of the above?

May God be with all of us in this critical struggle to improve and sustain the health and welfare of the good people of Amerika Samoa.

Soifua, Dr. Jim Marrone

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