After two weeks of emergency meetings between hospital, union, and County officials, an agreement was reached on a temporary “stabilization” plan that will cut 655 positions, delay debt payments and exact $30 million in concessions from Jackson Health System workers in Miami-Dade County.
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On March 6, Eneida Rolden, CEO of the Jackson Health System in Miami-Dade County, had announced plans to lay off 4,487 workers and close two of the system’s hospitals in response to a $229 million budget deficit. The announcement had been made at a special meeting of the Public Health Trust, the governing board of the Jackson Health System, which acts on behalf of the Miami-Dade County Commission.
The plan essentially amounts to a loan from Miami-Dade County that will last through September. In other words, it is at best an attempt to buy time. To pacify the immediate public outcry against the large-scale cuts, hospital officials are now moving to make piecemeal cuts that will eventually result in the same drastic reductions in services.
The Jackson Health System is Miami’s largest public medical service. Hundreds of thousands of uninsured and poor working people depend on the services provided by the system’s network of hospitals, primary care clinics, rehabilitation centers, nursing homes, and mobile clinics. It is one of the few places in the county where care is provided regardless of one’s ability to pay.
Rolden’s plans turned out to be far more draconian than what she initially reported to the press. Originally, she announced layoffs ranging from 900 to 2,000. The most drastic cut in services, she claimed then, would be the closure of a single emergency room.
But in the absence of the “stabilization” plan, Jackson’s workers would have recieved layoff notices on April 16. Jackson South Community Hospital and Jackson North Medical Center would have been closed by early May.
Vital services provided to community
Jackson is still at risk. The loan will only get it through September—after that, management will resume its offensive. If Rolden gets her way, the cuts will be devastating for workers and patients alike.
Several of the programs at risk of elimination are outpatient rehabilitation services, which will affect 35,000 physical therapy patients, 28,000 occupational therapy patients, and 2,000 speech therapy patients a year.
A Children’s Immunology Unit as well as the P.E.T. Health Center would be completely shut down. The P.E.T. Health Center’s mission is to prevent the spread of communicable diseases, including HIV/AIDS and sexually transmitted diseases, by focusing on early intervention for HIV spectrum disease and providing HIV testing and primary care services for patients.
The rationale for targeting these much-needed services cuts is based on profitability alone—a fact that Rolden’s so-called “recovery plan” does not even attempt to hide. It states very clearly that the elimination of the P.E.T. Health Center is required “because it is a high cost, low yield service line with negative financial impact on the System. … The site requires significant financial investment to meet quality and safety standards.”
The Miami metropolitan area has the highest AIDS rates in the nation, followed by the Ft. Lauderdale metropolitan area, which is directly north of Miami. To weigh the “profitability” of such program under such conditions is simply criminal.
Although these are the most drastic set of proposed cuts to date, they are not the first steps undertaken by Jackson officials during the ongoing economic crisis. Jackson officials have already closed two primary care centers in the county and have trimmed 600 jobs from its labor force since June 2009.
The hospital also stopped paying for outpatient dialysis treatment for 175 uninsured patients on Dec. 21. According to a Feb. 3 Associated Press report, 40 patients, half of whom are undocumented workers, were still looking for alternate treatment. Dialysis patients usually require treatment at least three times a week in order to prevent kidney failure and, ultimately, death.
Corporate media falsely blames the workers
What is the reason behind the financial crisis at Jackson Health System?
The major media outlets in South Florida have broadcast their typical anti-union propaganda, blaming the workers for Jackson’s economic issues. According to this false logic, cutbacks and layoffs are the only realistic solutions to a financial crisis. Working people, they claim, should not wage any struggles to push back these drastic measures, because they will just make it harder on their employers.
A March 4 editorial in the Miami Herald made exactly this anti-worker argument: “[L]ayoffs, or at the very least, renegotiating contracts to reflect today’s economic reality, can’t wait.” County officials have echoed these sentiments, with Commissioner Katy Sorenson stating: “[T]he unions must understand that we can’t go on like this. It will be pay cuts or layoffs.”
Health care workers and maintenance staff at Jackson, who have no control over the finances or the decision-making process of the hospital, are not to blame. In fact, Jackson’s management wages a constant struggle against its workers to ensure that the small minority at the top monopolizes all decision-makingby. The same is true of any capitalist enterprise in society.
Jackson’s unionized workers are the doctors, nurses, and health care professionals who provide the vital services to the poor and oppressed communities of Miami. They are the janitors, the maintenance people, and other support staff that provide a clean and safe environment to ensure that life-saving medical procedures can be carried out.
Gross mismanagement of financial resources and dubious accounting practices by hospital officials has played a major role in the current state of affairs. But the biggest cause of the financial mess at Jackson is the deepening economic crisis—for which the banks are responsible, not workers. The local media has underplayed this aspect.
Capitalist economic crisis leads to disaster at Jackson
Jackson has witnessed a large decline since the crisis began in its “operating revenue”—the money paid directly to the hospital from patients. Officials at every level of government in Florida have jumped on the misleading notion that Jackson’s operating model is “unduly burdened.” The increasing percentage of uninsured patients means that more and more people are unable to pay a significant portion of their hospital bills.
But why are so many people without insurance? The reality is that this increase of uninsured patients is an obvious outcome of the dramatic rise in unemployment.
A study by the University of Florida showed that nearly one in three people in Dade County were uninsured in 2004. That was during a time of relative “prosperity,” when unemployment ranged between 5 and 6 percent in Miami. The latest unemployment figures for the county have more than doubled, to a record-setting 12 percent.
The other major source of Jackson’s income comes from non-operating revenue provided by Dade County. The added income derives from a half-cent sales tax and a portion of collected property taxes. This revenue fell $79.1 million between the 2008 and 2009 fiscal years, a decline of 17.5 percent. The decline in tax revenue accounts for about a third of the overall current deficit faced by the Jackson Health System.
The decrease in sales tax revenue is an obvious result of an overall downward trend in consumer spending since the outset of the economic crisis. The decline in property tax revenue is an outcome of the acute foreclosure crisis faced by families in Florida, which has consistently ranked in the top three states hardest hit by foreclosures. In Dade County alone, there have been almost 150,000 foreclosure fillings since 2007, a dramatic climb compared to the roughly 27,000 filings for the three-year period of 2004 through 2006.
Politicians serving Wall Street opt for devastating cuts
Should the measures proposed by Jackson’s CEO be revived, they could push the roughly 4,000 workers who would receive layoff notices, along with the hundreds of thousands of poor and working people who depend on the services of Jackson, into further crisis.
That is not all. The proposed cuts and layoffs only cover a portion of the current deficit, and Jackson officials are expecting another $200 million deficit in the next fiscal year. They are just setting the stage for future attacks on Miami-Dade’s public health system.
There are no signs that the crisis of unemployment and foreclosures will turn around in the near future. Obama’s “Making Homes Affordable” program fails to address the principal reasons behind foreclosures. His extremely mild, market-based approach towards a “jobs program” shows that the Democratic Party, like the Republicans, will continue to play by the banks’ rules.
Florida officials have similarly been unable to put forward any solutions to the crisis at Jackson that does not include dramatic cuts to badly needed medical services.
Miami-Dade Mayor Carlos Alvarez used a portion of his State of the County speech to make it clear that there would be no county “bailout” for Jackson. He framed the issue in such a way as to associate the hospitals with the parasitic banks—a sick manipulation of the people’s righteous anger at the Wall Street bailouts.
After a legal analysis by the County Attorney’s Office showed that the county government would be on the hook for the salaries of the 10,500 union workers at Jackson if the hospital ran out of money, Alvarez attempted to move quickly towards a hostile takeover of the hospital’s finances. He gave County Commissioners only 12 hours to vote on an ordinance that would have dissolved the 16-member Public Health Trust, which is currently appointed by the entire commission.
In its place, Alvarez’s plan would create a seven-member board that he would directly appoint and would receive broad powers to implement cuts and layoffs unilaterally.
The county commissioners ultimately defeated the plan, but it is important to note why the mayor’s office would attempt such a heavy-handed move. As a loyal servant to the business interests in Miami-Dade, Alvarez decried the risk to the county’s credit rating if it had to assume the roughly $80 million a month in union salaries from Jackson. The county is already facing a deficit of $50 million.
In effect, Alvarez was ready to sacrifice the services needed by many poor and working people just to keep bailed-out Wall Street happy.
Jackson’s CEO Eneida Rolden herself has found it difficult to gather support from Dade County commissioners and state lawmakers, who are carrying out their own cuts and layoffs. The state of Florida faces a deficit of about $6 billion for this fiscal year.
Jackson’s crisis in the midst of the health care debate
The crisis at Jackson is taking place during the Obama administration’s final push for health reform. The one option that officials in Obama’s team have been vehemently against since the year-long debate began has been a single-payer system.
At Jackson, a single-payer system would dramatically reduce the complications in its billing procedures that brought in only one-quarter of the $4 billion billed last year. Eliminating the complicated system of private insurance companies would also eradicate its parasitic role in the health care equation. Roughly one-third of all money spent on health care ends up in the insurance companies’ private coffers.
Rolden and Martha Baker, president of SEIU Local 1991, which represents doctors, nurses and health care professionals at Jackson, have announced a joint trip to Washington to make direct requests to the Obama administration for an additional cash infusion. While the administration may claim it has no money for such rescues, the entire deficit faced at Jackson could be easily wiped away with the amount it spends in just 12 hours of the wars in Iraq and Afghanistan.
A broad people’s struggle needed to save Jackson
The current political leadership in Miami-Dade is unable to provide solutions outside of cuts and layoffs, because they are more concerned about profits than the needs of the people of Miami-Dade. Their loyalty lies with Wall Street, not with poor and working people.
There is a solution to this crisis, however, that can prevent layoffs and cuts to services. The people of Miami can wage a struggle and mobilize to demand that the Public Health Trust vote “No” to the cuts and layoffs. In reality, such a critical decision should not even be left up to a small group of elite politicians or administrators; it should belong to the communities that rely on Jackson the most. For right now though, we can struggle to prevent the county commissioners and Mayor Alvarez from giving this plan their final seal of approval.
It is dishonest and misleading for Miami’s political leadership to say there is no money for Jackson. The resources to solve this crisis are there, but poor and working people must now fight to take back their tax dollars and reprioritize where the wealth of society is spent.
A movement that is built around jobs, education, health care and housing—instead of using our tax dollars for war and occupation abroad—has the power to dramatically change society. We can fight the cutbacks at Jackson—and we can win.
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