Some large hospitals would see little change in funding. Smaller ones - such as Eagleville Hospital, a Montgomery County drug- and alcohol-treatment center that just downsized its staff by a fifth - might be rocked.
The ultimate effect on such inpatient centers could depend on the proposal's shock absorber: $78 million in new money that Ridge is offering for mental-health and drug and alcohol programs. That money would be allocated to counties based on the number of residents losing medical assistance.
The Welfare Department's analysis, dated Thursday and obtained on Friday by The Inquirer, comes to light as the Republican-controlled state Senate prepares to vote tomorrow on the proposed assistance cuts. A House vote is likely by March 31.
In all, hospitals across the state would see $317.8 million less in medical assistance funding as a result of new eligibility restrictions, according to the 27-page study. A total of 259,639 people are expected to be affected in the fiscal year that begins July 1.
State-funded medical assistance pays hospital bills for poor people who don't have other health insurance. Ridge proposes to stop medical assistance for adults ages 21 to 64 who have no minor children and are deemed able to work. Opponents of the cuts include the hospital industry, social-service agencies and advocates for the poor.
The new study's predictions, including its $127.5 million figure for the total effect on Philadelphia hospitals, are close to estimates offered earlier last week by the statewide lobbying group for hospitals.
According to the Welfare Department analysis, 40 percent of the cuts would land in Philadelphia, and about 8.6 percent in Montgomery County. The cuts in Bucks, Chester and Delaware Counties would make up an additional 7 percent.
In Montgomery County, 200-bed Eagleville would lose $8.8 million in medical assistance funding. That's 51.8 percent of the hospital's net patient revenues last year.
That would be the largest percentage loss of any facility in the state, according to the study.
``It's going to impact us dramatically,'' said Molly Grasso, spokeswoman for Eagleville, which provides inpatient drug and alcohol treatment.
Grasso said Eagleville reduced its staff by 20 percent in December and could be forced to make more cuts by the loss in funding.
As for newly ineligible patients in the facility when the changes take place, Grasso said the hospital was unsure whether they may be forced to leave. ``That would depend on [the Welfare Department's] measures to assure a smooth transition,'' she said.
Eagleville, Valley Forge Medical Center in East Norriton and other addiction-treatment centers would likely recoup some of their loss if and when the governor's $78 million in new money is parceled out.
Even after that money comes in, though, ``it's significantly less'' than the existing level of state funding, said Maureen King, director of planning at the Valley Forge center.
The estimated effect at that 70-bed center is ranked second only to that at Eagleville in the study.
``What a nice list to be on at the top!'' King quipped on Friday. ``As if there weren't a problem with drug and alcohol.''
The center, which offers addiction-treatment services, would see an estimated $4.7 million loss in medical assistance funding. That's 47.4 percent of net patient revenue.
``This [will have] a real domino effect,'' King said. ``The system will be paying more for it in the end.''
In Philadelphia, Temple University Hospital would see a loss of $15.2 million in medical assistance reimbursements for patient care, the study said. That would amount to 5.7 percent of the hospital's net revenues for all patients in the fiscal year that ended in 1995.
Dr. Leon S. Malmud, senior vice president of health sciences at Temple, said Friday that the hospital had budgeted a $5 million margin in the black.
The Ridge cuts ``would throw us in an operating deficit the day they enact this,'' predicted Malmud, who has testified in Harrisburg against the proposal.
He said the hospital already provides about $12 million a year in charity care - for poor people with neither medical assistance nor any other insurance. Malmud predicted that Ridge's plan would balloon that amount and force Temple to cut personnel and services.
Ultimately, he said, ``we may fail.''
Elsewhere in Philadelphia, the study estimated, Kensington Hospital would see a $1.3 million loss in funds - 23.4 percent, or nearly a fourth of net patient revenue at the small hospital on Diamond Street.
Charter Fairmount Institute, a psychiatric hospital in Roxborough, would face a 17 percent loss, while North Philadelphia Health System, which operates St. Joseph's Hospital and Girard Medical Center, would have to deal with a 14.6 percent loss.
The largest dollar loss would be at the Hospital of the University of Pennsylvania. An estimated $16.8 million loss there would equal 3.2 percent of net patient revenues, the study said.
In Delaware County, the study said, hardest hit would be Crozer-Chester Medical Center in Upland, which would lose $6.5 million or 2.9 percent of net patient revenue.
The Bucks County campus of the Medical College Hospital would lose $1.78 million, or 4 percent of its net patient revenue. Brandywine Hospital in Chester County would lose $914,000 - 1.5 percent of net patient revenue.
The Welfare Department's separate statistical breakdown found that 65.5 percent of the 259,639 people due to lose medical assistance are white. African Americans make up about 27.7 percent of the total; Latinos, 4.2 percent.
Two state House Republicans from Philadelphia, Reps. John J. Taylor and George T. Kenney Jr., said last week that they are exploring alternatives to Ridge's proposal.
That proposal is contained in a bill sponsored by Sen. James W. Gerlach (R., Montgomery), which is expected to be voted on Monday by the full Senate. A parallel bill could come up in the House Health and Human Services Committee as soon as Tuesday.
That's where Taylor, as a committee member, said he would make his stand. ``We'll certainly try to slow it down until we get something,'' he said.
Both Taylor and Kenney have asked whether the timetable can be accelerated for the state's HealthChoices plan, which is supposed to save money by creating managed care in Philadelphia and its suburban counties for those being removed from medical assistance. HealthChoices is to be phased in starting in November. If approved, the cuts in medical assistance are to take effect June 1.
``If we can move into managed care immediately, we wouldn't need to make these cuts,'' Taylor said.
``That's the way we're moving anyway,'' Kenney said, referring to the shift into managed care, which, in time, is expected to be applied statewide. ``Let's take a bolder step.''
Taylor said he also is looking into changing the state's assumption on how much federal funding Pennsylvania may eventually get to help with medical assistance.
State officials have tried to guess conservatively at what will come from Washington, where the federal budget deadlock persists.