There are mounting tensions between two of South Florida's largest institutions—Jackson Health System and the University of Miami medical school. For 59 years, they've been loyal partners working together to provide vital healthcare services to the poor and uninsured in Miami-Dade County. Recently, though, the relationship has become strained as Jackson's leaders, struggling to reduce enormous losses, have tried to cut their payments to UM. And UM has launched new, potentially competing ventures. Miami-Dade taxpayers pay $330 million a year to treat thousands of uninsured people who seek treatment in the county-owned Jackson system. Jackson also pays UM when its doctors treat the uninsured at Jackson. When patients become insured through Medicare, however, the care is shifted to UM, which then receives the reimbursement money. UM calls that patient choice. Jackson counters that its paying patients shouldn't be siphoned off to UM facilities.