April 17, 2015

AFP releases new anti-Medicaid expansion ad


As the gridlock over Medicaid expansion continues in Tallahassee, the conservative advocacy group Americans for Prosperity is making its position known with a new ad.

The ad ties Senate expansion plan to the politically charged Affordable Care Act, also known as Obamacare. It claims that arguments for expansion are "spinning out of control."

"Florida Senators have been engaged in a game of political spin," AFP State Director Chris Hudson said in a statement. "Instead of focusing on how to reduce the overall cost of health care and instill real reform, the Florida Senate led by President Andy Gardiner has been claiming that expanding a broken and jammed system will somehow solve the healthcare crisis, create jobs and save money, and improve access to care for the most needy. That's simply not true."

AFP has been advocating for other health care policies, including telehealth and measures that would broaden the scope of practice for nurses and other health care professionals.

April 16, 2015

Jeb Bush: Feds, Tallahassee should 'try to forge a compromise' on Medicaid expansion, hospital funding

Politics and Pie


CONCORD, N.H. -- He's been traversing the country building the foundations a juggernaut 2016 presidential campaign, but former Florida Gov. Jeb Bush still keeps an eye on Tallahassee.

Bush commiserated with Republican voters -- and enjoyed a piece of blueberry pie, breaking his ongoing paleo diet -- Thursday evening at a clubhouse on the outskirts of New Hampshire's state capital. Then he took questions from reporters, including one about what how the Florida Legislature and Gov. Rick Scott might overcome a stalemate over funding hospital charity care and expanding Medicaid. 

The standoff has effectively halted the annual lawmaking session, with no state budget deal in sight. Scott said Thursday he intends to sue the Obama administration over its threat to withhold federal funds for hospitals that treat the poor.

Bush hadn't heard of the yet-to-be-filed lawsuit, but suggested all sides sit down and find a solution.

"The feds and the executive branch and representatives from the House and Senate ought to get together and try to forge a compromise," he said. 

But would such a compromise involve expanding Medicaid, as proposed under the Affordable Care Act and rejected by the GOP-controlled Florida government in the past?

"I don't know," Bush said. "That's their job, frankly. Expanding Medicaid without reforming it is not going to solve our problems over the long run." Bush's spokeswoman told the Miami Herald on Friday that he opposes Medicaid expansion.

On Thursday, Bush touted reforms begun while he was governor that turned over control of Florida's Medicaid program to managed-care companies. He told voters gathered for a "Politics and Pie" event that the federal government should allow states to innovate on Medicaid to better fit their needs.

"We need to reform Medicaid, and there's a plan to do that in Florida that's a pretty good one, so if it was part of that, and there are trade-offs and all that stuff -- that's how you get past an impasse," he later told reporters.

This post has been updated to include Bush's spokeswoman.

Jackson employees push for Medicaid expansion

Jackson1Several dozen nurses, doctors and healthcare professionals from Jackson Health System made the case for Medicaid expansion Thursday in a creative way.

They said it with shoes.

A few weeks ago, powerful House Appropriations Chairman Richard Corcoran characterized the forces pushing for health care expansion as "Gucci-loafing, shoe-wearing special interests." The remark inspired Democratic Rep. Jose Javier Rodriguez to file a tongue-in-cheek proposal to tax Gucci shoes sold to lobbyists. 

On Thursday, the team from Jackson lugged a bag of well-worn tennis shoes to the Capitol to show what they wear to work.

"We don't exactly wear Gucci loaders and we are trying to save lives every day," said Martha Baker, a Jackson Health System nurse and president of SEIU Local 1991. "We want Medicaid expansion."

They used colorful flip flops to make their next point: that Gov. Rick Scott should again reverse his position and support Medicaid expansion

"We need you to flip back," Baker said.

With time running out in the 60-day legislative session, the House and the Senate remain gridlocked over the issue.


Scott to sue feds over hospital funding

Republican Gov. Rick Scott announced Thursday he will sue the federal government for allegedly coercing Florida to expand Medicaid.

“It is appalling that President Obama would cut off federal healthcare dollars to Florida in an effort to force our state further into Obamacare,” Scott said in a statement.

The announcement is but the latest round in an ongoing spat between Scott and the feds.

It centers around a $2.2 billion program known as the Low Income Pool, which provides funding to hospitals that treat uninsured and Medicaid patients. The LIP program is scheduled to expire in June, unless the state and federal government can negotiate a successor program. But despite weeks of negotiations, no deal has been reached.

In a letter Tuesday, the federal agency handling the negotiations told Florida’s Agency for Health Care Administration that any decision regarding LIP would be tied to whether the state uses federal Medicaid expansion money to expand coverage — a politically charged policy option Scott has recently come out against.

Scott said linking the two issues violated a U.S. Supreme Court ruling “that the president cannot force Medicaid expansion on states.”

“Not only does President Obama’s end to LIP funding in Florida violate the law by crossing the line into a coercion tactic for Obamacare, it also threatens poor families’ access to the safety net healthcare services they need,” Scott said.

He called the actions “outrageous and specifically what the Supreme Court warned against.”

The lawsuit stands to further tie up the budget building process, which is already behind schedule and is likely to force lawmakers into a special or extended legislative session.

More here.

April 15, 2015

Florida: Keep Medicaid expansion, LIP separate

One day after a top federal official informed Florida that the future of the Low Income Pool is tied to Medicaid expansion, Florida Medicaid Director Justin Senior sent a letter back, saying the two healthcare funding issues should be kept separate.

"Your letter, for the first time, clearly links a continued LIP with Medicaid expansion," Senior wrote. "In NFIB v. Sebeli us 132 S. Ct. 2566 (2012), the U.S. Supreme Court explicitly warned the federal government against attempting to coerce states into participating in Medicaid expansion -- yet that appears to be exactly what the federal government is attempting here."

Senior pointed out that his agency does not have the authority to expand Medicaid. But he said the Agency for Health Care Administration would soon file a petition to the federal government to have the $2.2 billion Low Income Pool renewed for two years. The program helps hospitals like Jackson Health System and Tampa General that treat low-income patients. 

"We hope the federal government receives our LIP amendment cordially, and recognizes it for the opportunity it presents for every Floridian to have access to quality, affordable private health insurance through the free market," Senior wrote.

One day earlier, Republican U.S. Sen. Marco Rubio and Republican U.S. Reps. Gus BilirakisCurt Clawson, Rich NugentIleana Ros-Lehtinen, Ted Yoho made a similar point in a letter to the same federal agency.

"Uncompensated care will still exist in Florida with or without the expansion of Medicaid, and thus it is important to continue the LIP so that the federal government and Florida continue to support providers who serve this ongoing uninsured population," the lawmakers wrote.

The letter estimated the cost at $1.6 billion, even with expansion.

"CMS should not destabilize, eliminate or hold these programs hostage to an expansion decision," the lawmakers wrote. "Continuing LIP, at approximately the current level of funding, would treat Florida equally with other states, like California, that have both expanded Medicaid and continued to receive uncompensated care for their remaining uninsured populations."

Gov. Rick Scott's office pointed Florida Republican members of Congress to the letter last week, saying the governor strongly supported it and suggesting they sign on.

Notably, not everyone did.

Read the two letters below.

Download Senior

Download Congress_letter

April 14, 2015

Tension mounts in Tallahassee over Medicaid expansion, hospital funding

Federal health officials turned up the pressure on Florida Tuesday, saying the future of $1.3 billion in federal funding for hospitals that treat low-income patients is tied to whether the Legislature expands Medicaid.

In a letter to Florida’s Medicaid director, a top federal official wrote that the federal government is willing to consider the state’s request to keep the so-called Low Income Pool (LIP) in place after the program ends in June. But U.S. Centers for Medicare and Medicaid Services Acting Director Vikki Wachino noted "the state's expansion status is an important consideration in our approach regarding extending the LIP program."

Senate President Andy Gardiner, R-Orlando, said the correspondence highlighted "the need to consider a comprehensive Florida solution."

"Time is of the essence,” he said. "The Senate remains open to meeting at any time to discuss our free-market approach to expansion or any alternative the House or governor would like to propose."

But House Speaker Steve Crisafulli, a leading opponent of Medicaid expansion, said LIP and expansion should not be linked, and blasted the federal government for holding Florida hostage.

"It is unthinkable that they would leave our state on the hook for over a billion dollars simply because they want a specific policy outcome," said Crisafulli, R-Merritt Island, in a terse statement.

The letter and reaction from House and Senate leaders is only the latest salvo in a nasty feud between Washington and Tallahassee about LIP and Medicaid expansion — two issues that have all but paralyzed lawmakers with only weeks remaining in the 60-day session.

More here.

Rick Scott's claim about LIP and Medicaid

Florida simply can’t trust the federal government to follow through on expanding Medicaid because Washington has already abandoned funding a current statewide health care program, Gov. Rick Scott says.

Scott is pointing to the state’s loss of federal money for safety net hospitals called the Low Income Pool. The Centers for Medicare and Medicaid Services made it crystal clear in February 2015 that some $1.3 billion in Florida’s LIP funding won’t be renewed after June 30. That left a billion-dollar hole in Scott’s proposed budget, which assumed that LIP money would be available.

"The same federal government that offers some money for a program is walking away from another health care program," Scott said during an April 9 stop in Sarasota. "How can you feel comfortable picking up another federal program when they are walking away from an existing program?"

The Florida House and Senate are currently debating a potential state solution to Medicaid expansion, but this claim deals with the specifics of this LIP funding -- namely what it is, how it’s funded and when Washington told Florida they’d be doing without. The issue sounds confusing, but don’t worry, Joshua Gillin of PolitiFact Florida will nurse you through it.

April 09, 2015

Sen. Gaetz: Scott has shifted Medicaid stand 'two or three times'

Don Gaetz has a way with words -- especially on the subject of Gov. Rick Scott.

The Republican senator from Niceville, asked about Scott's latest statement in opposition to a Senate plan to draw down federal money to expand health care to low-income Floridians, told Capitol reporters: "The governor is entitled to all of his positions on the issue."

Gaetz was smiling. But he wasn't kidding. And he kept going.

Elaborating on Scott's Medicaid stand, Gaetz said: "He's entitled to change his mind. But on this issue, he's changed it two or three times. Maybe he'll land sometime soon on a position that he'll hold for an extended period of time. I hope it's in favor of Sen. (Aaron) Bean's bill."

Bean, R-Fernandina Beach, is the sponsor of SB 7044, which would use billions in federal money to create a Florida health insurance exchange that senators say is not a full-blown expansion of Medicaid.

Gaetz's comments reflect the Senate leadership's growing frustration with Scott's unwillingness to fully engage on the biggest issue of the 2015 legislative session as Week Six prepares to draw to a close.

Gaetz also played an important role at a Senate hearing Tuesday in stalling the confirmation of Dr. John Armstrong, Scott's surgeon general and secretary of the state Department of Health, after Armstrong stonewalled senators' questions about the benefits of expanded health insurance coverage.

Gaetz said he likes Armstrong, has toured public health clinics with him and got a "nice note" from Armstrong after their sharp exchange. But he added: "As the chief health officer of the state, he has to, in my judgment, be able to answer direct questions about whether improved health access can result in better health outcomes. That's not a trick question."

Meet the pawns in the showdown over Medicaid expansion

Cell phone users, widows and widowers, college students and small businesses are the latest pawns in a showdown over Medicaid expansion in Florida.

On Thursday, the Florida House is expected to overwhelmingly pass a $690 million tax cut package that could save those groups money, but only if the Senate signs off on the plan.

Senate leaders say that won’t happen as long as negotiations remain stalled between the state and federal government over a $2.2 billion program that helps hospitals treat low income patients. In a compromise with the federal government, the Senate is proposing to restore those funds by expanding Medicaid, which House Republicans oppose.

Instead, the House is proposing tax cuts that closely resemble those proposed by Gov. Rick Scott, further solidifying their sudden alliance in opposing Medicaid expansion while further isolating the Senate.

“We are focused on tax cuts and not expanding Medicaid so that’s where we are and that’s the posture we’re in,” said House Speaker Steve Crisafulli, R-Merritt Island on Wednesday. “It would be hard for me to say no to ($690 million in tax cuts) as a Republican. I’m sure it was hard for them to say yes to Medicaid expansion.”

Senate President Andy Gardiner said Wednesday that Senators are ready to cut taxes by more than $800 million, but only if Florida gets back $2.2 billion in the Low Income Pool (LIP) program for hospitals.

"You've got a LIP issue, you have questions regarding (the U.S. Centers for Medicare and Medicaid Services)," Gardiner said. "We hoped we could move forward, but that's a big hole, so we'll just have to wait and see. But the Senate has put itself in a position where we have the tax cuts ready and ultimately we'll have a discussion and go from there."

Relations between the two chambers seem to be disintegrating. Last week, House Appropriations Chair Richard Corcoran, R-Land O'Lakes, said he would go to war against unnamed special interests before expanding Medicaid.

Continue reading "Meet the pawns in the showdown over Medicaid expansion" »

April 08, 2015

Why Florida became the Obamacare enrollment capital

via @chabelih

When Florida racked up impressive enrollment numbers in 2014 for insurance plans offered under the Affordable Care Act, some healthcare analysts were surprised.

In 2015, the Sunshine State did it again, surpassing enrollment projections and beating out much-larger California and even Texas, a state more populous, more uninsured and with similar Republican opposition to the law.

Despite an uninsured rate among the top five highest in the country, Florida’s Republican-led Legislature harbored an anti-Obamacare sentiment, making it an unlikely candidate to embrace healthcare reform. With the second Obamacare enrollment period all but over, why did Florida take the top spot, with 1.6 million enrollees?

Experts point to a variety of factors that, combined, likely elevated the state’s numbers. Using enrollment specialists that spoke a variety of languages helped bridge cultural and language divides to enroll specific groups such as the large pool of uninsured Hispanics. Small businesses jumped into the Obamacare field by selling policies alongside groceries and bill-paying services. And the Florida economy, based mostly on tourism and small businesses, helped the enrollment process because many mom-and-pop operations don’t offer insurance to employees.

Florida was primed to be an enrollment powerhouse.

More here.