May 21, 2015

Feds: Florida needs $1 billion for hospital funding

via @stevebousquet

TALLAHASSEE — The federal government told Florida on Thursday that the state will need $1 billion next year to maintain a hospital payment program that's at the center of a political stalemate preventing passage of a new state budget.

In a letter to state health officials, the U.S. Centers for Medicare and Medicaid services said the $1 billion would "maintain stability while the system transitions" to new ways of compensating hospitals for the high cost of treating poor patients, a program known as LIP or low income pool.

Tampa General Hospital, All Children's Hospital in St. Petersburg, Miami's Jackson Health System and Broward Health are among Florida's largest recipients of LIP money. In the current year, those hospitals were promised a total of $731 million in supplemental payments, provided through a blend of federal and local tax money that totals nearly $2.2 billion.

In their letter, the feds did not promise any LIP money. But a House Speaker Steve Crisafulli, R-Merritt Island, told lawmakers that the news is a "clear indication (that) Florida will receive a significant level of LIP funds, which will help us in our efforts to finish the budget by the July 1 deadline."

The $1 billion would revert to the level of LIP funding before 2014.

Senate President Andy Gardiner, R-Orlando, told senators that the news is further proof that a form of Medicaid expansion is the right solution.

"It remains clear that a sustainable long-term solution is needed," Gardiner told senators. "As you are aware, the Senate has proposed a Florida solution."

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May 20, 2015

Florida Republicans to Obama: Keep LIP program for hospital charity care


U.S. Sen. Marco Rubio and 11 other Republican members of Florida's congressional delegation sent a letter Tuesday to President Obama asking him to continue the federal Low Income Pool program in Florida.

The Health and Human Services Department plans to discontinue the current form of the LIP program, which provides hospitals with charity-care funding, by June 30. That has thrown Florida's healthcare budget into disarray, forcing a special legislative session beginning June 1 for lawmakers to craft a budget. The Senate wants to expand Medicaid under Obamacare to make up for some of the lost funding; the House doesn't. The feds say they want to work with the state to reach some sort of solution.

"HHS's refusal to continue LIP funding in Florida because the state has not expanded Medicaid is an inappropriate overreach and in direct contradiction to the Supreme Court decision," the Republicans' letter reads. It notes Jackson Health System in Miami would lose $237.2 million next year, and Mount Sinai Medical Center in Miami Beach would lose $16.2 million.

"We are requesting your immediate action to reverse HHS's decision to end LIP funding," the members of Congress wrote. "The well-being of Florida's low-income families will remain in jeopardy until your administration approves funding for these vital health services.."

Among the letter's co-signers were Miami Reps. Carlos Curbelo and Mario Diaz-Balart, and Ponte Vedra Beach Rep. Ron DeSantis, who is running for Senate in 2016.

May 13, 2015

Corcoran and Lee meet all day to discuss budget

The Legislature’s two budget chiefs met all day Wednesday to discuss ways to compromise on the impasse on Medicaid expansion, but don’t expect any breakthroughs, at least not yet.

House Appropriations Chair Richard Corcoran, R-Land O’Lakes said Wednesday’s meeting in the Capitol with Sen. Tom Lee, R-Brandon, was “super productive.”

But he also said it was “too early to say” when asked what, if any, common ground was reached. Lee and the Senate want to use federal Medicaid money to expand healthcare coverage; Corcoran and the House oppose that plan. That disagreement has held up a wider agreement on the state’s $80 billion budget. Lawmakers are scheduled to meet in the first three weeks of June during a special session to approve a budget. State government isn't threatened with running out of money until July 1, when the new budget year begins.

“The best part, from the House standpoint, was that it was the first real negotiation where there was give-and-take,” Corcoran said.

Corcoran did say he and Lee agree that both want a budget. A good thing, perhaps, for two budget chairs to agree on. But he hinted that desire might trump coming to a resolution on Medicaid expansion during the special session.

Asked if a discussion on expansion might be put off for a later date, perhaps at another special session, Corcoran replied that it was a “potential compromise and endgame.”

His negotiating partner, Lee, couldn’t be reached. Lee told the Associated Press that "a fair amount of progress" had been made Wednesday. Corcoran said Lee was joining him for wine and cigars later that night. He said, however, no major breakthroughs were expected at this gathering.

“It’ll be more social,” he said. “We won’t talk business.”

Scott asks federal health officials for guidance

Gov. Rick Scott floated a few broad ideas for expanding health care coverage in a letter to U.S. Health and Human Services Secretary Sylvia Burwell on Tuesday.

The letter, first reported by Politico, asked several questions intended to guide the governor's new Commission on Hospital and Healthcare Funding. Among them: Would the federal government be willing to give Florida a block grant to expand coverage? 

HHS has yet to respond.

Scott's letter came one day after he compared the Obama Administration to the Sopranos for allegedly coercing Florida into expanding Medicaid. Scott has also filed a lawsuit seeking to prevent the feds from linking expansion to the continuation of a federal-state hospital funding program known as the Low Income Pool.

Read the full text of the letter to Burwell here.

May 12, 2015

Gov. Rick Scott gets promise of a hearing on what he calls 'Sopranos'-like coercion from Obama administration

via @learyreports

Gov. Rick Scott continued his offensive against Medicaid expansion during a visit to Washington D.C. Tuesday, pressing members of the state delegation to make phone calls and write letters, and gaining assurance from a powerful committee chairman to hold a hearing on what Scott said was a "Sopranos"-like coercion from the federal government.

The governor echoed a theme from April, when he first compared the Obama administration's push to the TV show on organized crime.

Scott said Rep. Fred Upton of Michigan, chairman of the Energy and Commerce Committee, would hold a hearing his summer "to review this coercion."

Scott met with more than a dozen Florida Republicans and urged them to join the fight.

"They can continue to highlight what the federal government is doing, what the Obama administration is doing by, one, walking away from an existing program for poor families and, two, using coercion tactics -- this is the Sopranos," he said.

Scott dismissed a question about using Florida's budget surplus to avoid a case-line "continuation" budget. He said, however, that the spending plan would account for money that must be allocated under the voter-approved Amendment 1 for environmental conservation.

--ALEX LEARY, Tampa Bay Times

Who Rick Scott is talking to in Washington, D.C.

As part of a Washington, D.C., whirlwind tour — his second in as many weeks — Gov. Rick Scott is making stops with more than a dozen members of Congress.

Last time he visited the nation's capitol, Scott was there to negotiate with federal regulators on the health care funding stalemate in Florida. So far, no similar meetings have been announced for this trip. Yesterday, he had interviews with Fox News and Politico and met with Rep. Gus Bilirakis.

On the agenda for today are 14 additional Republican members of Florida’s congressional delegation:
* Rep. Jeff Miller
* Rep. Tom Rooney
* Rep. Ron DeSantis
* Rep. Ted Yoho
* Rep. Curt Clawson
* Rep. Ileana Ros-Lehtinen
* Rep. Mario Diaz-Balart
* Rep. Carlos Curbelo
* Rep. David Jolly
* Rep. Dennis Ross
* Rep. Rich Nugent
* Rep. Bill Posey
* Rep. Vern Buchanan
* Rep. John Mica

Plus other House and Senate leaders:
* Senate Majority Leader Mitch McConnell
* Rep. Fred Upton, R-Mich., chair of the House Energy and Commerce Committee

May 11, 2015

About Gov. Rick Scott's profit sharing idea...

How do state lawmakers feel about Republican Gov. Rick Scott's recent suggestion that hospitals pool their profits to cover charity care?

Senate Health and Human Services Appropriations Subcommittee Chairman René García, R-Hialeah, called the idea "worth exploring."

"I've always said that everything should be on the table," he said. "We need to have a comprehensive approach when we look at the delivery of healthcare that talks about access, quality, affordability and reducing the cost."

There, however, was a caveat.

"I think it would be very difficult for local communities to send their tax money to other communities rather than re-investing it in their own backyard," García said, pointing out that only some counties raise local dollars for health care. 

The idea may not go anywhere in the House.

"I think there are other solutions available to Florida that do not include a hospital profit share plan," Speaker Steve Crisafulli, R-Merritt Island, said in a statement.

For the past decade, Florida hospitals have relied on a federal-state program known as the Low Income Pool to help pay for charity care. But the program may not be renewed next year, meaning a loss of $1.3 billion in federal healthcare funding.

The House, Senate and governor's office are proposing different ways to plug the hole.

The Senate wants to accept $2.8 billion in federal Medicaid expansion money to help provide more coverage to low-income Floridians on the front end. The House wants to approve a series of reforms that would broaden access to health care and lower the cost.

Scott, meanwhile, has convened a commission on hospital and healthcare funding to explore how taxpayer-supported hospitals spend their money. He has asked the members to look specifically at profit sharing as a solution to the possible end of LIP.

Gov. Rick Scott appoints nine to hospital funding panel

Gov. Rick Scott on Monday named nine people to his newly created Commission on Healthcare and Hospital Funding.

None of the members are hospital executives. Only one is a medical doctor.

Missing from the list: Sens. Alan Hays, R-Umatilla, and Eleanor Sobel, D-Hollywood. 

Both volunteered to to serve.

Scott also announced that Florida Agency for Health Care Administration Secretary Liz Dudek and Surgeon General John Armstrong will serve as co-executive directors of the commission. The group's first meeting will take place in Tallahassee on May 20. 

The commission has been tasked with investigating outcomes at hospitals that receive taxpayer funding, as well as executive compensation and spending on lobbyists, advertising and political campaigns. The Republican governor also wants the group to explore the idea of profit sharing among hospitals.

Here are the names (and short bios) provided to reporters:

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May 10, 2015

What might legislative middle ground look like? Some ideas

Florida legislators may have ended their stalemate last week when they agreed to convene a three-week special session to resolve the budget crisis in June, but they didn’t agree on the hard part: how to resolve stark differences over health care.

Some compromise ideas are emerging — from using $600 million intended for tax cuts to bail out hospitals that treat poor patients, to seeking a one-of-a-kind federal waiver, to drawing federal money without passing it through Medicaid.

But finding the middle ground won’t be easy because of the deep ideological divide between House and Senate Republicans over whether or not to expand Medicaid to draw down federal money to provide healthcare for more than 800,000 uninsured residents who must otherwise rely on charity care.

“Ideologies are going to have to be on the back burner and good public policy that satisfies both sides is going to have to prevail,’’ said Rep. Holly Raschein, a Key Largo Republican whose district has among the state’s highest number of uninsured. She is among a minority of House Republicans who support taking federal money if it’s tied to an aggressive health care reform plan that reduces costs.

The legislative session ended abruptly April 28 when the House adjourned in protest over the impasse.

Among the ideas emerging to bridge the divide: bypass Medicaid, bypass hospitals, seek a new federal waiver or just plug the hole and buy time.

More here.

May 08, 2015

Gov. Rick Scott asks hospitals to consider profit sharing

Gov. Rick Scott is pitching a new idea to help Florida hospitals handle the potential loss of federal funds: profit sharing.

"This would be similar to how large market baseball teams share revenues with small market baseball teams," the Republican governor wrote in a Friday letter to hospital executives. "With the hospital industry's record-high profits, it does not make sense for the hospital industry to ask state taxpayers to back fill funding the Obama Administration has elected to terminate."

A spokeswoman for the Florida Hospital Association said her organization was still reviewing the letter.

Jackson Health System in Miami had not yet done so late Friday.

Scott's suggestion comes as lawmakers are struggling to build the state health care budget.

Federal health officials have said they will not renew a $2.2 billion federal-state program that reimburses Florida hospitals for charity care. The state proposed a successor to the so-called Low Income Pool, but has yet to hear back from the feds.

In his Friday letter, Scott suggested that the federal government was unlikely to continue the funding, and said state lawmakers should "begin preparing a state budget without any LIP funds from the federal government."

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