April 27, 2015

Notes from behind closed doors: Crisafulli on where Bush stands, standing firm

What did House Speaker Steve Crisafulli say last week during his closed door meeting with his Republican colleagues. 

Who knows. But here's the script that he worked off.

Ostensibly meeting to discuss history, Crisafulli's comments are rich with strategy and quite a few laments.

At the top of his beefs was his concern that the issue of Medicaid expansion was never supposed to be the dominant issue of the 2015 session.

"I worked with President Gardiner all summer to develop a work plan and talk about how we would handle session issues," Crisafulli says in the script. "Expanding Medicaid was never part of the agenda. In fact, he stated that he knew where the House was, and did not plan the issue in the Senate. Obviously, things have changed and rather than getting caught up in the why or the how, we are where we are today."

According to the script, Rep. Matt Hudson, R-Naples, then gave a presentation on the Low Income Pool money at the heart of this year's Medicaid expansion. Rep. Jason Brodeur, R-Stanford, then handed out an informational packet containing talking points, op-eds and an article he wrote with Rep. Matt Caldwell, R-Lehigh Acres.

The script then contains the text of Crisafulli's closing remarks.

"We did not create this problem -- the Federal Government did," Crisafulli states.

Continue reading "Notes from behind closed doors: Crisafulli on where Bush stands, standing firm" »

Senate President Andy Gardiner weighs in on Florida's LIP proposal

GardinerThe state Agency for Health Care Administration is now accepting public comments on Florida's proposal to continue the Low Income Pool, a federal-state program that helps hospitals cover the costs of treating uninsured and Medicaid patients. 

Among those weighing in: Senate President Andy Gardiner, R-Orlando.

Gardiner sent a letter to AHCA Medicaid Chief Justin Senior Monday pointing out one potential problem with Florida's pitch: It doesn't address Medicaid expansion.

"Specifically, we are concerned that with no suggestion of expanded coverage, such as the one recommended by the Florida Senate, the state may not be successful in gaining authority to spend $2.2 billion in LIP payments," Gardiner wrote. "Without additional coverage, your LIP model may not be construed as a first step in a transition plan."

Federal health officials have said their decision on LIP will be tied to whether Florida accepts federal Medicaid expansion dollars -- a plan the Florida House and Republican Gov. Rick Scott oppose.

Gardiner also sent a letter Monday to the federal agency that will be making the decision.

"We understand no firm decisions will be made until after a thorough review the application submitted by the Agency for Health Care Administration," Gardiner wrote to U.S. Centers for Medicare and Medicaid Services Acting Director Vikki Wachino. "However, if you are able to elaborate on your initial guidance now that a formal application has been submitted, that information may help us more accurately assess the fiscal and economic landscape for the state's budget."

Read both letters here.

April 24, 2015

Senate counter-offer: Expand health care coverage

The Senate doubled-down on its Medicaid expansion plan Friday, rejecting a proposal from the House to use $200 million in state money to help safety-net hospitals absorb a potential loss of $1.3 billion in federal health care funding.

The House made its offer -- which did not include expansion -- Thursday in hopes of jump starting stalled negotiations over the state health care budget. But Senate leaders insisted that providing coverage to more than 800,000 low-income Floridians was the better solution.

"(The House's) response indicates their continued unwillingness to deal with insurance coverage," said Senate Budget Chairman Tom Lee, R-Brandon. "And I understand that. I’m not surprised to see that. And our response indicates that we are not prepared to walk away from that."

Lee said using $200 million in state money to replace some of the Low Income Pool, a federal-state program that helps hospitals pay for uninsured and Medicaid patients, would be like charging Floridians twice for the same services, since Floridians already pay federal taxes.

"It is not an optimal situation," he said.

The LIP program is set to end on June 30, unless the federal government approves a proposed successor program. Federal health officials have said they are more likely to extend the funding if Florida expands Medicaid.

Continue reading "Senate counter-offer: Expand health care coverage" »

Florida House makes offer to help hospitals

In a last-ditch effort to end the budget stalemate, House Speaker Steve Crisafulli on Thursday offered to set aside $200 million in state money for the hospitals and county health departments that would be hurt by the end of a federal-state program known as the Low Income Pool.

It doesn’t back down from the House’s position, now 3 years old, to not expand Medicaid.

The House offer of extra money, which would come from reducing proposed tax cuts and spending on K-12 education, could be used to draw down an additional $305 million in federal funds, Crisafulli said, meaning about $505 million would help hospitals shoulder the cost of treating uninsured, under-insured and Medicaid patients.

Crisafulli conceded that the amount would be less than the $1.3 billion Florida hospitals had hoped to receive from the federal government.

"It's a conversation starter," he said.

Senate spokeswoman Katie Betta said that Senate President Andy Gardiner hadn't yet had time to review the proposal. But earlier in the week, Gardiner recommended dedicating as much as $600 million in state money in the absence of the LIP dollars.

Read more here.

April 23, 2015

Death, polls and jobs: Fact-checking claims about Medicaid expansion

A feud over Medicaid expansion that stretches from Tallahassee to the White House means the Florida Legislature may not pass a budget by the time the session ends on May 1. PolitiFact Florida has been fact-checking the fight over whether more poor Floridians will be able to qualify for heavily subsidized health insurance.

The federal government is offering billions if Florida expands Medicaid, paying 100 percent of the expansion at first and gradually downshifting to 90 percent in later years. The program currently eats up a sizable portion of the state budget.

The state Senate has supported the idea of some type of expansion, while the House remains opposed. Gov. Rick Scott has taken different positions on Medicaid over the years, but has settled into opposition during the session. He’s upped the ante on that by declaring he intends to sue the federal government.

Turn to PolitiFact Florida for the rest of our article about our Medicaid fact-checks.

Sen. Alan Hays volunteers for hospital funding commission

HaysSen. Alan Hays, R-Umatilla, wants to serve on Gov. Rick Scott's Commission on Healthcare and Hospital Funding, he said Thursday.

That's assuming such a commission is created, of course.

Scott proposed the idea earlier this week in light of the gridlock over Medicaid expansion and the potential end of the Low Income Pool, a federal-state program that helps hospitals treat uninsured and Medicaid patients.

Scott, who became a millionaire buying and selling for-profit hospitals, said the commission would "examine the revenues of Florida hospitals, insurance and healthcare providers and how any taxpayer money contributes to the profits or losses of these institutions in Florida.

"A thoughtful analysis of how taxpayer money supports Florida hospitals, insurance and healthcare providers will guide us in a Special Session and aid in the development of the Fiscal Year 2016-17 budget," he said in a statement. "This analysis will also help us prepare for the loss of LIP funding if the federal government decides to decline our amendment request before October."

On Wednesday, Scott called senators into his office and showed them the data on profit margins for local hospitals.

Hays, who supports the Senate plan for expansion, raised his hand to serve on Scott's new commission Thursday.

"I met with Gov. Scott yesterday and told him that I fully support his idea to form a commission to better understand the use of our tax dollars in the health care industry," Hays said in a statement. "If a commission is convened, I wish to serve on it and believe this could be a helpful tool as we work to address the health care challenges facing our state."

Hays noted that the House and Senate have until June 30 to pass a budget.

April 22, 2015

Scott takes aim at hospital profits with six-page list

As Gov. Rick Scott met with senators Wednesday to increase the pressure on them to pass his tax cut package, he was armed with a document.

Holding the six-page document, compiled by the Agency for Health Care Administration, Scott points to the data on profit margins for local hospitals in each member's district.  

In one column is the operating revenue, in another is the operating margin and in the third is the total margin. His argument: How can the state be willing to send tax money to hospitals that are making a profit? 

Scott, a former hospital executive who became a millionaire buying and selling for-profit hospitals, argues that hospitals are shielding their profits. 

It's an argument that Senate leaders say is appropriate -- but not as part of the ongoing budget battle and decision over health care policy. House Appropriations chairman Richard Corcoran disagrees and argues that the discussion is "imperative."

Here's Scott's hospital list.  Download Hospital Profits 4.22.15

GOP senator says Scott's use of 'nuclear option' makes no sense

Republican senators swapped stories on the Senate floor Wednesday after they held one-on-one meetings with Gov. Rick Scott. Lawmakers said Scott reminded them of his priorities of tax cuts and school spending and threatened to kill their bills and veto their budget items.

One GOP senator who was not invited to Scott's inner sanctum was Sen. Don Gaetz, R-Niceville, who has criticized Scott for shifting his position on Medicaid expansion and for Scott's unwillingness to negotiate a resolution to the health care budget stalemate. 

"He's not the first governor to threaten vetoes if he doesn't get his way on priorities. That's well within the rules," Gaetz said. "The problem is, that's the nuclear option. When the governor says, 'All your bills are dead and all your appropriations will be vetoed,' then there's really nothing else to talk about ... It has a tendency to stop productive conversation at that point."

Gaetz has been most critical of the Scott administration's failure, for nearly a year, to send an alternative plan to the federal government in anticipation of the end of a hospital funding program known as LIP, or the low-income pool. Gaetz calls the inaction "governance malpractice." Scott did send the feds the Senate's modified Medicaid expansion plan earlier this week.

"The meetings that have been held today lose him some ground in human relations," Gaetz said of Scott. "There are some senators who will not take kindly to being threatened."

April 21, 2015

Cheat sheet: House GOP's nine talking points on Medicaid expansion

To hold a meeting among House Republicans in private to discuss Medicaid expansion and the Low Income Pool, Speaker Steve Crisafulli said the meeting was for informational purposes only.

“It was strictly a history lesson for our members,” Crisafulli said. “It was important for us to do it.”

Yet the 20-page packet distributed to members during the secret meetings makes for a poor history. It’s more of a nine-step guide on how to defend the House’s double-down rejection of Medicaid expansion.

Crisafulli and other House leaders make it easy for any caucus members who might be wavering, or who might be running out of things to say in explaining their refusal. On page 3 of the packet,  nine talking points are provided.

Pay attention: We’ll probably be hearing these repeated over the next two weeks.

-- Medicaid expansion and the Low Income Pool (LIP) are separate issues. (Not if you’re the federal government and the Florida Senate.)

-- Nothing should give our state more pause in this debate than the Obama Administration’s attempt to force Florida to expand Medicaid under Obamacare in order to receive LIP funding.

-- It is unthinkable that the federal government would leave our state on the hook for over a billion dollars simply because they want a specific policy outcome. (That sounds hauntingly similar to what Gov. Rick Scott said. Wonder if they are sharing notes.)

-- I support a safety net for our most vulnerable citizens, but I believe that Medicaid expansion is the wrong approach to strengthening that net.

-- Just because a person has Medicaid does not mean they will have better health. They only scientific study of Medicaid in the country found that Medicaid patients’ clinical outcomes are no better than the uninsured.

-- There is also no flexibility in Medicaid expansion. Florida cannot choose the population, benefit, design, price or eligibility conditions.

-- Medicaid is supposed to be a safety net, but the expansion population goes beyond traditional Medicaid populations of vulnerable people like low-income children, the disabled, and the elderly.

-- We must take a very cautious and deliberate approach to implementing PPACA. If Florida expands Medicaid, it may not be able to undo that decision.

-- We will continue to listen to new ideas. I believe we should strengthen our safety net by continuing to find new and better market-based solutions that are sustainably funded and will provide Florida families and seniors with access to quality, affordable healthcare.

Overheard from a super secret House Republican meeting


For more than an hour, House Republicans met to discuss Medicaid expansion and how it relates to the Low Income Pool, the two issues that have made the legislative session screech to a halt.

But Republicans decided to ban the public from the meeting, claiming they wouldn't talk about pressing legislative matters.

So reporters had to stand outside and wait for lawmakers to come out and recap what they couldn't discuss in public. Yes, this is Florida, which prides itself on its open meetings law. And yes, despite that pride, legislators can lock out the press so they can discuss matters like Medicaid expansion.

Associated Press reporter Gary Fineout listened in to the meeting by placing his ear at the crack of door. It's not glamorous, but Fineout was able to catch certain phrases here and there. Here's what he told the rest of us as we waited for Republicans to end their secret meeting.

"We're asking you to trust us," Speaker Steve Crisafulli told Republican members. "Feel good about where you are." (applause)

Crisafulli told the caucus that former Gov. Jeb Bush was taken out of context when he was recently quoted on Medicaid.

"We're going to get beat up by the press," Crisafulli said.

"We're going to do what we can do to get out of town constitutionally, whether it's through a special session or extended session," Crisafulli said.

That sure sounds like strategy and discussing action on future legislative action. But afterward, Crisafulli pointed out that Medicaid expansion is not legislation that is before the House. It is, however, in front of the Senate, which Fineout said would subject the meeting to the open meetings law.

Crisafulli, however, said the House's general counsel, Matt Carson, had cleared the script that Crisafulli was reading from.

“I was very scripted. He said everything we were doing in that meeting was perfectly within the confines of the the law.”