April 28, 2015

Confused about session? Let us help you.

It's no longer a debatable claim to say that the 2015 legislative session has ventured into uncharted territory.

The session jumped off the rails at 1:15 p.m. Tuesday when Florida House Speaker Steve Crisafulli, R-Merritt Island, told his 119 colleagues in the lower chamber that they were done and could go back home three days before Friday's scheduled end date. The Senate, caught off guard, now plans to finish up Wednesday.

It's the first time since the Legislature started keeping records that the chambers will end regular session on different days.

So how did we get here? Where are we going? We may not know for some time, but here is a guide.

What happened?

The Florida House and Senate couldn't negotiate the one piece of legislation they are required to pass: a state budget. The House passed its $76.2 billion budget plan April 2, but it didn't include $4 billion that was included in the Senate's budget, which had passed hours earlier. For a month, the two chambers have not been able to agree on how to bridge that $4 billion gap.


There are two main reasons the House and Senate budget proposals were so different: a $2.2 billion federal-state hospital funding program known as the Low Income Pool, and Medicaid expansion. The LIP program provides funding to hospitals that treat large numbers of uninsured and Medicaid patients. It is scheduled to end June 30 under an existing agreement with the federal government. The Senate proposed a successor program and assumed the money would come through. The House did not include any LIP money in its budget. What's more, the Senate's proposed budget included $2.8 billion in federal Medicaid expansion money to provide health care coverage to more than 800,000 low-income Floridians. The House has long opposed that idea, likening it to an endorsement of Obamacare. Over the course of the session, the two sides refused to back off of their positions. They dug in even deeper this month when the federal government said it was more likely to approve a LIP successor if Florida expanded Medicaid.

This is all about Obamacare, isn't it?

Yes. For the past three years, Florida has refused $51 billion in federal money earmarked for expanding subsidized health care coverage under the Affordable Care Act, making it one of 22 states to do so.

Continue reading "Confused about session? Let us help you." »

As the House adjourns early over Medicaid battle, we look at claims on the Truth-O-Meter

A battle over Medicaid expansion led the Florida House to adjourn the session three days early on Tuesday, leaving hundreds of bills dead for now including $690 million in tax cuts, a priority of Gov. Rick Scott.

House Speaker Steve Crisafulli said the House will return when the Senate was ready to negotiate their budget differences but it was unclear when that would occur. They will have to come back in a special session to complete the state budget by the June 30 deadline.

Crisafulli echoed Senate budget chief Tom Lee who said Monday: "There's no possible hope for getting done at this time."

The Senate agreed to remain in session, sending bills symbolically to the House where they will die.

The House opposed the expansion of the health care program for the poor while the Senate advocated for a version of it, creating a major rift between the two GOP-dominated chambers. Scott, once a supporter of Medicaid expansion, opposed it this session and threatened to sue the federal government over it. (He officially announced that he filed the suit Tuesday afternoon.)

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.

While there was a long list of hot issues this session -- including whether to allow guns on college campuses and K-12 schools and a proposal for online voter registration -- in the end the feud over Medicaid was what brought the Legislature screeching to a halt.

Here’s a look back at some of our claims related to Medicaid expansion from PolitiFact Florida.

Florida Gov. Rick Scott files lawsuit against feds over hospital funding


Gov. Rick Scott followed through Tuesday on his promised lawsuit against the federal government over its threat to withhold hospital charity-care funding if Florida doesn't expand Medicaid. 

His office announced the filing shortly after the Florida House of Representatives adjourned its legislative session ahead of schedule, amid its budget stalemate with the Senate over healthcare. Scott declared his intent to sue 11 days ago.

The lawsuit was filed against the U.S. Department of Health and Human Services and its secretary, Sylvia Burwell, and the Centers for Medicare and Medicaid Services and its acting administrator, Andy Slavitt. View it here.

"President Obama's sudden end to the Low Income Pool (LIP) healthcare program to leverage us for Obamacare is illegal and a blatant overreach of executive power," Scott said in a statement. "His administration is effectively attempting to coerce Florida into Obamacare by ending an existing federal healthcare program and telling us to expand Medicaid instead. This sort of coercion tactic has already been called illegal by the US Supreme Court."

Speaker Steve Crisafulli pens op-ed: Why the Florida House opposes Medicaid expansion

House Speaker Steve Crisafulli wrote an op-ed column exclusively for the Tampa Bay Times explaining why the Florida House opposes Medicaid expansion. An excerpt:

We oppose expanding Medicaid because it is a broken system with poor health outcomes, high inflation, unseverable federal strings, and no incentive for personal responsibility for those who are able to provide for themselves. Under current law, Florida provides for our most vulnerable: low-income children, pregnant women, the elderly and disabled people.

Under federal law, other low-income Floridians have access to health care subsidies to buy private insurance for less than the average cost of a wireless phone bill. In fact, if we choose Obamacare expansion, 600,000 will lose eligibility for their subsidies, of which 257,000 would be forced into Medicaid.

Those who claim we should expand Medicaid to get Florida's money back should note that we already receive over $15 billion more each year than we send to Washington. It's deficit spending. The national debt burden today is $145,000 per household. Medicaid expansion would not be financed with the hard-earned dollars we have already sent to Washington — it would be financed by mortgaging our children's and grandchildren's future.

The Florida Senate disagrees and has unfortunately partnered with the Obama administration to demand Medicaid expansion. They suggest existing safety net funding (the Low Income Pool, or LIP) and our state budget are tied to federal health care policy goals.

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.