June 04, 2015

With no state plan, Florida's uninsured could rise by 1.3 million if court rejects subsidies

@dchangmiami

More than 1.3 million Florida residents — the most of any state — could lose their financial aid for health plans under the Affordable Care Act if the Supreme Court rules against the federal distribution of subsidies later this month.

New data released Tuesday by federal health officials in advance of the decision showed that Florida, which enrolled the most people in Obamacare, also stands to lose the most.

Those Floridians received an average subsidy of $294 a month in March to reduce their premiums, according to the new data. Among those Floridians, nearly 1 million also received financial aid from the government to reduce their out-of-pocket costs, such as co-payments, co-insurance and deductibles.

That means Floridians received at least $389 million in March from the federal government to help pay for their health insurance.

The subsidies are at the center of a Supreme Court case challenging the health law. In King v. Burwell, the plaintiffs argue that the language of the health law restricts the subsidies to states that established their own exchanges.

More here.

June 03, 2015

Senate opens health care debate with claim that Medicaid czar is now on board

The Florida Senate opened its debate on its health insurance reform plan Thursday by breaking news. 

The sponsor of the plan, Sen. Aaron Bean, R-Fernandina Beach, said that after consulting with the Senate staff overnight, the state’s top Medicaid chief, Justin Senior, changed his mind.

The Senate Florida Health Insurance Exchange plan, which Senior had concluded would reduce the number of insured, actually could work to expand insurance to the uninsured.

Senior, deputy director of the Agency for Health Care Administration, had called the decline a “death spiral” in testimony before the House on Monday. The Senate berated him for acting with political intent and intentionally misrepresenting the Senate bill.

Bean said Thursday that, upon further reflection and explanation, Senior agreed to help senators craft amendments that will give his agency more flexibility to determine rates and remove the prospect of a “death spiral.”

“He has removed those words and said he is ready to move forward,’’ Bean told the Senate on Wednesday.

In an email to the Miami Herald Thursday during Senate debate, Agency for Health Care Administration spokeswoman Shelisha Coleman confirmed Senior worked with the Senate but continues to have concerns that the federal government will not approve the FHIX plan because of the work requirements. 

"We can confirm we worked with the Senate as promised at the podium,'' Coleman wrote. "The amendment has changed the premium subsidy structure and the risk adjustment mechanism in a way that alleviates our death spiral concern. This does not resolve issues relating to the federal approval concerns or mean we have shifted our position which remains neutral.”

Here are the pre-amendment analyses on the Senate bill approved by AHCA: Download AHCA SB 2A  Download AHCA SB 7044

Senate to meet, ready FHIX for final approval

The Senate is expected to take up its Florida Health Insurance Exchange program this afternoon, readying it for final passage.

FHIX is a health care program designed to use federal Medicaid funds to subsidize insurance for low-income Floridians. Not every uninsured person would qualify, however. Participants must be able to prove that they are working, actively seeking work, in school, disabled or caring for a disabled relative to recieve support through the program.

The plan, largely the brainchild of Sen. Aaron Bean, R-Fernandina Beach, has been amended before unanimous committee votes twice this week, each time making it more palatable to conservative members of the Legislature, particularly in the House.

Under the current language, FHIX would sunset after two years. Majority Leader Bill Galvano, R-Bradenton, pushed for that change, saying it would allow the program to function as a pilot and could be evaluated at the two-year mark.

Support in the Senate should be nearly unanimous when they vote on it as Republican and Democratic leadership have been committed to the plan. The decision could come Thursday, unless senators decide to roll it to a final vote this afternoon.

June 02, 2015

Months of pent up frustration erupts as Senate berates AHCA Medicaid chief

Tom LeeMonths of frustration over stalled health care talks came to a head Tuesday as a Florida Senate committee berated the governor’s Medicaid chief for playing politics, and then subjected him to withering criticism over his lack of "quantitative analysis" of their bill.

 “You know where you’re supposed to be and it’s right here in this committee room,’’ boomed Sen. Tom Lee, R-Brandon, chairman of the Senate Appropriations Committee, to Justin Senior, the Medicaid director for the Agency for Health Care Administration who scrambled to the meeting after senators publicly complained about him being a no-show.

Lee accused him of being “derelict in his duty,’’ and of intentionally misrepresenting the economic impact of the Senate’s health insurance plan during testimony Monday before the House. He said that, as the Senate sought input about its plan to cover the uninsured, “neither your agency nor boss have been helpful in this process at all.’’

“I apologize,’’ Senior responded, but repeated his assessment that the Senate plan would not guarantee increased coverage.

Continue reading "Months of pent up frustration erupts as Senate berates AHCA Medicaid chief" »

Senate counters House criticism and calls out AHCA for 'disrepectful' no-show

The Florida Senate used a budget hearing on its FHIX 2.0 health insurance expansion plan to counter criticism from the House, make the case that the plan saves the state $1 billion, and publicly rebuke the governor’s Agency for Health Care Administration for failing to show up to answer questions.

“I find it inexplicable,’’ said Sen. Don Gaetz, R-Niceville. “I don’t know what the reason would be that the Agency for Health Care Administration would not accept an invitation to the senate and engage in this committee.”

Sen. Tom Lee, R-Brandon, chairman of the Senate Appropriations Committee noted that “there was an invitation” to AHCA and its deputy director Justin Senior who appeared before the House committee Monday.

“They are quite conspicuous in their absence,’’ he said.

Continue reading "Senate counters House criticism and calls out AHCA for 'disrepectful' no-show" »

June 01, 2015

No surprise: Senate panel OKs amended FHIX plan

The Senate Health Policy Committee unanimously passed its Florida Health Insurance Affordability Exchange Program, or FHIX, after amending it to be more palatable to conservative constituents and the House Republicans.

No surprise there as the initial plan was developed and passed by this committee during the regular session.

But House leadership remains opposed to the plan, which would seek federal money to subsidize insurance for low-income Floridians who are working, actively seeking work, in school, disabled or caring for disabled relatives.

"I'm hearing that it's a tough sell," said Sen. Aaron Bean, R-Fernandina Beach, who authored the plan. "We'll reach out to them (House leadership) best we can to reach out and see if we can't address their concerns, some of which were already brought up and we've already addressed."

A primer for those new to FHIX: Under the amended proposal, Floridians would have to prove they meet the employment, education or disability criteria to gain access to a health care exchange with heavy subsidies. They would also have to contribute to the program via monthly premiums ranging from $3 to $25.

May 30, 2015

Storm clouds remain over health care debate as legislative session begins

PETITION0529 RN CTJFor the first time in 12 years, Florida ended its regular session without a state budget, prompting legislators to reconvene — starting Monday — to finish the work.

But in a fitting nod to the atmospherics, the opening day of the three-week special session is also the official opening of the hurricane season — and the health care debate that sidetracked the state’s $80 billion budget debate continues to spawn political storms.

As of Friday, legislators did not have agreement on the size of the health care-induced budget hole, which means they can’t start budget negotiations. They don’t agree on how to craft a long-term fix to provide health insurance to the uninsured.

They agree tax cuts are good. But, because of the health care conflict, they don’t agree on how much they can afford this year. And the question of how much money to direct to Amendment 1, the water and land-buying initiative approved by 75 percent of voters last fall, is mired amid discord over whether to use it to buy land to clean the Everglades.

“We know how to get this done from where we are. It just may require a lot more compromise," said an optimistic Sen. Tom Lee, R-Brandon, the Senate Appropriations Committee chairman.

Rep. Richard Corcoran, R-Land O’Lakes, House Appropriations Committee chairman, believes there is middle ground. “We’re all in agreement we’ll get a budget," he said. “What we don’t agree on is how much flexibility to give each side to get there.”

The session begins at 1 p.m. Monday. The House will begin by scheduling a hearing on the Senate’s health insurance reform plan called the Florida Health Insurance Exchange, or FHIX — something it refused to do during the regular session.

More here.

Photo: Petitioners gather last week outside the office of Rep. Jose Oliva, the Miami Republican whose districts includes some of the highest number of uninsured in the state. 

May 29, 2015

Feds say they're not quite ready to approve governor's LIP plan

The federal Centers for Medicare and Medicaid Services said Friday that it has not signed off on the proposal by Gov. Rick Scott to rely on local governments and safety net hospitals to draw down money for the uninsured and raised concerns about the impact of the change on communities -- like Miami -- that provide the bulk of the funding for the Low Income Pool.

"CMS continues to be engaged with Florida regarding the state's LIP proposal and the May 26 letter but has not communicated approval,'' said Ben Wakana, press secretary for the U.S. Department of Health and Human Services said in response to a question by the Herald/Times. "CMS is reviewing the proposal and public comments, and working to understand the implications of the letter as well as the viability and sustainability of the proposed funding mechanism."

Under the governor's plan, announced by the Agency for Health Care Administration in a letter to the federal government on Wednesday, the state would offset the loss of $1 billion into the Low Income Pool by relying on local hospitals and local governments to raise $900 million in financing to draw down $1.2 billion in federal funds. The financing arrangements are known as intergovernmental transfers. 

As a return on their investment, hospitals would be rewarded a 10 percent profit -- a cost to the program of about $100 million. The state would then use the $1 billion promised by the federal government in Low Income Pool funding to reimburse teaching hospitals and increase patient reimbursement rates.

Continue reading "Feds say they're not quite ready to approve governor's LIP plan" »

Conservative Americans for Prosperity takes to TV to blast Florida lawmakers over Medicaid expansion

@PatriciaMazzei

Americans for Prosperity, a conservative group backed by the industrialist Koch brothers, is continuing to campaign against Medicaid expansion under Obamacare in Florida.

The group plans to launch a new television ad timed with the start of the special Florida legislative session, which begins Monday (a longer web version of the spot is below). AFP has also sent fliers to voters to targeting Republicans in the state Senate who back Medicaid expansion.

"The Florida Senate's Medicaid expansion plan is wrong for Florida," AFP state director Chris Hudson said in a statement. "The only thing that is certain is that Florida families who depend on this already bloated program will have an even harder time getting care and, like other states' expansions, it could cost billions more than expected, ultimately forcing legislators to raise taxes or make cuts from other essential services."

Hudson's father is state Rep. Matt Hudson of Naples.

A Healthy Florida Works Coalition, which supports Medicaid expansion as proposed by the Senate, has been airing its own ad in support of those lawmakers.

 

May 28, 2015

Scott's LIP plan would cut $214 million from hospitals, most in South Florida

Gov. Rick Scott released details of his latest proposal to draw down $2.3 billion in federal Low Income Pool funds on Thursday. While the formula is higher than previously announced, it does not use any state dollars to backfill the loss but it cuts reimbursements to hospitals by $214 million.

Hardest hit are hospitals that do the bulk of the state's charity care. Among those facing the deepest cuts are: Jackson Memorial (-$34.5 million), Broward General (-$22.3 million), Shands in Gainesville (-$34.5 million), Shands in Jacksonville (-$36.5 million) and All Children's Hospital in St. Petersburg (-$12.9 million.)

Under the plan, announced by the Agency for Health Care Administration in a letter to the federal government on Tuesday, the state would not lose $1 billion in federal health care money as previously suggested but the money would be offset by local hospitals and local governments, which would raise $900 million in financing to draw down $1.2 billion in federal Low Income Pool funds. The financing arrangements are known as intergovernmental transfers. 

As a return on their investment, hospitals would be rewarded a 10 percent profit -- a cost to the program of about $100 million. The state would then use the $1 billion promised by the federal government in Low Income Pool funding to reimburse teaching hospitals and increase patient reimbursement rates.

Continue reading "Scott's LIP plan would cut $214 million from hospitals, most in South Florida" »