October 12, 2014

Crist, Scott split on Medicaid expansion

As he gains momentum in the race for governor, Charlie Crist is driving a conversation on Medicaid expansion.

The Republican-turned-Democrat has become such a fervent supporter of the policy that he said he would consider using an executive order to get it done.

"A million Floridians are not getting the healthcare they need because of Rick Scott's lack of effort," Crist told the Herald/Times. "Florida deserves to have a governor who understands that this is affecting people’s lives."

Republican Gov. Rick Scott — who went from opposing Medicaid expansion to supporting it, albeit without ever really lobbying for it — hasn’t talked about the issue on the campaign trail.

But Scott said he was not surprised Crist would consider a using an executive order, drawing a comparison to the president.

"That is what President Obama does — refuses to work with legislators and just goes his own way and issues decrees," he said in a statement.

Observers say the issue may be key in the final weeks of the campaign. Read more here.

August 29, 2014

Florida Health Choices website aimed at the uninsured draws little interest

@tbtia

Last year, legislators allocated $900,000 to help Floridians find affordable health care through a new state-backed website.

At the same time, they refused to expand Medicaid or work with the federal government to offer subsidized insurance plans.

Six months after the launch of the state's effort, called Florida Health Choices, just 30 people have signed up. Another seven plans were canceled either because consumers changed their minds or didn't pay for services.

These numbers are dwarfed by the nearly 764,000 Floridians who are too poor to afford subsidized plans, yet can't qualify for Medicaid under Florida's stringent standards. They are supposed to be the target market for Health Choices.

But Health Choices doesn't sell comprehensive health insurance to protect consumers from big-ticket costs such as hospitalization. Instead, it has limited benefit options and discount plans for items like dental visits, prescription drugs and eyeglasses.

The plan's biggest backer in the Legislature blames the lack of business on the federal Affordable Care Act, which features comprehensive plans with varying subsidies for those who qualify.

Read more here.

August 26, 2014

Exemptions from the Affordable Care Act includes millions in bill-sharing groups

When she was eight weeks old, Ashlyn Whitney suffered a severe respiratory-tract infection that put her in an intensive care unit for 12 days.

“Because she was so young, she couldn’t handle it,” Ashlyn’s mother, Nicole Whitney, recalled. “They had to give her oxygen.”

The baby, now a year old, recovered from her illness, known as respiratory syncytial virus.The bill for her treatment at the West Boca Medical Center in Palm Beach County came to about $100,000 — a sum that included almost $4,000 in fees for her birth and pre- and post-natal care — but every dime of the tab was picked up by a medical bill-sharing organization set up for its Christian membership.

Such religious groups are exempt from the Affordable Care Act’s mandate that most Americans obtain health insurance or pay a penalty. Although as many as 30 million Americans will remain without health insurance by 2016, despite the best efforts of the ACA’s proponents, all but about seven million of them will be spared having to join the new system because of exemptions created by the act itself, according to an analysis by the Congressional Budget Office and the staff of the Joint Committee on Taxation.

The exempted religious organizations generally pool their members’ money to pay the medical expenses of anyone in the group who gets sick, injured or becomes pregnant. Also exempted from the law are members of federally recognized religious sects who have religious objections to insurance or to such systems as Social Security or Medicare.

Most of the other 20 exemptions address circumstantial situations such as homelessness, eviction, foreclosure, bankruptcy, the death of a close family member or an experience with domestic violence. Members of Native American tribes are also free to not sign up for health insurance, as are those whose income is too low or who are serving a prison sentence.

The organization that Nicole Whitney and her husband, Jonathan, joined two years ago was Medi-Share, a program set up in 1993 by the Melbourne-based, not-for-profit Christian Care Ministry, which says on its website that its members “make the rules — and their dollars don’t support unbiblical choices such as abortion, or drug or alcohol abuse.” More from Nick Madigan here.  

August 09, 2014

Rick Scott affirms support for Medicaid expansion, sticks to pro-business principles on health policy

@tbtia

Rick Scott swept into the Governor's Mansion fueled by his scorn for President Barack Obama's health reform law. So, when Scott announced last year that he supported expanding Medicaid — a centerpiece of the Affordable Care Act — the nation was amazed.

In an interview with the Times/Herald Friday, Scott reaffirmed his support for Florida taking $51 billion in federal money to provide health insurance for up to 1 million poor Floridians. And he said he sees no contradiction in the positions he has taken.

"While they spend 100 percent, I'm not going to stand in the way of the federal government doing something," he said. "What I'm not willing to do is put Florida taxpayers on the hook. … I've been very consistent and let's all remember that Obamacare is an absolute bad bill for patients, for families, for employers, for employees."

Now, as he seeks re-election, Scott said Friday that his pro-business views on health policy — honed as he led the nation's largest hospital chain — are firmly in place.

His actions on health-related issues as governor confirm it.

Read more here.

July 04, 2014

Demand that hospitals repay Medicaid funds latest sign of D.C.-Tallahassee rift

@tbtia

The federal government wants to recover $267 million from Florida hospitals it says were paid too much to care for the poor. And it wants the entire amount this year — a demand that is hitting safety-net hospitals like Jackson Memorial in Miami and Tampa General hard.

"Essentially it wipes out any profit we would have next year, so that's kind of why we're struggling with it," said Jackson Health System chief financial officer Mark Knight, noting the state's largest public hospital had operated in the red for years before turning things around.

Jackson stands to lose $47 million in Medicaid funding with this one issue. Tampa General would be out $13.3 million.

The federal demand is the latest incident highlighting tensions between Washington and Tallahassee over how to provide health care to the poor. Republican legislators rejected President Barack Obama's Medicaid expansion that would have provided health coverage for 764,000 uninsured Floridians.

But Tallahassee leaders wanted to continue receiving $1 billion a year in Medicaid Low Income Pool payments to hospitals. They even asked Washington for more from that program.

Read more here.

May 02, 2014

Diaz de la Portilla removes Public Health Trust language from trauma bill

South Florida observers were baffled when a Central Florida lawmaker proposed bill language that would strip the Miami-Dade County Commission of its authority to oversee labor agreements between Jackson Health System and its labor unions.

The provision was tucked into HB 7113 by Rep. John Wood, of Winter Haven. It met opposition from Jackson, the Miami-Dade Public Health Trust, Miami-Dade County and the healthcare employees union. 

Rep. Eddy Gonzalez, R-Hialeah, tried removing the language on the House floor last month, but couldn't muster the votes. A half-dozen lawmakers from Miami-Dade voted to keep the provision, including Rep. Michael Bileca, R-Miami, who sits on the Public Health Trust.

On Thursday, Sen. Miguel Diaz de la Portilla, R-Miami, succeeded in removing the provision from HB 7113 by amending the bill on the floor.

The proposal is expected to receive a vote in the Senate Friday. It would still need to return to the House for final passage.

April 16, 2014

Bill Nelson seeks local solution to expand Medicaid in Florida

@tbtia

Expanding Medicaid to cover thousands of uninsured Floridians has mostly been ignored by Republicans during this year's legislative session, but U.S. Sen. Bill Nelson is making a last-ditch effort to get it done.

Medicaid is a joint state-federal program, though most of the expansion called for under the Affordable Care Act would be funded by Washington. Still, Florida Republicans have balked, claiming that in the future, the burden on state funds would be too great.

Politics may be an even bigger problem than money, since Medicaid expansion is key to the success of President Obama's signature health law.

For months, Nelson has sought a way around the opposition while still meeting federal requirements. He thinks he has found it in a never-tried-before plan: Using health care dollars raised by counties to get the $3.5 billion needed to draw down $51 billion in federal funding.

"If you really want to get it done, and if your reason for opposing it really was that you didn't want to commit state tax dollars in the out years to expanding Medicaid, then this is the opportunity to do that," Nelson said Wednesday.

Read more here.

April 11, 2014

Union appeals to voters in the Medicaid "coverage gap"

The state healthcare workers' union has a new strategy in its fight to expand Medicaid coverage: reaching out to voters "who've been screwed out of healthcare coverage by their representative's refusal to act."

SEIU Florida will be knocking on doors this weekend in four state House districts.

The targeted lawmakers include Republican Reps. Manny Diaz, Jr., of Hialeah; Erik Fresen, of Miami; Kathleen Peters, of St. Petersburg; and Bill Hager, of Delray Beach. Each lawmaker represents more than 4,600 residents who are missing out on coverage, according a union analysis.

"It's time to bring this issue right down into each neighborhood, so people understand exactly what they and their friends, family and neighbors are losing because their elected representative has chosen politics over people," said Martha Baker, vice president of SEIU Florida and a nurse at Jackson Health System in Miami.

The GOP lawmakers say their position on Medicaid expansion is not driven by politics. Diaz, for one, said he opposes the policy because he does not believe it will improve most Floridians' access to quality healthcare.

"It's unfortunate that a labor union that is concerned about making money attacks elected officials that stand on principle for their constituents," he said Friday.

Medicaid expansion has been among the most controversial topics in the legislature.

Last year, the state Senate unanimously approved a bill that would have allowed the use of federal Medicaid expansion dollars to buy private insurance policies for poor Floridians. The House, meanwhile, voted to reject $51 billion in federal Medicaid funding.

A Medicaid expansion bill similar to last year's Senate proposal has stalled this year.

Hoping to apply pressure on lawmakers, SEIU Florida used Census and commercial figures to calculate the number of Floridians in the "coverage gap" in each state House district. The coverage gap includes people in Florida who don't qualify for Medicaid, but make too little to qualify for subsidies to purchase insurance on the federal exchange. The federal health care law anticipated that Medicaid expansion would fill this gap. States that declined the funds like Florida, however, still have a hole.

The three lawmakers with the largest number of constituents in the coverage gap are all from South Florida: Democratic Rep. Cynthia Stafford (11,496); Democratic Rep. Daphne Campbell (11,412) and Republican Rep. Manny Diaz (11,334).

Diaz is among the four lawmakers in the SEIU's sights.

The other three are Republicans who SEIU deems vulnerable in the 2014 election. 

Peters said she felt she was being unfairly targeted.

"This is just one group pushing their agenda through a negative campaign," she said, mentioning the work she has done to increase services for the homeless. "Any kind of statement that I'm not a caring person is just not true."

Fresen declined to comment.

Last year, SEIU produced TV ads targeted at half-dozen GOP lawmakers in Democratic-leaning districts.

April 10, 2014

Florida eye doctor emerges as top-paid doc in nation, data shows

A South Florida doctor under criminal investigation for alleged excessive billing of Medicare emerged as the federal health program’s top-paid physician in the nation Wednesday, according to the most detailed data on physician payments ever released in Medicare’s nearly 50-year history.

Salomon Melgen, a West Palm Beach ophthalmologist, was paid $21 million by Medicare in 2012 — more than any other physician who billed the taxpayer-funded program that year, according to new government data.

More than half of those payments went toward reimbursing Melgen for his injections of a costly drug, Lucentis, to treat patients suffering from a retinal disease, macular degeneration. His prolific use of that drug is at the center of the U.S. attorney’s investigation into Melgen’s practice, which thrives largely on payments from the Medicare program.

Kirk Ogrosky, an attorney for Melgen, issued a statement Wednesday denying that his client has defrauded the federal health program for seniors and the disabled.

“At all times, Dr. Melgen billed in conformity with Medicare rules,’’ said Ogrosky, a former federal prosecutor who for years fought Medicare fraud in South Florida and other hot spots.

“While the amounts in the CMS data release appear large, the vast majority reflects the cost of drugs,” Ogrosky said, adding that “the amount billed by physicians is set by law, and drug companies set the price of drugs, not doctors.’’ Story here. 

 

April 01, 2014

Fresen seeks to soften nursing education bill

A proposal winding its way through the Florida Legislature seeks to raise the bar for nursing education programs.

But on Tuesday, Rep. Erik Fresen, R-Miami, added a provision that would give struggling programs more leniency by allowing longer probationary periods before closure.

Among the potential beneficiaries: politically connected Dade Medical College.

Three of Dade Medical College’s nursing programs are on probation for low passing rates on the national licensing exam, according to the college’s website.

Fresen said his amendment was not intended to benefit Dade Medical College, or any of the other 21 nursing programs on probation. “It allows the [state] nursing board to extend probation at their discretion,” Fresen said.

But Linda Quick, the president of the South Florida Hospital & Healthcare Association, raised concerns about the provision — and said she suspected it was likely influenced by Fresen’s ties to college executives.

“Anything that prolongs the period of time that institutions have to meet basic standards is not a good idea,” Quick said. “They should be able to do it sooner rather than later.”

Read more here.