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.

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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.

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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.

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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" »

Miami groups petition for Medicaid expansion at state Rep. Jose Oliva's office

via @chabelih

At a busy corner in the ZIP code with the highest number of Obamacare enrollments in the nation — 33012 in Hialeah —demonstrators armed with 30,000 signatures knocked on the door of state Rep. Jose Oliva’s office Thursday hoping to gain his support on the issue that has polarized Florida’s lawmakers: Medicaid expansion.

About 30 people showed up for the rally led by SEIU Local 1991, a union representing 5,000 healthcare workers in the Jackson Health System. They sought to convince Oliva — who was not in his office — and other House Republicans opposing expansion to change their minds before the start of the legislative special session next week.

The Affordable Care Act, also known as Obamacare, includes a provision to expand Medicaid. Florida is among the 18 states that have not chosen to expand and a bitter dispute between Republicans in the House and Senate over the issue forced an early end to the regular session.

The groups delivered the signatures, collected over several months from around the state, to Oliva’s second-floor office at a shopping center, urging him to listen to his constituents.

“His constituents are telling him: ‘We want healthcare. We are buying healthcare under the Affordable Care Act,’” said Martha Baker, president of the local SEIU, before leaving the petition with Oliva’s secretary.

More here.

May 27, 2015

South Florida lawmakers take up Medicaid expansion at health forum

via @chabelih

With a special legislative session set for next week, South Florida lawmakers, hospital representatives and health groups gathered Wednesday to discuss Medicaid expansion, the future of healthcare in Florida and a looming Supreme Court decision on subsidies.

Sen. Rene Garcia, a Miami Republican who chairs the Senate healthcare budget committee, in a panel discussion with Sen. Anitere Flores, R-Miami, and Rep. David Richardson, D-Miami Beach, said a healthcare crisis still exists in Florida after the Legislature adjourned without passing a budget. About 850,000 Floridians fall into the healthcare “gap” created when Florida chose not to expand Medicaid.

Garcia said he is frustrated with the House’s refusal to explore options for Medicaid expansion: “It just makes no sense to me that you cannot sit in a room and have a conversation as to how we are going to fix the problem.”

The panel offered some hope of a solution to the impasse, noting that House appropriations chair Rep. Richard Corcoran, R-Land O’Lakes, called the Senate’s proposed Medicaid expansion plan “exciting” earlier this week, with the caveat that the Senate guarantees it will take up several other House proposals.

Still, no House Republicans attended the Health Foundation of South Florida’s forum, though they were invited.

More here.

White House 'disappointed' over Florida Medicaid-expansion impasse

@PatriciaMazzei

President Obama's two-day stop in Miami has nothing to do with Florida's upcoming special legislative session forced by a disagreement over how to fund healthcare.

But the White House couldn't avoid a reporter's question Wednesday about the president's opinion on the opposition from statehouse Republicans to expanding Medicaid under Obamacare.

"We have demonstrated a willingness to work closely with state leaders to tailor solutions" to their residents, Press Secretary Josh Earnest said when asked about the issue in a conference call with Florida reporters. "The refusal of Republican officials in Florida to put the interests of their citizens ahead of their own political arguments is something that we've been disappointed by."

Obama arrives Wednesday afternoon for a pair of Democratic Party fund-raisers. Earnest's question-and-answer session was intended to delve into the president's visit Thursday to the National Hurricane Center, where he will ask people to prepare for the annual storm season that formally begins June 1.

Yet with Gov. Rick Scott and the GOP-controlled Legislature still at odds over how to craft a state budget in the special session that begins the same day, Earnest had to address the impasse. He said the U.S. Health and Human Services Department is open to a compromise -- if Florida is.

"There are officials at HHS who continue to be in regular contact with Gov. Scott's office, and we continue to be ready and willing to engage in serious discussions about a Florida-tailored Medicaid expansion proposal that would help 750,000 people in Florida get access to quality, affordable health coverage," Earnest said.

(The number is closer to 850,000 people, according to a different study than the one cited by the White House; the figure depends on how the uninsured are measured. Both studies rely on statistical formulas to update old data.)