April 02, 2015

It's come to this, Florida: House vs. Senate, the battle over Obamacare

The stage is set of an epic budget showdown between the Florida House and Senate.

Later today, the House will vote -- and overwhelmingly approve -- its $76.2 billion budget. On Wednesday, the Senate unanimously approved its $80.4 billion budget 36-0.

Lawmakers have only one month to bridge that $4.2 billion gap, one of the widest budget discrepancies at this stage of the 60-day legislative session in recent memory.

And it’s all over Obamacare.

For the past three years, Florida has refused $51 billion in federal money earmarked for expanding subsidized health care coverage. The Senate is now advancing a plan to expand coverage through the use of a state-run marketplace for private insurance. But the House has refused to consider it. Many have speculated that the federal government won't extend Florida's program for low-income patients unless the legislature expands Medicaid.

The state Agency for Health Care Administration announced on Wednesday that federal health care officials are temporarily suspending negotiations with Florida over aid to low-income-pool (LIP) hospitals, which is a $2.2 billion program.

Continue reading "It's come to this, Florida: House vs. Senate, the battle over Obamacare" »

As pressure mounts, health care talks delayed

Federal health care officials are temporarily suspending negotiations with Florida over a $2.2 billion program that helps safety-net hospitals, the state Agency for Health Care Administration said Wednesday.

Agency Secretary Elizabeth Dudek called the news "sudden and disappointing."

Dudek said Florida's conversations with the federal government over the so-called Low Income Pool program "had been productive and positive until this point," and suggested the move "could signal the abrupt end of this federal healthcare program in Florida."

The U.S. Centers for Medicare and Medicaid Services declined to say why its chief negotiator would be unavailable for the next two weeks. But a CMS spokesman said the agency planned to "remain in contact with the state."

The federal government's announcement only adds to the tension in Tallahassee over next year’s budget. House and Senate lawmakers are about $5 billion apart because the Senate budget is counting on receiving billions of dollars in federal aid, including the LIP money.

Sen. René García, R-Hialeah, who had discussed the LIP program with federal officials in Washington one day earlier, said was puzzled over the federal government’s action.

"I don’t know where this is coming from," García said. "When we met with them, they were very receptive to working with us."

More here.

April 01, 2015

Top Florida Democrats pitch Medicaid expansion in Tallahassee

DwsAs the state House and Senate considered their respective budget proposals on Wednesday, two of Florida’s top Democrats traveled to Tallahassee to keep the pressure on lawmakers to expand Medicaid.

U.S. Rep. Debbie Wasserman Schultz, who also chairs the Democratic National Committee, said she had "direct conversations" with federal health care officials -- and that Florida shouldn't expect to have the $2.2 billion Low Income Pool program renewed unless it expands Medicaid.

"They are already very seriously looking at whether LIP should be extended at all," Wasserman Schultz told Senate Democrats. "It is certainly less likely that it would be extended if Medicaid is not expanded, and obviously that would be devastating."

U.S. Sen. Bill Nelson said he, too, was doubtful that the federal government would continue funding LIP. He said he met with House Speaker Steve Crisafulli, R-Merritt Island, on Wednesday to make that point.

Nelson said U.S. Department of Health and Human Services Secretary Sylvia Burwell considered LIP "paying two times for the same thing" because states can already tap into federal Medicaid expansion dollars to expand health care coverage. 

"At this late hour, HHS will work with the legislature on a transition on LIP, but not where you just fund LIP and don't take what's been offered," he said. "The day of reckoning is here."

The Democrats struck a different tone than state Sen. René García, R-Hialeah, who on Tuesday met with representatives from the federal Centers for Medicare and Medicaid Services in Washington. Garcia pitched the federal health officials on a Senate plan to develop a successor plan to LIP, and said he had received positive feedback.

The trip drew sharp criticism from the House on Wednesday. House Health Care Appropriations Subcommittee Chairman Matt Hudson said he had not had a conversation with the federal government “because frankly, it is not [his] responsibility to do so."

"The responsibility of negotiating falls squared upon the Agency for Health Care Administration, the executive branch,” Hudson said.

Senator "encouraged" by talks with federal health officials

ReneState Sen. René García, R-Hialeah, left Washington Tuesday feeling "encouraged" by his conversations with federal health officials, he said.

He and Sen. Garrett Richter, R-Naples, made the last-minute trip at the request of Senate President Andy Gardiner

The two lawmakers met with representatives from the U.S. Centers for Medicare and Medicaid Services to discuss Florida's Low Income Pool program. The federal government has said it will not continue the $2.2 billion hospital funding program in its current form, blowing a sizable hole into the state health care budget.

García said he outlined a Senate proposal for a LIP replacement program, which would distribute the money more broadly than the current model does.

"I wanted to present our case as to why I think the LIP model that we have is something they can approve, and to try to get them to move on LIP so we can know what to do in the state of Florida as we go into budget conference," he said.

The feedback, he said, was "very positive."

García stressed the fact that the legislature has only a few more weeks to finalize Florida's budget, he said. 

"We can't do our budgets without them," García said.

The hour-long discussion also covered Medicaid expansion.

"There was a conversation on both [the LIP and Medicaid] fronts because in our budget, one is tied to another," García said. 

For the past three years, Florida has refused $51 billion in federal money earmarked for expanding subsidized health care coverage. The Senate is now advancing a plan to expand coverage through the use of a state-run marketplace for private insurance. But the House has refused to consider it.

Some observers have speculated that the federal government won't extend Florida's LIP program unless the legislature expands Medicaid. 

García said his plan was to send a clear message on both issues.

"We want CMS to know that the Senate is serious about the Low Income Pool and the issues around Medicaid and the plan that we have," he said.

García and Richter weren't the first Floridians to meet with CMS about the LIP program. The state Agency for Health Care Administration has spent the last several weeks trying to negotiate a successor program.

On Tuesday, Agency Secretary Liz Dudek said she was unaware the two senators were meeting with CMS. She said the agency had already presented the Senate proposal.

García said his trip was not meant supersede the those negotiations.

"We were not there to negotiate," he said. "All we were there to do was... let them know we are working on it and trying to find solutions."

March 31, 2015

Florida lawmakers travel to DC to talk health care

ReneWondering why Sens. René García, R-Hialeah, and Garrett Richter, R-Naples, aren't in Tallahassee today?

They are meeting with the U.S. Department of Health and Human Services.

The two lawmakers flew to Washington at the request of Senate President Andy Gardiner, spokeswoman Katie Betta said.

The purpose of the trip: to get a better idea of where Florida stands on some key health care issues.

"With tomorrow marking the halfway point of the session, we are nearing the time when the legislature is going to have to start finalizing decisions on the budget," Betta said.

Among the unresolved issues: what the future holds for Florida's Low Income Pool program.

The federal government has said it will not renew the $2.1 billion program, which helps hospitals treat uninsured and Medicaid patients, as it exists today. But the state and federal government have been unable to reach consensus on a successor program. 

The Senate recently recommended a new program would distribute the Low Income Pool funds more broadly than the original program. It was not clear how the idea was received by the U.S. Centers for Medicare and Medicaid Services.

The Senate has also been driving a push to expand health care coverage to nearly one million poor Floridians. That, too, would require approval from the federal government, assuming it passed through the resistant House.

Medicaid expansion supporters strike back

One day after a conservative advocacy group sent out mailers attacking the senators who support Medicaid expansion, a coalition of business leaders released a video thanking the Senate for its "bold leadership and courage."

The group, a Healthy Florida Works, was instrumental in drafting the Senate's plan to expand healthcare coverage to nearly one million poor Floridians.

"As highlighted in the coalition’s new video, the Senate's comprehensive health care package will save the state billions, create good paying jobs and provide health care coverage to more than 800,000 Floridians," the group said in Tuesday press release.

The video will be blasted out on social media and will run in certain TV markets.


March 30, 2015

Conservative group targets senators who voted for Medicaid expansion plan

The conservative advocacy group Americans for Prosperity Florida sent out mailers Monday targeting the 23 senators who have approved the proposed alternative to Medicaid expansion.

Among them: Sens. Rene Garcia, R-Hialeah; Anitere Flores, R-Miami; Oscar Braynon, D-Miami Gardens; and Gwen Margolis, D-Miami.

"We are reaching out to Floridians in every district of every member of the Senate that has taken a vote in favor of expanding the broken and bloated Medicaid system under Obamacare," AFP state director Chris Hudson said in a statement.

The mail piece also went to residents of Senate President Andy Gardiner's central Florida district.

The Senate has been advancing plan to use federal money to extend healthcare coverage to nearly one million low-income Floridians. The proposal is not Medicaid expansion as envisioned under the Affordable Care Act. Instead, it would require Florida create a state-run marketplace for private health insurance. What's more, beneficiaries would have to pay small monthly premiums and meet a work requirement.

Still, House Speaker Steve Crisafulli, R-Merritt Island, has said he isn't interested.

Gardiner said he agreed with AFP that "Florida should not expand the existing Medicaid program."  

"What we have done instead is to develop a consumer-driven approach that provides access to high-quality, affordable health care coverage while promoting personal responsibility," he said in a statement. "Our plan includes conservative, free market guardrails that will control the cost and growth of the Medicaid program for Florida’s taxpayers." 

Still, state director Hudson said the Senate would be better off focusing on the overall cost of health care.

"We have been advocating for expanding telemedicine, reforming certificate of need, and expanding scope of practice as some of the possible ways the Senate can take bold steps to making health care more affordable and available to all Floridians," he said.

March 20, 2015

Obamacare turns 5: What came true and what didn't

Predictions about the health care law were a dime a dozen back in 2010. Supporters contended that virtually everyone around the country would soon have access to affordable insurance. Opponents said the law would cost a fortune by adding to the national debt and killing jobs.

Actually, none of those things have happened.

As the Affordable Care Act makes its way to its fifth anniversary on Monday, the law has taken twists and turns, moving off course from where everyone thought it would be.

Once expected to insure 32 million new Americans by the end of the decade, the projected target has been downgraded to 27 million — far from the universal coverage many proponents hoped for.

Unforeseen developments, like significant changes in health cost trends and a sweeping Supreme Court decision on Medicaid expansion, have meant the insurance provisions in the law will cost $139 billion less over the next five years than it was supposed to back in 2010. That has quieted some critics who expected massive, deficit-inflating costs.

In five years, the law has steadily navigated toward its overall goal of decreasing the number of uninsured Americans, without dramatically disrupting the overall health care industry, for better or worse. Yet.

"The whole thing has been in much slower motion that what was predicted," said Michael Tanner, health care analyst with the libertarian Cato Institute. "Whether you thought something good was going to happen or something bad, you sort of thought it would have happened by now. Instead, it’s just been creeping along."

For the rest of the article by Angie Drobnic Holan and Steve Contorno, check out PolitiFact.

March 19, 2015

House, Senate clash on healthcare budget

The Florida House and Senate rolled out vastly different healthcare spending plans this week, putting the two chambers on a collision course over the state budget.

The proposals are $5 billion apart — more than the entire budget for the state of Vermont.

The Senate version includes $2.8 billion in federal money to pay for expanded healthcare coverage, something the House adamantly opposes. It also includes a $2.2 billion program known as the Low Income Pool that helps hospitals treat uninsured, under-insured and Medicaid patients.

Reaching consensus on the two issues will be difficult, and could require an extended or special legislative session. For now, leaders in both chambers are holding firm.

"Those are the Senate's priorities," Senate Health Appropriations Subcommittee Chairman René García said Thursday.

Building the healthcare budget is more complicated than usual this year, in part because the LIP program is set to end on June 30. The federal government has said it may be willing to approve a replacement program, but the negotiations are ongoing.

There’s also the issue of Medicaid expansion, a provision of the Affordable Care Act.

Continue reading "House, Senate clash on healthcare budget" »

March 17, 2015

Alternative to Medicaid expansion moves swiftly through the Florida Senate

A second Senate panel on Tuesday approved a proposal to extend federally-subsidized healthcare coverage to nearly one million poor residents.

The plan -- known as the Florida Health Insurance Affordability Exchange Program, or FHIX -- would create a state-run private health insurance marketplace. Participants would have to pay small monthly premiums and meet a work requirement.

Several members of the public spoke out against the bill Tuesday, including Bill Herrle of the National Federation of Independent Business.

"Business owners are very concerned for the future of this state when we become attendant to the whims of federal agencies," he said.

Other speakers voiced concerns about the work requirement and monthly premiums.

But by and large, representatives from hospitals, the business community and consumer advocacy groups gave their support.

"Extending healthcare coverage will benefit every Florida family, including those in our Hispanic community, and it will help Florida businesses," said President of the Florida State Hispanic Chamber of Commerce Julio Fuentes.

Members of the Senate Health and Human Services Appropriations Subcommittee agreed, approving the bill by a unanimous vote.

"This is no longer a Republican or a Democratic issue," said Senate Health and Human Services Appropriations Subcommittee Chairman Rene Garcia, R-Hialeah. "Are there issues with the Affordable Care Act? Absolutely... But to deny the hardworking men and women of this state access to health care, to me, is completely irresponsible."

The panel put the pressure on the House, which has opposed expanding Medicaid as envisioned under the Affordable Care Act.

"It's time that the House takes up the bill, looks out for Floridians, stops dealing in talking points and moves on," said Sen. Joseph Abruzzo, D-Wellington.

When asked if he believed the House would consider the plan, Senate Health Policy Committee Chairman Aaron Bean turned to baseball.

"It's the third inning of a nine-inning ball game," Bean said. "I'm looking for some big play in a latter inning for us to score on this issue. It's early."