June 15, 2015

Remember those House bills on healthcare cost? Senate says never mind, let's study it

The Florida House's attempt to get the state Senate to focus on passing legislation aimed at controlling health care costs is now getting the same treatment as the Senate's to expand health insurance with Medicaid money -- it's dead.

Sen. Aaron Bean, R-Fernandina Beach, chairman of the Senate Committee on Health Policy on Monday cancelled Tuesday’s scheduled meeting of his committee to take up six bills that have passed the House and instead released a statement calling for a joint House and Senate "Task Force on Health Care Policy Innovation."

“Last week, our committee held a workshop where we reviewed and discussed several pieces of legislation designed to expand access, increase competition and lower the cost of health care services in our state,'' he said in a statement. "In one form or another some of these policy ideas have previously earned support in the Senate, while others are new and have not yet been fully explored."

The House last week passed six bills that said would contain health care costs and the Senate last week held a workshop on some of the ideas. The bills stripped away regulations by eliminating the certificate of need for hospital expansion, opened the door to off-site surgery and recovery centers, allowed advanced-registered nurse practitioners and physician assistants to prescribe controlled substances, and created new options for state employees to choose from health-insurance plans.

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June 14, 2015

No back-up plan in Florida if SCOTUS guts Obamacare subsidies

via @dchangmiami

There is no official plan. There is no time to execute one, even if there were a plan. And, perhaps most importantly, there appears to be no political leadership in Florida to act if the Supreme Court rules this month that more than 6 million Americans, including about 1.3 million Florida residents, can no longer receive federal subsidies that help pay for their health insurance under the Affordable Care Act, according to health policy experts.

Many scenarios could play out if the Supreme Court rules that billions of dollars in health insurance subsidies, including an estimated $389 million a month for Florida residents, can only be distributed through exchanges established by a state, as the plaintiffs argue in King v. Burwell.

But absent a ruling that provides for a temporary extension of subsidies for residents of the 34 states that rely entirely on the federal exchange at HealthCare.gov, health policy analysts say any long-term solution comes down to state action — or Congress.

“There aren’t a lot of fallback options in place at this time," said Cynthia Cox, associate director of health reform and private insurance for the Kaiser Family Foundation, a California-based health policy research nonprofit group.

In Florida, legislators have no official plan — though conversations have been taking place — and they likely will look to the federal government first for a solution if the Supreme Court rules for the challengers, said Diane Hilligoss, a University of Michigan law student and researcher who interviewed Florida lawmakers and others in the spring for a study published by Health Affairs, a health policy journal.

More here.

June 10, 2015

Judge denies Gov. Scott's request for mediation over LIP program


A federal judge on Wednesday denied a request from Gov. Rick Scott that the court intervene in the state’s ongoing negotiations with healthcare regulators over the extension and revamping of a $1 billion government program that pays hospitals for caring for uninsured and under-insured patients.

In denying Gov. Scott’s request, Chief Judge for the U.S. District Court in Pensacola M. Casey Rodgers cited a June 19 hearing in the state's lawsuit against the U.S. Department of Health and Human Services that will require “extensive preparation on the part of all parties.’’

If the court were to compel mediation in the federal-state negotiations over the hospital payment program known as the Low Income Pool or LIP, then such an order “would be unduly burdensome, expensive, and not likely to advance the process any faster than the expected proceeding currently scheduled,’’ Rodgers wrote.

Gov. Scott issued a written statement following the judge's order, lamenting what he has repeatedly alleged are coercive tactics by the federal government to pressure Florida to adopt Medicaid expansion. 

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June 09, 2015

Gov. Rick Scott, and HCA, back House effort to deregulate hospital expansion

Gov. Rick Scott joined with House leaders and his former company Tuesday and put his support behind a plan to eliminate the controversial law that requires state approval for the building of new hospitals.

“Driving down healthcare costs is essential to expanding access to coverage and increasing quality,'' Scott said in a statement.

The House Health Innovation Subcommittee voted 9-3 along party lines to eliminate the so-called "certificate of need" process that requires state regulators to review and approve the construction of any new hospitals, the replacement of existing hospitals, or the development of certain expansive medical services such as organ transplants.

"When you have a free market, you get a better product at a lower cost and that’s going to help the access,’’ said Rep. Jason Brodeur, R-Sanford, sponsor of the bill.

Opponents, including the Florida Hospitals Association, warned however, that removing the regulation would discourage hospitals from building and expanding in poor areas, resulting in health care deserts as hospitals concentrate in affluent neighborhoods.

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June 06, 2015

House members reject entitlements for others, but enjoy taxpayer-paid health plan themselves

IMG_4830One of the chief arguments Florida House Republicans made Friday when they rejected the Senate plan to help 600,000 working poor get health insurance is that it would create a taxpayer-funded entitlement and would be hard to repeal.

What they didn’t mention during the debate is that they are entitled to a very generous health insurance package that costs $22,000 a year — with premiums mostly covered by Florida taxpayers. And, over the years, they have rejected any attempts by Gov. Rick Scott to reduce the benefit.

For many of the 160 members of the Florida House and Senate, the prospect of having to scramble for cash to pay for medication and doctor visits is not something that keeps them up at night. According to financial disclosure statements, 54 legislators are millionaires and 145 of them are enrolled in the taxpayer-financed State Group Health insurance plan, which includes about 80,000 full-time state workers.

The monthly cost per legislator: $180 a month for a family, or $2,160 a year, and $50 a month, or $600 a year for individuals. That’s only a fraction of the average monthly family premium paid by most Floridians — $1,347 — according to data tabulated by the Kaiser Family Foundation.

Until last year, House members were part of a group of state workers who got an even better deal: $30 a month for family health insurance coverage, and $8.34 a month for individuals. That group, along with 800 legislative staff, the governor and his Cabinet are among about 17,500 state workers, known as the Senior Management and Select Exempt Service, who pay the lowest costs in the state.

More here

Photo: House Appropriations Chairman Richard Corcoran and House Speaker Steve Crisafulli listening to House presentation on Senate health insurance bill Monday. Photo by Mary Ellen Klas

June 04, 2015

Questions and questions: a healthy sampling of 67 of them on health insurance

Rep. Mia Jones, D-Jacksonville, received kudos as she answered questions on the Senate health insurance expansion plan, SB 2-A, from both Democrats and Republicans, for more than 2.5 hours Thursday. 

Here's an abbreviated version of the top 67 questions, followed by Jones' answers: 

Continue reading "Questions and questions: a healthy sampling of 67 of them on health insurance " »

Dueling facts sheets emerge over health insurance debate

We're counting questions asked of Rep. Mia Jones, D-Jacksonville, tasked with defending the Senate Republican's health insurance plan on the floor of the House today, and she's answered at least 50 at this point.

Meanwhile, each chamber released a set of fact sheets explaining their case.

Here is Senate fact sheet: Download Senate facts on FHIX 

Here are House's:  Download FHIX 3.0 Senate Amendment Summary  Download New Fiscal Analysis for FHIX 3.0 (1)

White House economists say that expanding insurance in Florida will save 900 lives

via @dchangmiami

The Obama administration weighed in on Florida’s legislative debate over Medicaid expansion Thursday with an updated version of a report from the White House Council of Economic Advisers, first released in summer 2014 and updated for this year, counting the ways the Sunshine State would gain by opening eligibility for the government healthcare program to nearly all low-income adults.

Most of the projected gains have been trumpeted before: billions of dollars in federal funding and fewer people uninsured or facing medical debt. But, in a reflection of how intense the debate has become, the state-by-state report adds a new measure this year: fewer deaths.

If the 22 states that have not yet expanded Medicaid did so, the report states, 5,200 deaths would be avoided each year. In Florida, the report estimates, 900 fewer people would die each year once coverage was fully in effect.

Washington, D.C., and the 28 states that have already expanded Medicaid will avoid 5,000 deaths per year, according to the report, which derived the estimates from various studies, including two that looked at mortality and access to care after state Medicaid expansions.

The White House released the report, titled Missed Opportunities, just as Florida’s Senate gave bi-partisan approval to a plan that expands Medicaid by drawing federal money into a privately run program to provide subsidized health insurance to low-income, working Floridians.

More here.

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


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