June 25, 2015

1.3M Floridians to keep Obamacare subsidies after SCOTUS ruling

via @dchangmiami @chabelih

The U.S. Supreme Court ruled Thursday by a 6-3 vote that more than 6 million Americans, including 1.3 million Floridians, can continue to receive subsidies under the Affordable Care Act to buy health insurance through the federally run exchange at HealthCare.gov.

Ruling in the case of King v. Burwell, the Supreme Court upheld the Obama administration’s interpretation of the health law that allows billions of dollars in health insurance subsidies — including an estimated $389 million a month for Florida residents — to be distributed in the 34 states where the federal government operates the insurance exchange because the state decided against it. 

Writing for the majority, Chief Justice John Roberts acknowledged that the challengers' "arguments about the plain meaning . . . are strong."

But, he noted: "Congress passed the Affordable Care Act to improve health insurance markets, not to estroy them."

From the majority opinion: "In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase."

Dissenting were Justices Antonin Scalia, who read his opinion from the bench, according to a report from SCOTUSblog.com, Clarence Thomas and Samuel Alito. Scalia was critical of the health law in his reading from the bench.

From Scalia's dissent: "We should start calling this law SCOTUScare."

More here.

Florida politicians react to SCOTUS ruling on Obamacare


The U.S. Supreme Court on Thursday upheld subsidies for the Affordable Care Act, allowing Obamacare to continue as it exists today. Here's the reaction from Florida politicians, updated as they come in:

U.S. Sen. Marco Rubio, R-Florida (also 2016 presidential candidate)

I disagree with the Court’s ruling and believe they have once again erred in trying to correct the mistakes made by President Obama and Congress in forcing Obamacare on the American people.

Despite the Court’s decision, ObamaCare is still a bad law that is having a negative impact on our country and on millions of Americans. I remain committed to repealing this bad law and replacing it with my consumer-centered plan that puts patients and families back in control of their health care decisions. We need Consumer Care, not ObamaCare.

Former Gov. Jeb Bush, 2016 Republican presidential candidate (also released a video statement)

I am disappointed by today’s Supreme Court ruling in the King v. Burwell case. But this decision is not the end of the fight against Obamacare.

This fatally-flawed law imposes job-killing mandates, causes spending in Washington to skyrocket by $1.7 trillion, raises taxes by $1 trillion and drives up health care costs.  Instead of fixing our health care system, it made the problems worse.

As President of the United States, I would make fixing our broken health care system one of my top priorities.   I will work with Congress to repeal and replace this flawed law with conservative reforms that empower consumers with more choices and control over their health care decisions.

Here is what I believe:  We need to put patients in charge of their own decisions and health care reform should actually lower costs.  Entrepreneurs should be freed to lower costs and improve access to care – just like American ingenuity does in other sectors of the economy. 

Americans deserve leadership that can actually fix our broken health care system, and they are certainly not getting it now from Washington, DC.  

Continue reading "Florida politicians react to SCOTUS ruling on Obamacare" »

June 24, 2015

As agreement puts end to LIP debate -- for now -- it also means losses for local hospitals

@MaryEllenKlas @dchangmiami

The tumultuous debate over the future of healthcare funding for the poor came to a quiet end Tuesday as the governor signed into law a budget that includes $1 billion in federal funds to pay for charity care and raise Medicaid rates at Florida hospitals.

In a letter to state officials, the federal Centers for Medicare and Medicaid Services (CMS) said they have “agreed in principle” to a Florida plan for distribution of the Low Income Pool (LIP) funds that pay for hospital care for Medicaid beneficiaries and the low-income uninsured. The plan also calls for paying higher Medicaid rates to hospitals, particularly those that care for large numbers of uninsured patients.

State lawmakers had to redesign the LIP program and raise Medicaid reimbursement rates because the federal government reduced LIP money for Florida by $1.2 billion for the coming year, which led to a budget impasse between the House and Senate this spring and then to a special session on the budget that ended last week.

The Senate, siding with business groups, hospitals and health insurers across the state, wanted to offset the loss of LIP money by creating a privately-run insurance exchange to draw down federal Medicaid expansion money available under the Affordable Care Act. But the House rejected the plan, resulting in the budget standoff. 

Government regulators agreed to extend Florida’s 9-year-old LIP program, but capped spending for the coming year at $1 billion in combined federal and state funds. Under the agreement, combined LIP spending will be capped at $608 million the following year, starting in July 2016.

For this year’s budget, legislators decided to inject $400 million in state funds, which will draw down $600 million in federal matching funds, to raise Medicaid rates for hospitals — offsetting the reduction in LIP funds with higher rates.

Continue reading "As agreement puts end to LIP debate -- for now -- it also means losses for local hospitals" »

June 23, 2015

What Jeb Bush said in Miami this month about SCOTUS and Obamacare


When he spoke to reporters in Miami on June 5, Jeb Bush was asked what government should do if the U.S. Supreme Court rules subsidies for the Affordable Care Act unconstitutional (a decision is due by Monday).

Here's what Bush said:

I think Congress ought to proactively unite behind an alternative to the status quo that would allow for a continuation -- as proposed, for example, by Sen. [Ron] Johnson [R-Wisconsin], or a variation of that -- where we would extend this out so there's not big disruption. But also give states the power to change Obamacare. In Florida it might mean less mandates -- no employer mandate, no employee mandate -- a high-deductible, lower-cost insurance that’s focused on catastrophic coverage in an exchange that's not coercive. So I think this is the opportunity for Republicans to not just talk about how bad Obamacare is -- which it is -- but also to unite behind an alternative. And Congress would have to do this. If not, the governor is stuck, and the Legislature is stuck, in a precarious position.

June 17, 2015

Gov. Rick Scott won't drop lawsuit against feds until decision made on LIP


A federal court hearing that could have featured testimony from Florida Gov. Rick Scott and U.S. Health and Human Services Sec. Sylvia Burwell was canceled today after Gov. Scott withdrew his request that the judge in the case compel the government to continue a hospital payment program set to expire on June 30.

Judge M. Casey Rodgers issued the order today canceling the hearing previously set for Friday, and she ordered the federal government to file a response by July 8 to Gov. Scott's legal complaint that the Obama administration was attempting to coerce Florida to adopt Medicaid expansion by withholding a decision on the hospital payment program known as Low Income Pool.

In a legal brief filed Wednesday, Gov. Scott stated that the Florida Legislature's budget agreement assumes LIP funding will continue and that the proposal sets aside sufficient funds to pay state hospitals that care for large numbers of uninsured and under-insured  patients on Medicaid.

"The budget agreement thus mitigates the threat of imminent harm to the State, its healthcare providers, and their patients,'' the legal brief states.

Continue reading "Gov. Rick Scott won't drop lawsuit against feds until decision made on LIP" »

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.

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

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. 

Continue reading "Judge denies Gov. Scott's request for mediation over LIP program" »

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.

Continue reading "Gov. Rick Scott, and HCA, back House effort to deregulate hospital expansion " »

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