April 24, 2015

Florida House makes offer to help hospitals

In a last-ditch effort to end the budget stalemate, House Speaker Steve Crisafulli on Thursday offered to set aside $200 million in state money for the hospitals and county health departments that would be hurt by the end of a federal-state program known as the Low Income Pool.

It doesn’t back down from the House’s position, now 3 years old, to not expand Medicaid.

The House offer of extra money, which would come from reducing proposed tax cuts and spending on K-12 education, could be used to draw down an additional $305 million in federal funds, Crisafulli said, meaning about $505 million would help hospitals shoulder the cost of treating uninsured, under-insured and Medicaid patients.

Crisafulli conceded that the amount would be less than the $1.3 billion Florida hospitals had hoped to receive from the federal government.

"It's a conversation starter," he said.

Senate spokeswoman Katie Betta said that Senate President Andy Gardiner hadn't yet had time to review the proposal. But earlier in the week, Gardiner recommended dedicating as much as $600 million in state money in the absence of the LIP dollars.

Read more here.

April 23, 2015

Death, polls and jobs: Fact-checking claims about Medicaid expansion

A feud over Medicaid expansion that stretches from Tallahassee to the White House means the Florida Legislature may not pass a budget by the time the session ends on May 1. PolitiFact Florida has been fact-checking the fight over whether more poor Floridians will be able to qualify for heavily subsidized health insurance.

The federal government is offering billions if Florida expands Medicaid, paying 100 percent of the expansion at first and gradually downshifting to 90 percent in later years. The program currently eats up a sizable portion of the state budget.

The state Senate has supported the idea of some type of expansion, while the House remains opposed. Gov. Rick Scott has taken different positions on Medicaid over the years, but has settled into opposition during the session. He’s upped the ante on that by declaring he intends to sue the federal government.

Turn to PolitiFact Florida for the rest of our article about our Medicaid fact-checks.

Sen. Alan Hays volunteers for hospital funding commission

HaysSen. Alan Hays, R-Umatilla, wants to serve on Gov. Rick Scott's Commission on Healthcare and Hospital Funding, he said Thursday.

That's assuming such a commission is created, of course.

Scott proposed the idea earlier this week in light of the gridlock over Medicaid expansion and the potential end of the Low Income Pool, a federal-state program that helps hospitals treat uninsured and Medicaid patients.

Scott, who became a millionaire buying and selling for-profit hospitals, said the commission would "examine the revenues of Florida hospitals, insurance and healthcare providers and how any taxpayer money contributes to the profits or losses of these institutions in Florida.

"A thoughtful analysis of how taxpayer money supports Florida hospitals, insurance and healthcare providers will guide us in a Special Session and aid in the development of the Fiscal Year 2016-17 budget," he said in a statement. "This analysis will also help us prepare for the loss of LIP funding if the federal government decides to decline our amendment request before October."

On Wednesday, Scott called senators into his office and showed them the data on profit margins for local hospitals.

Hays, who supports the Senate plan for expansion, raised his hand to serve on Scott's new commission Thursday.

"I met with Gov. Scott yesterday and told him that I fully support his idea to form a commission to better understand the use of our tax dollars in the health care industry," Hays said in a statement. "If a commission is convened, I wish to serve on it and believe this could be a helpful tool as we work to address the health care challenges facing our state."

Hays noted that the House and Senate have until June 30 to pass a budget.

April 22, 2015

Scott takes aim at hospital profits with six-page list

As Gov. Rick Scott met with senators Wednesday to increase the pressure on them to pass his tax cut package, he was armed with a document.

Holding the six-page document, compiled by the Agency for Health Care Administration, Scott points to the data on profit margins for local hospitals in each member's district.  

In one column is the operating revenue, in another is the operating margin and in the third is the total margin. His argument: How can the state be willing to send tax money to hospitals that are making a profit? 

Scott, a former hospital executive who became a millionaire buying and selling for-profit hospitals, argues that hospitals are shielding their profits. 

It's an argument that Senate leaders say is appropriate -- but not as part of the ongoing budget battle and decision over health care policy. House Appropriations chairman Richard Corcoran disagrees and argues that the discussion is "imperative."

Here's Scott's hospital list.  Download Hospital Profits 4.22.15

GOP senator says Scott's use of 'nuclear option' makes no sense

Republican senators swapped stories on the Senate floor Wednesday after they held one-on-one meetings with Gov. Rick Scott. Lawmakers said Scott reminded them of his priorities of tax cuts and school spending and threatened to kill their bills and veto their budget items.

One GOP senator who was not invited to Scott's inner sanctum was Sen. Don Gaetz, R-Niceville, who has criticized Scott for shifting his position on Medicaid expansion and for Scott's unwillingness to negotiate a resolution to the health care budget stalemate. 

"He's not the first governor to threaten vetoes if he doesn't get his way on priorities. That's well within the rules," Gaetz said. "The problem is, that's the nuclear option. When the governor says, 'All your bills are dead and all your appropriations will be vetoed,' then there's really nothing else to talk about ... It has a tendency to stop productive conversation at that point."

Gaetz has been most critical of the Scott administration's failure, for nearly a year, to send an alternative plan to the federal government in anticipation of the end of a hospital funding program known as LIP, or the low-income pool. Gaetz calls the inaction "governance malpractice." Scott did send the feds the Senate's modified Medicaid expansion plan earlier this week.

"The meetings that have been held today lose him some ground in human relations," Gaetz said of Scott. "There are some senators who will not take kindly to being threatened."

April 21, 2015

Cheat sheet: House GOP's nine talking points on Medicaid expansion

To hold a meeting among House Republicans in private to discuss Medicaid expansion and the Low Income Pool, Speaker Steve Crisafulli said the meeting was for informational purposes only.

“It was strictly a history lesson for our members,” Crisafulli said. “It was important for us to do it.”

Yet the 20-page packet distributed to members during the secret meetings makes for a poor history. It’s more of a nine-step guide on how to defend the House’s double-down rejection of Medicaid expansion.

Crisafulli and other House leaders make it easy for any caucus members who might be wavering, or who might be running out of things to say in explaining their refusal. On page 3 of the packet,  nine talking points are provided.

Pay attention: We’ll probably be hearing these repeated over the next two weeks.

-- Medicaid expansion and the Low Income Pool (LIP) are separate issues. (Not if you’re the federal government and the Florida Senate.)

-- Nothing should give our state more pause in this debate than the Obama Administration’s attempt to force Florida to expand Medicaid under Obamacare in order to receive LIP funding.

-- It is unthinkable that the federal government would leave our state on the hook for over a billion dollars simply because they want a specific policy outcome. (That sounds hauntingly similar to what Gov. Rick Scott said. Wonder if they are sharing notes.)

-- I support a safety net for our most vulnerable citizens, but I believe that Medicaid expansion is the wrong approach to strengthening that net.

-- Just because a person has Medicaid does not mean they will have better health. They only scientific study of Medicaid in the country found that Medicaid patients’ clinical outcomes are no better than the uninsured.

-- There is also no flexibility in Medicaid expansion. Florida cannot choose the population, benefit, design, price or eligibility conditions.

-- Medicaid is supposed to be a safety net, but the expansion population goes beyond traditional Medicaid populations of vulnerable people like low-income children, the disabled, and the elderly.

-- We must take a very cautious and deliberate approach to implementing PPACA. If Florida expands Medicaid, it may not be able to undo that decision.

-- We will continue to listen to new ideas. I believe we should strengthen our safety net by continuing to find new and better market-based solutions that are sustainably funded and will provide Florida families and seniors with access to quality, affordable healthcare.

Overheard from a super secret House Republican meeting


For more than an hour, House Republicans met to discuss Medicaid expansion and how it relates to the Low Income Pool, the two issues that have made the legislative session screech to a halt.

But Republicans decided to ban the public from the meeting, claiming they wouldn't talk about pressing legislative matters.

So reporters had to stand outside and wait for lawmakers to come out and recap what they couldn't discuss in public. Yes, this is Florida, which prides itself on its open meetings law. And yes, despite that pride, legislators can lock out the press so they can discuss matters like Medicaid expansion.

Associated Press reporter Gary Fineout listened in to the meeting by placing his ear at the crack of door. It's not glamorous, but Fineout was able to catch certain phrases here and there. Here's what he told the rest of us as we waited for Republicans to end their secret meeting.

"We're asking you to trust us," Speaker Steve Crisafulli told Republican members. "Feel good about where you are." (applause)

Crisafulli told the caucus that former Gov. Jeb Bush was taken out of context when he was recently quoted on Medicaid.

"We're going to get beat up by the press," Crisafulli said.

"We're going to do what we can do to get out of town constitutionally, whether it's through a special session or extended session," Crisafulli said.

That sure sounds like strategy and discussing action on future legislative action. But afterward, Crisafulli pointed out that Medicaid expansion is not legislation that is before the House. It is, however, in front of the Senate, which Fineout said would subject the meeting to the open meetings law.

Crisafulli, however, said the House's general counsel, Matt Carson, had cleared the script that Crisafulli was reading from.

“I was very scripted. He said everything we were doing in that meeting was perfectly within the confines of the the law.”

April 20, 2015

When Marco Rubio compared Common Core to Florida battle over LIP and Medicaid expansion


New Hampshire voters don't really know or care about Florida's fight with the federal government over hospital charity funding and Medicaid expansion under Obamacare. But Marco Rubio used the tussle as an example Friday in Manchester about what he characterized as Washington's threat over state capitals.

An educator at Manchester Community College, where Rubio held his first campaign event since announcing his 2016 presidential candidacy, asked him about Common Core, the controversial education standards that many Granite State Republicans consider a four-letter word.

Rubio said he was "cautious" about giving the federal government any role in setting school curricula.

"I've always made the argument that the federal government always ends up turning a carrot into a stick," he said. "They'll tell you these are the standards we want you to meet, but it's just a carrot. If you do it, we'll give you money. They ultimately turn it into a stick and force you to do it."

Then he pivoted to Florida, where the Republican state House and Gov. Rick Scott are battling the Republican state Senate over whether to accept federal dollars to expand Medicaid to plug a budget hole caused by the feds' ending of the indigent-hospital fund known as the low-income pool.

"Just now in Florida there's a big fight going on -- it has nothing to do with education, it has to do with healthcare," Rubio said. He explained LIP and said it "has nothing to do with Medicaid expansion."

"The federal government is now telling Florida, if you don't do Medicaid expansion under Obamacare, we won't give you the LIP money," Rubio said. "And I fear the same thing the same thing's going to happen with a program like Common Core."

Rubio, a former Florida House speaker, later told reporters that he disagrees with the feds.

"I don't think the government should hold them hostage," he said. "And that's what's happening: The federal government is basically telling the state, unless you do something we want on an unrelated matter, you wont get LIP funding. I think it's an example of federal overreach and what federal agencies always do."

Asked a similar question a day earlier in New Hampshire, Rubio's likely rival former Gov. Jeb Bush said the state and federal governments should look for middle ground to resolve the impasse, which is holding up next year's budget. A Bush spokeswoman later added that Bush opposes Medicaid expansion.

What polls say about Medicaid expansion in Florida

The Florida Legislature is split on what to do about Medicaid expansion, but House Speaker Steve Crisafulli said that isn’t the case for many constituents.

"If you go into a federal program like that, you will soon find out what it means to be married to Washington. There's folks that are not in this chamber today because of that very issue," he told radio station WUSF’s Health News Florida. "People spoke in those districts, and we feel like Medicaid expansion isn’t necessarily a very popular issue on the street."

The Florida House and Senate are currently debating whether to expand the program to insure the very poor as part of contentious budget negotiations. Crisafulli, R-Merritt Island, opposes Medicaid expansion and was speaking broadly about how discussing it had doomed some candidates’ political ambitions. His office said he "was speaking as a matter of his perspective."

But we at PolitiFact Florida thought his statement can be verified or contradicted by public opinion polls. And since it's such a critical issue in Florida, we decided to take a look.

See what Joshua Gillin of PolitiFact Florida found.

Negotiations over hospital funding inching along

Florida has officially petitioned the federal government to renew a $2.2 billion program for hospitals that treat low-income patients, the state Agency for Health Care Administration said Monday.

State health officials are asking the U.S. Centers for Medicare and Medicaid Services (CMS) to continue the so-called Low Income Pool program through June 30, 2017. They have submitted a plan created by the Florida Senate that would distribute the funds more broadly than in the past.

"We are expediting our submission of this LIP model in order to help CMS speed up their decision," Secretary Liz Dudek said in a statement. "CMS knows that our budget depends on their rapid response to this model."

The agency will allow members of the public to submit comments on the plan from April 21 through May 22, and will hold public meetings in Orlando (4/29), Miami (4/30) and Tallahassee (5/1).

The uncertainty surrounding the Low Income Pool has brought the budget building process to a virtual halt in Tallahassee. It has also become part of a larger debate on whether to extend subsidized health care coverage to more than 800,000 low-income Floridians.

Last week, Republican Gov. Rick Scott announced his plans to sue the federal government for saying the future of the LIP program would be tied to the Legislature's decision on Medicaid expansion. Scott called the move "a coercion tactic."

The politicking continued Monday, when Texas Gov. Greg Abbott commended Scott's decision "to take legal action to protect these important constitutional principles."

"Texas will support Florida in its litigation against the federal government," said Abbott, a Republican whose state is in a similar situation. "Medicaid expansion is wrong for Texas. Florida's approach should be determined by Floridians, not coerced by federal bureaucrats."