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Dominic Calabro, Bob Ward: It’s time to rethink class size requirements

Remember the last special legislative session when the world was abuzz with the news that $100 million more was being added to the schools budget?  Now, imagine at least 20 times that amount being added every year. It could happen.

Substantial scientific research shows that the current class size requirement in the Florida Constitution loses much of its effect above the Grade 3 level. That means that the state is plowing about $2 billion each year into an unproven education reform which does little to help our children succeed. Simply put, it’s money that could be better spent on other educational programs.

Since 2002, taxpayers have invested more than $36 billion to reduce class sizes with the expectation that smaller classes will improve student achievement, but they have little to show for that investment in most grades. The most definitive study of class size reduction in Florida, conducted by Harvard University researchers, shows that class size reduction had no discernible impact on student achievement, absenteeism or behavior in grades 4-8. There is evidence that smaller classes for PreK through 3rd grade has promising effects on student learning, and both Florida TaxWatch and the Florida Council of 100 agree those class sizes should remain small or get smaller. However, the substantial body of research shows that the policy should be abandoned for grades 4 and above with the money reinvested in strategies that will increase student learning.

That’s the underlying theme of years of TaxWatch research, available on the TaxWatch website, and the Florida Council of 100’s recent report, Horizons 2040:  Prekindergarten to Grade 3. Horizons 2040 makes numerous recommendations for improving our school systems, including attracting and retaining high-performing teachers and leaders; expanding high-quality voluntary prekindergarten programs; providing school districts with a flexible source of funds for specialized student populations, such as English language learners, struggling or at-risk students, or students needing intensive reading instruction; expanding the use of technology and personalized methods of school instruction; and even reducing class sizes where proven effective like in grades PreK-3. The Council of 100 recommends paying for these enhancements with class size savings, and years of independent research by Florida TaxWatch concurs with the need to reinvest the money wasted on class size reduction.

Despite the substantial investment of state funding and the flexible methods to comply with the constitutional requirement afforded by statute, local school districts continue to struggle financially to meet the requirements and some districts have had to choose between hiring more teachers and saving vital programs.

Florida TaxWatch and the Council believe that there is no substitute for having a well-qualified and experienced teacher in every classroom and that districts need the flexibility to cater to the educational needs of their students.

The idea would be for the Legislature to develop a special list of uses for the money and then let school districts decide how best to allocate the dollars to help their students. For example, a district with many English Language Learners might want to invest in more reading coaches while a district needing laptops could spend its funds on that. Additionally, school districts could use the repurposed funding for the No. 1 factor in a student’s success — hiring and paying more outstanding teachers.

To make this happen, though, we must amend the Florida Constitution. The Florida Council of 100 has proposed just such an idea to the Constitution Revision Commission (CRC), and it’s vital that we all get behind it.

Florida is the only state that gives taxpayers a voice in amending their state constitution through a Constitutional Revision Commission. Every 20 years, this body meets to consider reforms that will better serve the people and taxpayers. The CRC is a once in a generation opportunity to make a real difference in the lives of our children. Please join TaxWatch in calling on the CRC to take up this issue and put it on the 2018 ballot for all to vote on. Our students and the taxpayers of Florida funding their education deserve nothing less.


Dominic Calabro is president and CEO of Florida TaxWatch; Bob Ward is president and CEO of the Florida Council of 100.


Ron Sachs: Gov. Scott demonstrating finest leadership in Florida’s darkest hours of Hurricane Irma

Florida Governor Rick Scott is delivering the most defining moments of his nearly seven years in office as he continues to urge Floridians to prepare for, evacuate from and stay safe in the face of Hurricane Irma’s imminent threat to human life. As we witness the single best demonstration of leadership by a governor whose near-total focus since January 2011 has been on “jobs,” Gov. Scott is doing the best job of his tenure in helping millions of Floridians deal with the ominous approach of this natural-born killer.

The governor is devoting his total leadership to an important, incessant daily presence on multiple platforms, including frequent live statewide and national broadcasts. There is no self-aggrandizement involved in the smart, strong and strategic voice and vision Scott is displaying. He is calmly but surely delivering a consistent, confident and comforting set of useful updates and relevant warnings by stressing real and present dangers to us all. And, by properly using the power of his office and all of the appropriate resources of state government at his command, Scott has been pitch-perfect in his words and actions.

Just a few key examples are worth noting now:

  • The frequent updates, warnings, and advice for what to do, how to do it, and when to do it, with a cumulative positive impact to motivate people to follow directions in their own best interests.
  • The early decision to waive highway tolls to ease wave after wave of evacuees is likely going to save precious time and countless lives. Rescinding weight restrictions for trucks will enable timely delivery of supplies into Florida.
  • Activation of Florida Air and Army National Guard; advance declaration of emergency in all 67 counties – and outreach to President Trump for advance and post-storm emergency federal resources.
  • The diplomacy apparent in the preparations and responses among local, state and federal entities is already setting a modern model for ensuring that all forces are coordinating and cooperating, rather than competing and conflicting.

Yes, it would be the job of any governor to be the “Emergency Manager-in-Chief” in the face of such a horrific and deadly danger that is about to unleash what could become the worst natural disaster in Florida’s and America’s modern history. But actually doing the job requires a combination of skill, commitment and managerial excellence that can reveal either a governor’s great leadership ability or an untimely, woeful inadequacy. If you’re the governor, you don’t get to blame a chief of staff, communications director or emergency operations center for your own leadership failings when it really matters the most.

Fortunately for Florida, Gov. Scott’s demeanor, decision-making and dedication are reflecting that he has the “right stuff” – at the right time.

Going back 25 years ago to Hurricane Andrew’s deadly visit to Florida in August 1992, Gov. Lawton Chiles presided over what was then the worst natural disaster in modern history, with 44 deaths and $30 billion in damage. With far less technology available then to help, Chiles still marshaled every resource possible to essentially relocate the major functions of state government to South Florida, before and after the storm.

The recovery and rebuilding of damaged communities from Andrew became a complete focus for state government, typified by a special session of the Florida Legislature convened in December 1992. Then, in an appeal for humanity and unity above anything else, Chiles – a Democrat – forged a total nonpartisan alliance with an increasingly Republican Legislature to “ensure that hurricane victims do not become political victims, too.” Among the other key takeaways from Chiles’ leadership through Andrew was his insistence on a new paradigm for how local, state and federal emergency managers interact and cooperate. (That same lesson had to be learned again after a similar breakdown among the three levels of government in the response to Hurricane Katrina’s devastation in Louisiana.)

Gov. Jeb Bush arguably used the levers of power with greater ease than any modern Florida governor to achieve a specific agenda in many new policy initiatives, including some that still generate partisan debate today. But it was Bush’s brilliant management and personal leadership through multiple natural threats to Florida’s people, communities and resources that properly won his legacy as the state’s best ever “Master of Disaster.” No governor before or since was confronted with so many natural threats – mostly in a series of hurricanes and wildfires – that presented a test of leadership on an ongoing basis. Governor Bush passed that test, repeatedly, with A-plus marks and set the highest bar for what a chief executive ought to do to protect Florida.

At any time in Bush’s eight years as governor, the poor handling of even a single hurricane or wildfire would have been the dark cloud that might still define his era as governor. Instead, even political rivals and adversaries openly heap deserved praise on how deftly Governor Bush demonstrated his finest leadership skills with such total aplomb in so many stressful, dangerous times.

It’s OK to differ with any governor over politics and policies on education, human services, budget and taxes, or anything else. But the leadership we all need in a crisis has to be valued above any differences we have over issues that seem far less important when weighed against protecting lives.

As all of Florida and many parts of the U.S. brace for Irma’s already-deadly force, there is a sense of unity of purpose in the laser-focus on safety. The courageous and herculean efforts of thousands of first responders, state and local government officials, nonprofit agencies and countless volunteers will be key to enduring, surviving and recovering from the assault that Irma is about to unleash.

Governor Scott’s leadership is being tested as never before – and surely we need strong, steady leadership to help guide us through Irma’s approach, impact and aftermath. While there is so much to still do ahead, Governor Scott has shown he is up to the task of leading us through this worst threat. In our own way, as we ask God to protect our people, homes and communities, we can also put in a timely prayer for Governor Scott’s continued fine leadership.


Ron Sachs is CEO of Sachs Media Group, which produces “Get Ready, America!” – a national hurricane safety initiative: He served as communications director to Gov. Chiles.

Cheryl Elias: Addressing Florida’s opioid crisis must include helping the person with the addiction

Each day it becomes more and more apparent that opioid addiction and trafficking are plaguing Florida. According to the Florida Department of Law Enforcement, five out of the nine types of drugs that caused the most deaths in 2015 were ones that fall within the category of opioids.

Two years later, we are seeing the effects of opioid addiction escalate and there does not seem to be a part of the state, rural or urban, that has not seen some impact.

Drug addiction and abuse is a major public health problem in the U.S. and associated costs go well beyond the standard medical bills. Costs related to drug addiction encompass those that result from developing other chronic health conditions, increasing crime rates, loss of work productivity and even unemployment.

In hospital costs alone, this epidemic cost Florida more than $1 billion in 2015. And let us not forget drug addiction’s impact on families and communities. The emotional hardships felt by those trying to help the person suffering from addiction are often unimaginable and the fact that their own lives are turned upside down cannot be ignored.

Understanding that addiction’s impacts reach far and wide, it becomes clear that to make any difference we need to address this issue in a comprehensive way.

Thankfully, our leaders in government are quickly realizing opioid addiction’s impacts and catastrophic effects and are taking action. Just this year, Sen. Marco Rubio was an original cosponsor of the Synthetics Trafficking & Overdose Prevention (STOP) Act to help reduce the flow of illicit fentanyl into the country, and he is also working with U.S. Health and Human Services in bringing grant dollars into the state aimed at combatting opioid trafficking and abuse in Florida.

Sen. Rubio understands how pressing this issue is for Floridians, and the actions he has taken this year are commendable.

However, efforts to address this issue should not stop there. There is still a long road toward a Florida free of opioid abuse, and part of this strategy should include providing proper treatment to those who suffer from addiction.

Patients seeking help in their recovery should have adequate access to all FDA-approved treatment options, including those which are non-opioid based. People can react differently to the same medication. What works for some will not necessarily work for all, and treatment should ultimately depend on the patient and the health care professional overseeing their recovery.

The goal here is to reduce and even eradicate addiction in the state of Florida to provide a more safe and promising future for everyone. Every Floridian can benefit from a reduced incidence of opioid addiction and abuse, so why not do everything we can to help those who need it most?


Cheryl Elias is Executive Director of the U.S. Rural Health Network, an organization dedicated to creating and maintaining a dialogue between national health care advocates and rural communities.


Manley Fuller: Legislators must implement Amendment 1 conservation spending

Our Florida elected legislators are coming back to Tallahassee this month to begin deliberating the public’s business. In legislative committee meetings, they will start deciding which issues will become priorities for the official 60-day 2018 legislative session that begins in January.

One question all citizens should be asking our lawmakers: Will they once again blatantly ignore Florida voters by failing to appropriate adequate funds for state conservation land buying?

Florida voters are divided on many things, but on this, we are clearly united. Just look at the numbers: Voters approved adding the Florida Water and Land Conservation Amendment (Amendment 1) to our state Constitution in 2014 by a landslide — it got a whopping 75 percent majority, more than any other ballot initiative or candidate. Its title was clear: “Water and Land Conservation — Dedicates funds to acquire and restore Florida conservation and recreation lands.”

Yet our state lawmakers in the past two years have boldly swiped the money that voters earmarked for conservation land-buying and instead spent it on other things it’s not supposed to pay for, like state equipment, government worker salaries and even insurance premiums. This year’s state budget had zero dollars for Florida Forever, a program that used to get $300 million a year to buy conservation lands. This is not right, and we need to demand that our elected officials fund conservation land-buying in the 2018 Legislative session.

Take a look at the map that accompanies this article. You can see the lands that our state could buy or have conservation easements on if lawmakers spent our tax dollars as the Water and Land Conservation amendment requires them to do. The map shows potential conservation lands with willing sellers which the state has already approved for purchase. The tax money is available to move forward with those purchases, but lawmakers aren’t doing their jobs by directing the money where it is supposed to go.

The Water and Land Conservation Amendment requires that, for the next 20 years, 33 percent of the proceeds from the already-existing real estate documentary-stamp taxes go for conservation land acquisition and restoration. When it became clear lawmakers were ignoring the voter mandate, our group — the Florida Wildlife Federation — along with the Sierra Club, St. Johns Riverkeeper, and the Environmental Confederation of Southwest Florida went to court on behalf of Florida citizens. Our case is still ongoing.

Floridians have made it clear that we want our land and water conserved as a legacy for future generations. We want a green infrastructure to support the assets that make this a great place to live. We want clean water for people and wildlife. We want places set aside so that every inch of our state is not covered by strip malls, golf courses and housing developments.

Legislators made a promise to represent us, and it’s wrong for them to keep ignoring us. Let your legislator know you are tired of this, and that you want the dollars you voted for conservation land-buying to be directed to conservation land-buying in the 2018 Legislative session.


Manley Fuller is president of the Florida Wildlife Federation.

Christian Cámara: In Florida insurance market, all is not equal

According to a study conducted by the risk assessment group Karen Clark & Co., if Hurricane Andrew hit today, it would cause nearly $50 billion of insured losses, compared to its $15.1 billion in 1992.

Indeed, Florida enjoys a relatively stable insurance market with more companies writing more policies. However, there are concerns that new, untested insurers may not survive a major strike. While it is true that several newer, smaller companies do not maintain the levels of surplus that more established companies do, they make up for it by purchasing reinsurance.

Reinsurance is insurance for insurance companies. Most isolated claims — fires, thefts or damage by random thunderstorms — are paid out of a company’s surplus, while larger losses from widespread catastrophes like hurricanes trigger insurers’ reinsurance contracts. Given Florida’s natural risks, the cost of reinsurance factors heavily in the calculation of homeowners insurance rates.

The good news is reinsurance prices have dropped precipitously over the past decade. This “buyer’s market” has allowed insurance companies to purchase more coverage for less, thus strengthening their finances and permitting them to write more policies. As such, Florida’s property insurers should be able to weather a large hurricane, all things being equal.

The bad news is, all things are not equal.

Currently, Florida’s insurance market is being undermined by a cottage industry exploiting an insurance practice called assignment of benefits (AOB). This allows a third-party contractor — such as a roofer or water-extraction company — to assume control of a homeowner’s policy to collect payment directly from the insurance company. Although a normal practice in other areas such as health insurance, Florida’s litigious environment has encouraged bad actors to inflate their bills and then file frivolous lawsuits for small, simple or even uncontested claims. The result: higher insurance rates.

But leaving AOB abuse unaddressed doesn’t just cause higher rates.

The models used to calculate an insurer’s risk exposure, which then determines how much surplus and reinsurance they must maintain, do not normally factor fraud and abuse costs. Therefore, a storm may actually wind up costing more than models suggest. Therein lies the problem: companies that have amassed enough resources to cover legitimate hurricane claims, as required by law, may not have enough to cover fraud, unnecessary litigation or other AOB-related abuse.

According to the Office of Insurance Regulation, water claims filed under an AOB have much higher severity — generally at least 50 percent more — than claims filed without one. In 2010, only 6 percent of claims were filed using an AOB; by 2015, the figure jumped to 16 percent and continues to rise.

These figures are all related to non-catastrophe water claims, so it’s impossible to predict how many hurricane claims would be filed utilizing an AOB. But one thing is certain: given current trends, if an Andrew were to strike today, the estimated $50 billion price tag may turn out to be a lot more with the addition of AOB abuse — and many insurers may not be prepared for it.

A moderate AOB reform package passed the Florida House of Representatives with bipartisan support this year, but died in the Senate. If higher rates aren’t enough to push senators to pass necessary reforms, perhaps the threat of insolvencies and thousands of unpaid hurricane claims may do the trick.


Christian Cámara (@ChristianCamara) is a senior fellow at the R Street Institute, a member of the Stronger Safer Florida coalition.

Adam Putnam: The right to vote

On July 4, 2017, 15,000 immigrants were sworn in as new American citizens — something each and every one of them worked hard to attain. On that day, they earned the most sought-after citizenship in the world and swore they would support and defend our Constitution. And on that day, along with their citizenship, they were granted the right and the responsibility to vote,

Voting is a right that we, as Americans, hold dear. It is the right to choose the leaders who represent us. It is the foundation of a democratic republic. That’s why we must protect that right and not minimize the value of it by allowing noncitizens the same right.

There are more than 11 million illegal immigrants currently living in the United States. These illegal aliens have crossed our borders, violated our laws and ignored the processes we have in place to keep our citizens safe.

And, yet, there are cities throughout the United States that willingly ignore this violation of the law. Many cities, like New York, Chicago and Los Angeles, proudly call themselves “sanctuary cities,” where violent illegal aliens can find refuge and forgiveness for any violations of the law they have committed. These sanctuary cities put the safety of all American citizens at risk to harbor fugitives.

Even worse, some cities across our nation have taken it a step further. Not only are they allowing violent illegal aliens to remain within their boundaries without the threat of getting caught, but some cities are going so far as to grant illegal aliens the right to vote in America.

In San Francisco, voters passed a proposition in 2016 that grants illegal aliens with school age children the right to vote in school board elections. The proponents of the measure argued that they wanted better representation on the school board, and, if their kids — children of illegal immigrants — are in school, then they should have a voice on the school board.

Now, a college town in Maryland is mulling a similar initiative. College Park is currently weighing a new measure to permit illegal aliens vote in elections. Proponents of the measure argue that residents — no matter their legal status — rely on critical government services and should have the opportunity to weigh in. Should College Park approve this absurd measure, it would be one of 11 cities in the Maryland to do so.

Cities like San Francisco and College Park, among others, have lost their American values, and have been overrun by liberals. They have forgotten the principles our nation was founded on — the right for American citizens to choose our leaders — in granting foreigners who violated our laws to come to our country the right to shape our country’s future through voting.

It is simple: You are either an American citizen or you are not. If you are, you enjoy the rights and privileges of American citizenship. And you also bear the responsibility to ensure its safety and survival for generations to come. The right to vote should not be allowed or practiced by anyone who was not born in our country or who has not taken the necessary, legally required steps to become a citizen of our nation. This right is too precious to grant to those who have not earned it.


Florida Agriculture Commissioner Adam Putnam is a native of Bartow. He is a Republican running for Governor.

Andrew Behrman: Burdensome requirement threatens health centers’ ability to offer care

With governments wrestling with the ever-increasing costs of health care, it is critical for all of us to consider ways Florida can save money while still serving those with limited access to care. This is why we should all support the mission of Florida’s 49 Federally Qualified Health Centers (FQHCs), which serve over 1.4 million low-income, uninsured patients and save the state hundreds of millions of dollars that otherwise would be needed for costly emergency room services.

Unfortunately, the ability for our centers to continue to provide critical services to even more uninsured patients is in jeopardy because of an unnecessary bureaucratic rule that would expand significant inefficiencies in the state’s existing reimbursement system.

Earlier this month the Trump administration approved a Florida Medicaid waiver increasing Low Income Pool (LIP) funding to $1.5 billion. A relatively small portion of this, $50 million per year for the next five years, was specifically designated to help FQHCs cover the significant costs of uncompensated care for low-income or uninsured patients. This funding is absolutely crucial for our centers’ ability to serve vulnerable communities. The Florida Agency for Health Care Administration’s proposed reimbursement system would create unwarranted administrative hoops and delay our ability to serve these Floridians.

Our centers are a key part of Florida’s health care safety net. We operate in every Florida county, with over 460 locations across the state, and by law cannot turn away any patient who needs our services. Our doctors treat patients who desperately need access to care but cannot afford it. More than one-third of our patients are uninsured, and another half depend on Medicaid or Medicare.

By seeing these patients in our centers, we avoid the need for visits to hospital emergency rooms — saving the state hundreds of millions of dollars each year. Despite this tremendous return on investment, the state has dramatically cut our funding to a mere $9 million last year and then, to make matters worse, reduced it further to $6 million in the current fiscal year.

The recently approved LIP funding is absolutely essential for us to be able to continue operations and serve Florida’s communities efficiently. But forcing all reimbursements to go through managed care organizations, rather than state paying bills directly, will lead to delay and inefficiency making it difficult for our centers to operate.

Since our centers are required to see every patient who comes in the door, they will continue to do so for as long as they possibly can. However, it is fair to be concerned about the potentially dire consequences. Many community health centers are struggling now to make ends meet in the face of delayed and disputed reimbursements, and we fear this will only worsen if the managed care organizations are given even more authority over payment decisions.

The money is available, and our centers are ready to meet the ever-growing need for their services. If freed from burdensome requirements on the new funds, our centers can provide additional medical care, which in turn will lead to even greater savings for the state. AHCA must allow our centers to access the funding, without unnecessary roadblocks that delay the ability to provide the care our communities so desperately need.


Andrew Behrman is president and CEO of the Florida Association of Community Health Centers.


Amy Mercado: The never-ending battle against higher premiums

We recently learned that if the Donald Trump administration pulls Obamacare subsidies, premiums will jump 20 percent on the most popular coverage, according to the nonpartisan Congressional Budget Office. This would be very bad news for Floridians who are already struggling with the rising costs of health care.

Our state has led the nation in Obamacare sign ups with more than 1.6 million enrolled in 2017, up from 1.1 million the prior year. This is due, in some part, to the refusal of leadership in Tallahassee to expand Medicaid that left up to 1 million Floridians without access to the health care coverage they need to live and work.

If there is any doubt about the dire need for affordable health care coverage, 45 of 50 states have fewer uninsured people than Florida. We simply can’t afford any premium increases.

That’s why it’s also important to once again delay the looming Health Insurance Tax.

This Health Insurance Tax, also known as the “HIT tax,” was previously delayed by Congress for the current year. The delay received bipartisan support, with 400 members of Congress voting in favor of the delay, and it was signed into law by President Barack Obama.

The Health Insurance Tax is estimated to increase premiums on certain policies by about 3 percent in January 2018. Seniors enrolled in Medicare Advantage and small-business owners, their employees and their families will also have to pay more out of pocket.

And the state Medicaid budget will be squeezed even more than it is already — especially bad timing considering the Florida Legislature just cut funding for care provided to Medicaid patients.

As a working mom, businesswoman and former health care worker, I know that every penny counts. When you can’t afford coverage, you can’t afford to get sick.

I also know these numbers don’t tell the whole story.

When we talk about health care here in Central Florida or anywhere in the country, we need to think about our friends, our family and our neighbors — real people trying to make ends meet.

That’s who pays higher premium costs due to the actions or inactions of our lawmakers.

When I go back to Tallahassee for committee weeks and the 2018 Legislative Session, I promise to continue fighting for better access to the health care coverage Floridians deserve.

I hope that our federal lawmakers, Sens. Marco Rubio and Bill Nelson, and our local Congressional Delegation, including Reps. Stephanie Murphy, Darren Soto and Val Demings will support continued Obamacare subsidies and also delay the Health Insurance Tax for 2018 to keep premiums from rising on small businesses, seniors and our state budget.

Floridians can’t afford any premium increases.

We need more affordable coverage, not less.


Amy Mercado represents District 48 in the Florida House of Representatives.

Ed Pezalla: Pharmacy benefit manager are meeting challenge in reducing Rx costs, improving clinical quality

In the current debate over health care, employers, unions, and government programs all agree on the need to provide prescription drug coverage at lower costs while increasing the quality and clinical value of pharmacy benefits.

That’s why the companies and public programs providing prescription drug coverage hire pharmacy benefit managers, or PBMs. Through their expertise and market scale, PBMs are able to reduce drug costs by negotiating rebates and discounts from big drug companies and drugstores. It would be too expensive and complicated for employers, or other payers, to match PBMs’ ability to reduce drug costs, while providing access.

Though drugmakers continue to raise prices out of proportion to increases in value, PBMs are doing their job by keeping drug costs down. A recent report by QuintilesIMS Institute showed that discounts, rebates, and other price concessions on brand-name drugs reduced overall drug spending by an estimated 28 percent in 2016. The report also shows that net price growth – the price payers actually pay – for prescription drugs is likely to remain in the 0-3 percent range, largely because of the work of payers and PBMs.

Having been involved as a clinician representing insurers and PBMs for more than 25 years, I know firsthand the importance of leveraging savings while ensuring that patients have the medications they need.

One patient-friendly cost savings option that PBMs provide to consumers is home delivery of chronic medications.  As more and more people move to a “home-delivery economy” for many of their needs, mail-service pharmacies are a natural extension that adds convenience and lowers costs. By using home delivery, consumers can avoid multiple (and unnecessary) trips to the drugstore while receiving private counseling from trained pharmacists seven days a week, 24-hours a day.

Mail-service pharmacies feature cutting-edge technology that can track and improve patients’ adherence to prescribed medications. Research shows that better adherence to prescribed drug regimens means that patients won’t need as many trips to the doctor or hospital, lowering overall health care costs for everyone.

It’s easy to see that PBMs reduce drug costs, but often overlooked is the clinical value that they provide payers and patients. PBMs work in coordination with their clients in carefully evaluating new drugs, review existing drugs, and apply sophisticated drug assessments that promote the best use of complex medications, and the appropriate use of mainstay drugs.

Pharmacists, doctors and other professionals employed by PBMs review the medical evidence for every drug approved by the FDA and assist in managing drug-related side effects and provide support so that patients stay on their drug regimens and out of the hospital. That, in turn, lowers costs for patients and the entire health care system.

These formularies organize medications according to their therapeutic effects and create logical sequences for their use based on clinical effectiveness, place in therapy according to national guidelines, and safety.  Generic and lower cost brand medications can be incentivized before more expensive medicines because they work well for the majority of patients and have lower copays.

Lastly, as the health care sector moves toward payment for value rather than volume, PBMs are providing expertise in developing and executing on these types of contracts that are intended to ensure that our pharmaceutical dollars are spent on drugs that provide the best outcomes.

These agreements require a high level of sophistication about drug use patterns and patient outcomes, as well as the ability to monitor and improve patient compliance and measure relevant outcomes.

As the public debate continues to unfold on health care, PBMs are part of the solution that lowers drug costs and improve quality.


Ed Pezalla, M.D., MPH, is a leading innovator and consultant on payer strategy for pharmaceutical and device manufacturers, and is currently a Scholar-in-Residence at the Duke-Margolis Center for Health Policy in Washington.


Janet Cruz: Hillsborough school AC issues part of much bigger problem

With a new school year kicking off this month, parents across Florida logically expected that the state is providing the proper environment necessary for children to achieve their greatest potential.

That’s why I was outraged to read last week about students in Hillsborough County who are languishing in sweltering classrooms because the school district simply does not have the resources to fund the proper maintenance of air conditioners in schools.

Make no mistake about it: this is a moral failure by Republican leaders in Tallahassee who are more interested in helping the for-profit charter school industry than in ensuring the more than 2.5 million children in traditional public schools have the resources they need to succeed. For the last 20 years, there has been a relentless assault on traditional public schools in order to siphon your tax dollars into the pockets of corporations and eventually privatize Florida’s entire public education system.

This past legislative session we heard a lot about not picking winners and losers, but a look at the numbers show where Republicans’ priorities lay.

Right now, there are around 4,270 traditional public schools in our state and there are about 650 charter schools.

Last year, both traditional public schools and charter schools received $75 million in Public Education Capital Outlay, or PECO, funding. This is the funding pool schools draw from to pay for the construction of new schools or buildings and for maintenance and upkeep of existing facilities, such as repairing air conditioners.

It’s obvious that charter schools will be receiving far more money per-facility than our traditional public schools. What makes this equal split even more alarming is that as recently as the 2012-2013 and 2013-2014 budgets, public schools received no funding at all, but charters received over $140 million. While public schools struggle to dig out of a hole they were left in by Tallahassee Leadership, charters continue to rake in your tax dollars.

What’s even more egregious is that you, the public, don’t even own the facilities that charter school operators are using your tax dollars to fix up. In fact, investors from Oregon spent over $100 million this month buying charter school real estate in Florida and while many so-called “charter management organizations” purport to care about education, in many cases they are nothing more than glorified real estate holding companies.

Making matters worse, the Legislature continues to make it more difficult for districts to make up the loss of funding from Tallahassee with local tax dollars.

Originally, districts could collect $2 for every $1,000 in taxable property value to help fund capital projects. That was rolled back to $1.50 during the height of the Recession, resulting in millions of lost dollars for districts statewide.

Also, as part of the monstrous education bill, HB 7069, rammed through the Legislature this year despite bipartisan opposition, districts will now be forced to share a portion of those already scant local tax dollars with charter schools. Again, your tax dollars being used for the maintenance and upkeep of facilities the public does not own.

Why is it so important that your tax dollars are going to schools the state doesn’t own? According to a report by The Associated Press, over $70 million in PECO funding went to charter schools that have closed since the year 2000. Your money went to fund improvements at facilities that were then potentially sold off at a profit. That’s blatantly wrong.

I want to commend the incredible jobs that our Hillsborough County school district employees are doing with limited resources. This is not just a Hillsborough County issue though. In Polk County alone, funding for current and future capital construction projects are facing a shortfall of $447.7 million when accounting for projected student growth over the next 10 years.

In response to these shortfalls, local districts are being forced to run campaigns to raise sales taxes or property taxes to make up the difference because Republicans in Tallahassee have abdicated their responsibility to properly care for our public education system.

It is past time for a reordering of priorities in Tallahassee. As House Democratic Leader, I am proud to lead a caucus that will always fight for the children in our public schools and to ensure that your tax dollars are enhancing education for all of Florida’s students. We will continue that fight in the upcoming session to work to repeal HB 7069 and to increase the amount of PECO funding for our traditional public schools.

Our children, parents and hardworking public-school employees deserve it.


Janet Cruz is Minority Leader of the Florida House of Representatives.

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