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Congressional Puerto Rico task force releases final recommendations

A bipartisan Congressional task force heavily influenced by Florida’s U.S. Sens. Bill Nelson and Marco Rubio released its final report Tuesday on dealing with Puerto Rico’s economic collapse offering scores of recommendations for helping the U.S. territory, its economy and it’s people.

Authorized last summer by the Puerto Rico Oversight, Management, and Economic Stability Act, or “PROMESA,” the task force has been working for six months to prepare a blueprint for the official federal agency created in that same law that will oversee the territory’s economic governance for the near future, the Puerto Rico Financial Oversight and Management Board.

Most of the recommendations could be passed by Congress and signed by the president, pushing reforms independent of the management board. Some are recommendations for the island’s commonwealth government to tackle. Others fall more in line with hopes for changes.

“The Task Force is of the view that Puerto Rico’s best days lie before it, not behind it.” the Congressional task force members including Nelson and Rubio wrote in a joint statement issued Tuesday. “The members of the Task Force have worked across party lines to identify steps that can be taken to help Puerto Rico’s economy stabilize and grow. The Task Force hopes that its work will serve as a platform for continued bipartisan efforts to support the American citizens in Puerto Rico.”

The island’s economy is spiraling downward, and the governor announced in June of 2015 that the Puerto Rico government could not pay its $70 billion in debts. Unemployment, poverty and crime rates are higher than any state’s. Puerto Ricans are fleeing by the ten thousand a month, mostly to Florida, and overwhelmingly to Central Florida. Island schools, first-responder agencies and other agencies have been cut to what many observers say are critically low levels. Health care reportedly has been particularly rocked by inequitable Medicaid rates, a mass exodus of doctors and other health care providers, and the epidemic outbreak of the Zika virus.

The congressional report is 125 pages long.

Among the task force’s recommendations:

* Repeal an exemption in a 1940 law that otherwise provides some investment protection to companies.

* Congress needs to enact an equitable and sustainable legislative solution to the financing of Puerto Rico’s Medicaid program early in 2017.

* Changes also should be made to how Medicare is administered on the island, possibly changing the opt-in requirement for Puerto Ricans who want Medicare Part B.

* Congress should expand the federal child tax credit in Puerto Rico so families there with one or two children can claim it just as families in the states do.

* Congress also should consider other tax reforms to bring Puerto Rico’s tax laws more in line with the states.

* Increase the amount of excise tax on Puerto Rico and Virgin Islands rum, and imported rum, that is paid back to the island’s government.

* Congress should extend the tax deductions available in the states for qualified film, television, or live theatrical productions to Puerto Rico.

* The government of Puerto Rico should fully reform the Puerto Rico Electric Power Authority, which the task force said “does not inspire confidence” with its high-priced and unreliable electrical production and grid.

* The National Science Foundation, in collaboration with other government and non-government stakeholders, take all feasible steps to ensure continued operation of the Arecibo Observatory.

* The government of Puerto Rico should make it a priority to redevelop the former Naval Station Roosevelt Roads.

* The U.S. Army Corps of Engineers should expedite plans to restore the Martín Peña Channel.

* Congress should consider whether to authorize Puerto Rico to have greater flexibility in its use of Unemployment Compensation benefits for the purpose of increasing employment.

* The Small Business Administration should assess and reform its rate structures, limits, and contribution formulas for making small business loans in Puerto Rico.

* Congress should create a program for contracting preference program for Puerto Rico small businesses to participate in federal contracts.

* Congress should enact a law allowing Zika virus and other communicable diseases to qualify as a “disaster,” making affected small businesses eligible for emergency loans.

* Congress should hold a hearing to determine if Social Security Supplemental Security benefits should be extended to disable people in Puerto Rico.

* The government of Puerto Rico should develop a comprehensive economic development strategy that exploits the island’s many comparative advantages.

* Someone with expertise in Puerto Rico tourism should be appointed to the United States Travel and Tourism Advisory Board.

* The U.S. Economic Development Administration should base its Puerto Rico representative in Puerto Rico, rather than in Philadelphia.

* And, regarding future status – statehood, independence, continuance as a U.S. Territory, the Task Force simply stated Congress should take it seriously: “If the government of Puerto Rico conducts a plebiscite authorized and funded by Public Law 113-76, the Task Force recommends that Congress analyze the result of this plebiscite with care and seriousness of purpose, and take any appropriate legislative action,” the task force concluded.

 

Joe Negron envisions block grant system for Medicaid in Florida

Senate President Joe Negron wants to start preparing for a day when Congress turns the Medicaid system into a block-grant program administered by the states.

“What I’d like to see the Legislature do … is to start building the framework of what a block grant program would look like now that there is a reasonable chance that that could happen,” the Stuart Republican told reporters Tuesday during a briefing in his Capitol office.

“I don’t want to wait until the federal government acts and Congress acts and we go into the next session and try to build it. I would like to fill out the model of what a Florida-run Medicaid would look like, and then — if and when Washington acts — Florida would be ready to go.”

Republican President-Elect Donald Trump has proposed switching Medicaid, which mostly covers low-income people, from an entitlement program largely paid for by the federal government into block grants that would allow states to exercise more control. They could save money by providing care to fewer people.

Negron cast his proposal in more generous terms.

“Rather than treating Medicaid as a program where even the vocabulary that we use is disparaging, in my opinion — we say someone is on Medicaid, as if it’s an addiction; no one says, ‘I’m on health insurance’ — use an ownership adjective,” he said.

“I would like to see a system that empowered our friends and neighbors, millions of them, who get their health care from Medicaid.”

In other words, Medicaid no longer would represent “second-tier medical care,” Negron said.

“That’s what I aspire to. Part of that would come if the state is given the opportunity to build a program that looks like Florida and addresses our issues.”

Such a system also might address the “Medicaid gap” — a problem for people in states, like Florida, that passed on Medicaid expansion under the Affordable Care Act. Many people make too much to qualify for Medicaid but don’t quality for insurance subsidies through that law’s federal insurance exchange.

“I would hope that we would address that,” said Negron, who opposed expanding Medicaid under the ACA, which he would like to see repealed.

“If there’s a block grant program to the state, that opens an opportunity to a new discussion,” he said.

As for the loss of insurance subsidies if Republicans in Congress repeal the ACA, “that’s an issue we would have to address if and when that happens.”

Donald Trump action on health care could cost Planned Parenthood

One of President-elect Donald Trump‘s first, and defining, acts next year could come on Republican legislation to cut off taxpayer money from Planned Parenthood.

Trump sent mixed signals during the campaign about the 100-year-old organization, which provides birth control, abortions and various women’s health services. He said “millions of women are helped by Planned Parenthood,” but he also endorsed efforts to defund it.

Trump once described himself as “very pro-choice.” Now he’s in the anti-abortion camp.

Still, the Republican has been steadfast in calling for repeal of President Barack Obama‘s health care law, and the GOP-led Congress is eager to comply. One of the first pieces of legislation will be a repeal measure that’s paired with cutting off money for Planned Parenthood. While the GOP may delay the impact of scuttling the law for almost four years, denying Planned Parenthood roughly $400 million in Medicaid funds would take effect immediately.

“We’ve already shown what we believe with respect to funding of Planned Parenthood,” House Speaker Paul Ryan, R-Wis., told reporters last month. “Our position has not changed.”

Legislation to both repeal the law and cut Planned Parenthood funds for services to low-income women moved through Congress along party lines last year. Obama vetoed it; Trump’s win removes any obstacle.

Cutting off Planned Parenthood from taxpayer money is a long-sought dream of social conservatives, but it’s a loser in the minds of some GOP strategists. Planned Parenthood is loathed by anti-abortion activists who are the backbone of the GOP coalition. Polls, however, show that the group is favorably viewed by a sizable majority of Americans — 59 percent in a Gallup survey last year, including more than one-third of Republicans.

“Defunding Planned Parenthood as one of their first acts in the new year would be devastating for millions of families and a huge mistake by Republicans,” said incoming Senate Minority Leader Chuck Schumer, D-N.Y.

Democrats pledge to defend the group, and they point to the issue of birth control and women’s health as helping them win Senate races in New Hampshire and Nevada this year. They argue that Trump would be leading off with a political loser. But if he were to have second thoughts and if the Planned Parenthood provision were to be dropped from the health law repeal, then social conservatives probably would erupt.

“They may well be able to succeed, but the women of America are going to know what that means,” said Rep. Diana DeGette, D-Colo., citing reduced access to services Planned Parenthood clinics provide. “And we’re going to call Republicans on the carpet for that.”

At least one Republican senator, Susan Collins of Maine, may oppose the effort. Collins has defended Planned Parenthood, saying it “provides important family planning, cancer screening and basic preventive health care services to millions of women across the country.” She voted against the health overhaul repeal last year as a result.

Continued opposition from Collins, which appears likely, would put the repeal measure on a knife’s edge in the Senate, where Republicans will have a 52-48 majority next year. Senate GOP leaders could afford to lose just one other Republican.

Anti-abortion conservatives have long tried to cut Planned Parenthood funds, arguing that reimbursements for nonabortion services such as gynecological exams help subsidize abortions. Though Planned Parenthood says it performed 324,000 abortions in 2014, the most recent year tallied, the vast majority of women seek out contraception, testing and treatment of sexually transmitted diseases, and other services including cancer screenings.

The drive against Planned Parenthood picked up steam in 2015 after an anti-abortion group called the Center for Medical Progress released secretly-recorded videos that it claimed showed Planned Parenthood officials profiting from sales of fetal tissue for medical research. The measure, however, would strip Planned Parenthood’s Medicaid funding for only a year, a step taken to give time for continued investigations of Planned Parenthood’s activities. A House panel is still active, but investigations by 13 states have been concluded without charges of wrongdoing.

Planned Parenthood strongly denied the allegations and no wrongdoing was proved, but the group announced in October that it will no longer accept reimbursement for the costs involved in providing fetal tissue to researchers.

The defunding measure would take away roughly $400 million in Medicaid money from the group in the year after enactment, according to the nonpartisan Congressional Budget Office, and would result in roughly 400,000 women losing access to care. One factor is that being enrolled in Medicaid doesn’t guarantee access to a doctor, so women denied Medicaid services from Planned Parenthood may not be able to find replacement care.

Planned Parenthood says private contributions are way up since the election, but that they are not a permanent replacement for federal reimbursements. “We’re going to fight like hell to make sure our doors stay open,” said Planned Parenthood spokeswoman Erica Sackin.

Republished with permission of The Associated Press.

Poll: Only about 1 in 4 wants Donald Trump to repeal health law

Only about one in four Americans wants President-elect Donald Trump to entirely repeal his predecessor’s health care law that extended coverage to millions, a new poll has found.

The postelection survey released Thursday by the nonpartisan Kaiser Family Foundation also found hints of a pragmatic shift among some Republican foes of “Obamacare.”

While 52 percent of Republicans say they want the law completely repealed, that share is down from 69 percent just last month, before the election. And more Republicans now say they want the law “scaled back” under the new president and GOP Congress, with that share more than doubling from 11 percent before the election to 24 percent after.

Kaiser CEO Drew Altman said the foundation’s polling experts aren’t quite sure what to make of that finding, and will continue to track the apparent shift in future polls. The organization is a clearinghouse for information and analysis about the health care system.

It could be that some Republicans “got a protest vote off their chests, and they’re done with that,” Altman said. “They now have a more moderate position.”

After branding the Affordable Care Act a “disaster” during an election campaign that saw big premium hikes unveiled in its closing days, Trump has been saying he’d like to keep parts of the law.

On Capitol Hill, Republican leaders are trying to choreograph a legislative dance that would let them quickly repeal “Obamacare,” then allow an interlude to segue to a replacement. The complex undertaking is fraught with political risk, because success is not guaranteed. It could disrupt coverage for millions by destabilizing the law’s already fragile health insurance markets, such as HealthCare.gov.

The poll found some skepticism about that approach. Forty-two percent of those who want the 2010 health care law repealed said lawmakers should wait until they figure out the details of a replacement plan before doing so.

Americans were divided on next steps for President Barack Obama‘s signature law. Overall, 30 percent said the new president and Congress should expand what the law does, and another 19 percent said it should be implemented as is. On the other side, 26 percent said the law should be entirely repealed and 17 percent called for it to be scaled back.

Among Trump voters, 8 in 10 viewed the health care law unfavorably, and half wanted it entirely repealed.

As Republicans start to make changes in health care, potentially revamping Medicare and Medicaid as well, the politics of the issue could turn against them, Altman said. “They are going to go from casting stones to owning the problem,” he said.

The poll found majorities across party lines support many of the health care law’s provisions, but not its requirement that individuals have coverage or risk fines, and its mandate that medium-to-large employers pay fines if they don’t offer health insurance.

Among the provisions with support across party lines:

— Allowing young adults to stay on a parent’s insurance until age 26.

— No co-payments for many preventive services.

— Closing the Medicare prescription drug coverage gap known as the “doughnut hole.”

— Financial help for low- and moderate-income people to pay their insurance premiums.

— A state option to expand Medicaid to cover more low-income adults.

— Barring insurance companies from denying coverage because of a person’s medical history.

— Increased Medicare payroll taxes for upper-income earners.

The telephone poll was conducted from Nov. 15-21 among a nationally representative random digit dial sample of 1,202 adults, including people reached by landlines and cellphones. The margin of sampling error is plus or minus 3 percentage points for the full sample. For subgroups, the margin of sampling error may be higher.

Republished with permission of The Associated Press.

CNN reports, eloquently, on the nightmare that is Florida Medicaid

It’s been ten years, almost to the day, since Congressman-elect Charlie Crist pulled $360 out of his pocket to pay for a year’s supply of thermal blankets for 12-year-old Kevin Estinfil, and pulled the plug on state lawyers who’d been fighting in the Third District Court of Appeal to deny the boy the basic supplies that were keeping him alive.

Back then, Crist was the Florida Attorney General who had just been elected Governor, and Kevin was confined to a Medicaid group home for children with life-threatening medical conditions. Kevin’s case turned up on Crist’s radar thanks to bad publicity courtesy of Miami Herald reporter Carol Marbin Miller, but not before the state had spent enough money jerking Kevin’s caregivers around to pay for a warehouse full of thermal blankets.

Today, half of Florida’s children rely on Medicaid “insurance,” and the plan is managed as badly now as it was a decade ago.

People who study Medicaid for a living will not be surprised by anything in the damning new report from CNN Senior Medical Correspondent Elizabeth Cohen, and neither will families who have sacrificed their savings, their careers, and any hope of a normal life for the sake of a child who will never be able to care for himself.

For the rest of us, Cohen’s look into the lives of Florida’s “health care refugees” is a bone-chilling holiday buzzkill.

Among the refugees are Kim and Richard Muszynski, formerly of Boynton Beach. With good jobs and longtime Florida roots on both sides of their blended family, they could not have imagined packing it in and starting over in Colorado.

But that’s what they did, after five-year-old daughter Abby, who was born with a life-threatening genetic disorder, had one near-death experience too many due to the toxic combination of underfunding and red tape for which Florida’s Medicaid program is infamous.

In Colorado, Abby’s physical health and her parents’ mental health have improved dramatically. Somehow, America’s Centennial State has figured out how to give children enrolled in its Medicaid program the therapies and medications ordered by doctors, without interference from Dr. No at the Department of Pennywise, Pound Foolish.

Another member of the Florida Medicaid Diaspora is three-year-old Sofia Patriarca. Like Abby, her needs are complex and will require round-the-clock care all her life. Sofia’s parents sold their family pizzeria in Lantana and will relocate to a state that’s safer for children with unique abilities.

“Medicaid forces us to give our children subpar care,” Sofia’s mother, Stefany Garcia-Patriarca, told CNN. “They treat them like animals instead of children.”

It took special courage for Heather Rosenberg to tell CNN that she and her husband have considered leaving Florida to obtain better health care for their children. As foster parents to 16 children, three of whom they adopted, Rosenberg is an expert on Florida Medicaid.

She described it to CNN as “horrible” and “an absolute nightmare,” hastening to that she speaks as a mother, and not in her role as — wait for it — children’s ombudsman at the Florida Department of Children and Families.

Florida spends a small fortune recruiting foster and adoptive families, and promises that they will not have to dip into their own pockets to fund essential medical services that are beyond the reach of all but families with the richest private insurance plans.

No matter how much room people like the Rosenbergs have in their hearts, they’ve only got 24 hours in a day, and they should not have to spend a minute of it begging the state to keep its promises to Florida’s Medicaid eligible children.

Marco Rubio promises to push for Medicare reimbursement increases for Puerto Rico

U.S. Sen. Marco Rubio promised Wednesday he will push for increased doctor reimbursements for Medicaid and Medicare as part of a package to bring Puerto Rico’s federal benefits in line with states.

Rubio, a Republican member of the bi-partisan, bi-cameral Congressional Task Force on Puerto Rico Economic Growth, met with an invited group of 20 Florida-resident Puerto Rican business and political leaders gathered in Orlando to seek suggestions on what the task force should push for from the federal commission overseeing the restricting of the territory’s finances.

There, Rubio promised to back those reforms and others, including tax credits to assist the people on the island in dealing with the economic crunch that is near bankrupting the government, straining services and decimating health care options as doctors flee the island. But he did not agree with everything suggested, notably as he defended keeping the 96-year-old Jones Act that regulates shipping to and from the island.

“I’m very confident that is going to be one of the recommendations that we’ll offer,” Rubio said of increasing Medicare payments to doctors so they can be encouraged, first, to serve Medicare patients, and second, to not flee the island seeking more money. “And I am hopeful it will make it into the task force’s document.”

The roundtable-style meeting, which featured Republican state Reps. David Santiago, Rene Plasencia, and Bob Cortes, a few representatives of Puerto Rican chambers of commerce and bar associations, and a few other business groups, and former U.S. Surgeon General Antonia Coello Novello, was officially a congressional meeting, not a campaign event.

Rubio is seeking re-election against U.S. Rep. Patrick Murphy of West Palm Beach. And he later acknowledged the importance of the Puerto Rican vote for him, or Murphy, to win Florida. And Rubio contended that he’s worked for six years on Puerto Rican issues, accusing Murphy of “just discovering Puerto Rico three weeks ago.”

Rubio offered no talk of financial bailouts and promised no deals that would put Puerto Rico’s government and people ahead of stateside investors when it comes to getting paid.

Instead, Rubio said the goal is to remove as many federal impediments as possible to open the island up for business investment, which he said is key to expanding the economy, wages, and taxes to fund the government.

“What can we do, what changes can be made in the federal government, to make the island a magnet for investment?” Rubio inquired.

He also said that ultimately Puerto Rico’s long-term status — remaining a U.S. territory, becoming a state, or becoming an independent country — must be decided as soon as possible, before it can offer the long-term sense of stability investors are looking for.

The task force Rubio was appointed to — along with Florida’s Democratic U.S. Sen. Bill Nelson — is to make recommendations by mid-December to the Puerto Rico Oversight Board, a board created by Congress this past summer that will act as executor in restructuring the island government’s debt and finances.

Rubio said many Republicans have been opposed to increasing payments to the island because they are fiscal costs to the federal government. But he said they must understand hundreds of thousands of people are fleeing the island for Florida and elsewhere to seek better health care and services, and in particular there is a brain drain of doctors and other professionals, so those fiscal costs would not be new, just moved from the states, if they can entice people to stay.

“It’s OK if people want to move. It’s not OK if people have to move,” Rubio said.

 

 

Case managers sue Sunshine Health for unpaid overtime

A Medicaid managed-care case manager is suing her employer, a state of Florida contractor, for unpaid overtime — one of many similar suits filed around the country against the company’s corporate parent.

Shanna Veit filed her proposed collective- and class-action suit in Leon County Circuit Civil court against Sunshine State Health Plan, seeking an unspecified amount of “unpaid overtime wages,” her complaint said.

The state contracts with the health plan to manage benefits under Medicaid, the joint state-federal health care program for the poor.

Sunshine Health is wholly owned by Centene Management Co., which specializes in health care for the underinsured and uninsured.

Centene has faced numerous lawsuits in several states involving allegations of unpaid overtime.

In June, the company “reached a $4.5 million settlement with a group of nurses who accused the health care company of failing to pay them millions of dollars in overtime,” Law360 reported.

Centene had said the nurses — who worked in California, Illinois, Missouri and Ohio — “were exempt from overtime requirements” under the federal Fair Labor Standards Act (FLSA), according to the site.

In July, the 5th U.S. Circuit Court of Appeals upheld a summary judgment against the company in a Texas case brought by former case managers and nurses. The court agreed the workers didn’t fall under the FLSA’s overtime exemptions.

Case managers like Veit developed care plans, assisted with referrals and helped resolve complaints, the suit said. She and others like her were “required … to work long hours and on weekends, including overtime hours,” for which they weren’t paid, her suit said.

Court dockets show 10 other case managers have “opted in” to join the action. Requests for comment were left with Sunshine Health’s and Centene’s corporate communications teams Wednesday afternoon.

Veit is represented by Tallahassee attorneys Sean Culliton and John C. Davis, and Pensacola attorney Jeremiah Talbott.

Jennifer Ungru: Funding for hospitals serving low-income patients presents challenges, opportunities

Three little letters — L-I-P — can spell panic in the hearts and minds of many hospital officials, as revenue estimators are forecasting a lean budget year for 2017.

LIP or the Low Income Pool is a combination of state and federal funding that helps supplement Medicaid payments hospitals receive. The funding comes from local tax dollars matched with federal Medicaid funds.

The LIP program was designed to ensure a significant return on investment for the local contributors because the local dollars invested in this program supporting Medicaid are optional.

Additionally, the program allows for a significant return on investment for the local tax districts that choose to invest in these programs in their communities and contribute the money on behalf of a named hospital.

Here’s how it works: Local tax districts contribute the money on behalf of a named hospital, the local dollars then draw down federal dollars where the combined amount is large enough to be worthwhile for participation in the program, as well as creating a remaining “pool” to be divided among other low-income-serving health care providers.

 This “guaranteed return” allowed for named hospitals to increase their Medicaid rates as well as “buy back” past legislative cuts to Medicaid hospital rates — a practice others who rely on state dollars to support their programs and services only dream about.

The remaining “pool” would be divided among the other providers based on a legislative formula agreed to by the federal government.

At the height of the program, these combined dollars accounted for nearly $2 billion in health care funding, or roughly 15 percent of total hospital Medicaid reimbursement. Since the overall health care budget is so large, this number needs to be put into perspective. Consider, outside of stand-alone children’s hospitals, Medicaid, on average, is only about 20 percent of a hospital’s overall payments.

Unfortunately, like all good things, Florida’s LIP program has an expiration date. In 2015, the Obama administration announced the program would be phased out within two years. For 2016/2017 the traditional $1 billion LIP program, the “pool,” was limited to approximately $680 million and the corresponding $800-900 million hospital rate enhancement investment was eliminated altogether.

Not only were the dollars limited, even the structure of the pool was dramatically changed, leaving questions as to whether local hospitals will even participate in this final year of the program.

Next year, the federal government will remove its remaining $400 million from the program. While local shares of the initial and current program still exist, those entities will have to determine how to best use those dollars.

Leaving state budgeters with the question of what to do next. Removing almost $2 billion within the health care system across the state in a period of two years is a lot, no matter where you stand on the issue.

The state has three options: do nothing and the program ceases, attempt the funding status quo and use general revenue to pick up the federal share, or try something new. As explained below, each option presents challenges and opportunities for our state policymakers.

— Do nothing. Local governments can decide what to do with the local tax dollars they’re collecting. Two years ago, local governments submitted $760 million to LIP, and this year, locals may contribute up to $272 million to the pool. This is a lot of money that can make a dramatic difference in local communities. Local governments could continue to collect the same tax dollars but reinvest them in ways to support local health care needs, or even return the dollars back to the taxpayer. Doing nothing, some would argue, levels the playing field. Unlike other programs that rely on state funding, hospitals have uniquely been able to “buy back” past budget cuts. Doing nothing would force hospitals to realize a true cut as other worthwhile programs have faced during lean times.

— Use state revenue to fill the hole. Remember Special Session 2015? For 2015-2016 budget, the Legislature provided an additional $400 million for hospitals within the Medicaid budget to soften the impact of the phasing out of the program. Lawmakers could provide a similar increase again. Because these dollars are designated for those hospitals that serve a larger portion of lower-income Floridians, some argue these supplemental payments actually keep the cost of health care down and avoid shifting the cost to privately insured customers.

— Finally, the Legislature could do something new, be bold and try to shake up the way of thinking in health care. To change behavior, the state needs to change the motivation. One option would be to build an incentive structure with local and state matched dollars focused on rewarding programs that actually lower the cost of health care. Instead of just bailing out the hospitals and increasing rates, why not set up a system where the state will match the local contribution when an ER diversion programs actually show true cost savings to the state. Emergency departments are the most expensive settings for care. If hospitals are truly committed to ER diversion, then why are wait times advertised regularly and off-site ERs are being built more rapidly than Starbucks? To make this work, the savings would have to be actual savings to the state, not just cost avoidance. While everyone talks about the rise in health care costs, we haven’t given a great look toward rewarding efforts that truly lowers the costs for Floridians. It is an idea worth lawmakers taking a look.

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Jennifer Ungru is a corporate affairs adviser in Jones Walker LLP’s Tallahassee office. Before joining Jones Walker, Ungru served as the chief of staff for the Agency for Health Care Administration (AHCA), which oversees the state’s Medicaid program and regulates more than 45,000 health care facilities. During her tenure, the agency implemented major health reforms, including the movement to Statewide Medicaid Managed Care, the largest procurement in state history.

Personnel Note: Beth Kidder named interim deputy secretary for Medicaid

beth-kidder-head-shot-2015Beth Kidder is Florida’s new interim deputy secretary for Medicaid, overseeing the state’s nearly $26 billion state program that pays health costs for the poor.

Christine Sexton of POLITICO Florida reports the announcement was made Oct. 6 in an email to Agency for Health Care Administration employees.

In the current year budget, Sexton writes, the Medicaid program is slated for $25.7 billion, which could increase to $26.4 billion to pay health care costs for elderly and disabled Floridians who qualify.

Kidder is taking the place of Justin Senior, who left Oct. 3 to become the agency’s interim secretary.

Senior replaced Liz Dudek, who has led the AHCA since the agency’s creation in the 1990s.

State records show Dudek was paid $141,000 annually. Senior, who reported directly to Dudek, earns $142,000 a year.

Dudek, who resigned unexpectedly Sept. 21, served as AHCA Secretary for both Gov. Rick Scott and former Gov. Charlie Crist.

Before becoming interim deputy secretary for Medicaid, Sexton notes Kidder served as assistant deputy secretary for Medicaid policy and quality. According to a state government website, Kidder has been with the state since 2001 and earns $120,000.

8 Reasons Rick Scott is the perfect veep for Donald Trump

Rick Scott is basically as awful as Donald Trump in so many ways. But before Floridians start petitioning Trump to introduce Scott to a presidential election turnout and an embarrassing loss before Scott runs for U.S. Senate in 2018, read all eight reasons.

8) Cons. Scott didn’t build his $300-some million fortune with a fraudulent university, but he did help build a company that defrauded Medicare and Medicaid by way more, paying a record $1.7 billion fine.

7) Muslims. Scott was offending Muslims and Hispanics long before Trump descended down the escalator at Trump Tower. Scott put some of his first campaign dollars into fearmongering about Muslims in “Obama’s Mosque” near Ground Zero in 2010. Also, mic cut.

6) Hispanics. Similar to Trump, and despite all evidence, Hispanics love Scott, according to … only Rick Scott. Scott claims he “won” the Hispanic vote in 2014, despite actually losing it by 20 percent.

5) Little Marco. While Trump’s insults are infamous, Scott is doing his part in Florida. He backed Trump over Rubio (and Jeb!) and is now working against Rubio in his U.S. Senate race, supporting mini-Trump Carlos Beruff, best known for unapologetically calling President Obama an “animal.”

4) Smarts. Trump could own Anderson Cooper‘s “RedicuList” segment, but Scott once got on it for insulting “everybody’s intelligence” trying to defend himself for using on-duty cops at campaign events.

3) Votes. Trump needs turnout to be as depressed as Jeb! after South Carolina. Scott has been hard at work, rolling back civil rights reforms that allowed nonviolent ex-felons to vote.

2) Money. Scott won in 2014 by outspending his opponent on TV by $33 millionRomney lost Florida by less than 1 percent in 2012, but only outspent Obama by $17 million. An extra $16 million might have bought 29 electoral votes.

1) Florida. Trump can’t win without Florida, and Rick Scott knows how to win here.

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Kevin Cate owns CATECOMM, a public relations, digital, and advertising firm based in Florida.

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