Medicaid Archives - Page 7 of 31 - Florida Politics

Lots added to budget but not more money for Medicaid HMOs

More than $300 million in additional revenue was plowed into the budget late Monday night but, apparently, leaders did not agree to spending any more money on Medicaid.

That’s a disappointment to the managed care plans participating in Florida’s mandatory Medicaid managed care program. They were hoping for an increase of $57 million in “grants and donations” trust funds that could be used to draw down federal matching funds.

In all, it would have been about a $110 million infusion for the plans, about 25 percent of the original $400 million bump in rates the plans requested at the beginning of the 2015 Regular Legislative Session.

The Florida Association of Health Plans President and Chief Executive Officer Audrey Brown said pharmaceutical costs were not properly contemplated in the current rates the HMOs are being paid. Brown said the agency has not properly adjusted the second-year rates — which are in draft form — to accommodate for the costs of name brand drugs.

“We look forward to working with the agency and the Legislature on adequate rates so that we can continue to ensure high quality care for Florida’s most vulnerable citizens,” Brown said in an email statement.

Agency for Health Care Administration Secretary Liz Dudek scoffed at the notion that the 13 plans that participate in the Statewide Managed Medical Assistance Program needed a $400 million increase in current-year rates. In a letter to health plans, Dudek  said that under the current contracted rates with HMOs, the state is saving slightly more than 5 percent compared to prior year’s spending after the shift to statewide Medicaid managed care.

“The $400 million in current year increase demanded by the plans would offset the vast majority of those savings,” she wrote.

Florida Law requires HMOs to maintain solvency requirement in the greater amount of:

  • $1,500,000;
  • 10 percent of total liabilities; and
  • 2 percent of total annualized premium.

Insurance Commissioner Kevin McCarty issued a memorandum to HMOs in May advising that the solvency requirements are in effect at all times, not just the end of each quarterly reporting period.

McCarty’s memo also puts in bold and underlines the message that it’s a felony for any officer of director of an HMO to accept or renew insurance or provider contracts if the officer knew the HMO was impaired or insolvent.

While the health plans were pushing to get money to increase their current rates, Dudek’s agency has shared a draft of proposed rate increases for the upcoming 2015-16 year. The draft rates show the plans could see an average 6 percent increase in rates. That’s far less than the 12 percent increase the plans were advocating.

Steve Crisafulli downplays Senate rejection of House health care proposals

House Republicans earlier this month rejected a Senate proposal to extend health coverage after a bitterly divisive debate that last nearly seven hours.

House leaders such as Rep. Jason Brodeur and House Speaker Steve Crisafulli contended a better way was to fix other problems with the state’s health care laws.

The answer from the Senate?

No debate, no vote. At least not now.

On Monday, Senate Health Policy Committee Chairman Sen. Aaron Bean announced his committee wouldn’t be voting on a number of bills the House sent to the Senate for consideration this session.

The timing comes as legislators are frantically trying to reach a final deal on a new state budget and raised the possibility of another breakdown between the two chambers.

Crisafulli, though, doesn’t see it as a snub. Instead, the Speaker chose a more conciliatory, and perhaps sarcastic, note. “We understand that you cannot force another Chamber to take up legislation,” the speaker said in a statement.

The House of Representatives would not consider the Senate’s proposal to expand Medicaid under ObamaCare. The Senate advanced the plan, dubbed FHIX, as conservative noting that it had prerequisites for eligibility such as work requirements and co-payments. FHIX — and the House’s refusal to bring the issue up during the 2015 regular legislative session — led to a budget impasse during the regular session and, eventually, the special session.

Bean cancelled the Health Policy Committee meeting scheduled for Tuesday. His committee discussed several of the House’s proposals last week but didn’t take a vote on any of the issues.

Bean said in the statement that in the days following his panel’s workshop the consensus view in the Senate is that a 20-day budget special session does not lend itself to a “thorough and proper vetting of foundational changes to our health care delivery system.”

Bean also asked for the creation of a Joint Legislative Task Force on Health Care Policy Innovation that could begin meeting in the interim between the special session and the regularly scheduled 2016 legislative session in January.

Bean said in his release that Senate President Andy Gardiner is open to the idea.

Crisafulli said he “welcome(s) discussions on these bills because much work needs to be done to lower costs and improve healthcare quality and access for all Floridians.”

Spokesperson Michael Williams said the speaker supports the ideas of a joint legislative task force.

Julie Delegal: Health care defeated by politics of personal resentment

State Rep. Mia Jones tried.

In the spirit of compromise, the Democrat from Jacksonville moved right to embrace the health care-expansion plan backed by the Florida Senate: the Florida Healthcare Affordability Insurance Exchange, aka FHIX.

Jones told The Jacksonville Times-Union that she had set aside her doubts about the plan and would “stand on the shoulders” of Florida’s 800,000 working uninsured in her fight to get them covered. She fought for the workers who build our houses in 100-degree heat, clean Florida’s hotel rooms, pour your coffee every morning, and sell you shoes at the mall.

These are able-bodied — for now — adults who, despite working every day, often at multiple jobs, still can’t afford to purchase health insurance. Florida FHIX would have enabled workers who earn up to 138 percent of the poverty level to use federal subsidies — money that Florida taxpayers have already sent to Washington — to buy coverage.

Billed as a free-market solution — as opposed to Obamacare — Florida’s FHIX would have required participants to pay premiums of up to $25 per month and show proof of work, school, or a job search.  Among the plan’s advocates was a John-Thrasher-conservative, Fernandina Beach Republican Sen. Aaron Bean, who was quoted as saying that this was “not your grandfather’s Medicaid expansion.”

The FHIX plan was, instead, innovative in the way that former Gov. Jeb Bush’s Med-waiver program was innovative when it was introduced about a decade ago.

Like Bush’s plan, FHIX would have used Medicaid funds to pay private entities to meet participants’ healthcare needs. Like Bush’s plan, it could have produced a savings that could be put toward something else. And despite the James Madison Institute’s protestations to the contrary, implementing FHIX would not have been mutually exclusive to pursuing other healthcare reforms.

In fact, in passing up FHIX, lawmakers passed up an opportunity to attach meaningful reforms to the package.

Yes, the Medicaid reimbursement rate needs to be raised. But doesn’t that have a better chance of happening if private insurers are in the negotiating room?

Yes, we could stand to roll out some carefully constructed pilot programs in telemedicine. Why not negotiate with the feds to use Medicaid money to do just that?

Why not?

Partisan politics, that’s why not. Specifically, it’s the far right’s reliance on a certain, divisive brand of ideology. My husband, the political scientist, calls it “the politics of personal resentment.”

The politics of personal resentment dictates that no one should ever, ever have something that only I deserve. The politics of personal resentment relies, implicitly, on the notion that some people are simply better than other people.

It defaults back to power structures that endow white people, male people, and wealthy people with a sense of automatic authority. It defers to the most powerful, and faults the least among us for being vulnerable.

The politics of personal resentment uses language like “able-bodied adults with no children” to distinguish those people from “the rest of us.” Conjuring the ghost of Ronald Reagan, dog whistles such as “American values” and “welfare queens” echoing in their minds, lawmakers set out to put themselves above the working poor in Florida. Their ideology, you see, depends on these false hierarchies — depends on being “better than.”

The politics of personal resentment blames poor people for being poor, whether or not they’re working one, two, three, or more jobs to feed themselves and their families. It begrudges a hand-up because it can.

Practitioners of this divisive and ugly brand of rhetoric point accusatory fingers at those who simply want a shot at the American Dream. “You’re not worthy,” lawmakers have told 800,000 Floridians. “You are somehow … less.”

We have already decided that we will not, as a nation, turn people away when they’re in need of medical treatment. We’ve already agreed, on an implicit level, that access to quality health care is, like education, essential to equal opportunity.

We’ve now decided, in Florida, to pretend that we give a damn, using the most inefficient means available: the ER as primary care.

But as we turn our backs on people who need a hand up, we need to face the irony: The same people whose ideological intransigence has them scoffing at the workers who fix their cars, or cook their dinners, or change their sheets in Tallahassee hotel rooms have no problem accepting taxpayer-subsidized health care.

Personally, I resent the hell out of them.

Julie Delegal, a University of Florida alumna, is a contributor for Folio Weekly, Jacksonville’s alternative weekly, and writes for the family business, Delegal Law Offices. She lives in Jacksonville. Column courtesy of Context Florida.

Gary Stein: 6 degrees of health care is no idle game

One of the great advantages of the universe as well as one of its biggest problems is that everything is connected to something. From the forces that act on the tiniest subatomic particle to the most massive of planets, nothing works apart from everything. Nothing exists entirely within a vacuum, completely unaffected by anything around it.

For years, people have been playing games like “six degrees of Kevin Bacon” to prove the fact that anything is eventually connected to everything.

The budget process in Tallahassee is like a game, too. In fact, it is like several games rolled into one. It is one part poker, one part fencing, one part chess and one part big sliding puzzle.

The ultimate goal for everyone in the process is to start with a picture of what they want, and, they hope, to end up with what they need. To win, you have to persuade the other side to make compromises they didn’t even consider until the handwriting appeared on the wall. Just like chess, you have to think several moves ahead. Just like in poker, you have to study your opponent’s nuances to figure out what their last move meant, and what their next move will be. Just like in fencing, it is all in the timing of thrust and parry.

The similarity to a big sliding puzzle is obvious. Pieces and offers slide across an ever-moving landscape until everything settles into their final place and the final vote is taken on the balanced budget. Move one piece at the last minute, and you see again that, even though the categories may have looked separate, altering any piece’s size, shape or color can change everything.

In the House, with its “finite total” approach, the only way to get an increase for the category you think needs it is to take away funding from someone one else who wants it. Players have to consider whether an increase in a pot of money to help get kids necessary technology for education or vocational training could be done by taking it away from an agency like Big Brothers and Sisters or Laura’s Kids. They can be very stressful decisions, and this sliding puzzle sometimes comes with grave consequences to getting the job done.

To ignore any piece of the game as unrelated, and you ultimately lose.

One solid example involves the pieces associated with health care. The big argument at the end of the Session was whether Medicaid expansion and the Low Income Pool funding were truly separate. The governor went so far as to sue the federal government for assuming one isn’t possible without the other.

In part he is right. You can have full LIP funding but not Medicaid expansion. However, it’s like having a car with a half tank of gas and a cross-state trip to make. You can take the trip, but you may not make it to your destination, at least not without getting some gas from someone else, say, a school bus. Just realize that you may get where you have to go, but the kids might not get to school.

Now the Legislature is working with a truncated LIP budget, but with none of the money that could have come from the federal government in that seemingly “disconnected” matter of Medicaid expansion. Thus the health care needs go unmet for more than 800,000 Floridians, many of them working poor.

They are destined to end up in emergency rooms where costs are high and the money from LIP, for the most part, won’t be there. It would have helped the hospital pay for the care needed for those able-bodies, hardworking people because they have no way to pay for their healthcare. Or else they go to work sick or miss their desperately needed hourly pay that pays bills and buys the things, a cycle that keeps our economy sound.

Now that the Medicaid expansion piece has been archived for another session, our lawmakers are working on a budget with missing pieces. The budget can still be made, and they have worked long and hard at the various conference meetings, in the open and behind closed doors. There has been great wailing and gnashing of teeth. Committee meetings, conference meetings and even the Regular Session have been shut down when things went badly.

Many projects and funding needs have hit the budget room floor with no chance of getting picked up again this year. Even the money that conservatives, including the governor, wanted for economic development has been lost. So missing out on the pieces and connections that healthcare provides has even reduced the state’s ability to bring in new jobs and industries that would put more money into the economy and, eventually, the state budget.

It has been said that you shouldn’t sweat the small stuff, even though, eventually, it’s all small stuff. Here’s a corollary: If you don’t sweat the health stuff, you will soon find out that, eventually, it’s all health stuff.

Ignoring the connectivity of the situation has its consequences.

Gary Stein MPH, a native Detroiter, worked for the Centers for Disease Control, landed in the Tampa Bay area to work for the State Tobacco program and is now a health advocate and activist and blogger for Huffington Post. Column courtesy of Context Florida.

Everybody’s working over the weekend, really

Legislative leaders on Friday said the House and Senate budget chairs would continue to work over the weekend in order to bring the General Appropriations Act in for a landing.

The goal is for a copy of the budget to be on lawmakers’ desks by Tuesday so they can wait the mandated 72 hours before voting on the bill. Friday was the initial deadline for Sen. Tom Lee and Rep. Richard Corcoran to “bump” any unsettled issues to Senate President Andy Gardiner and House Speaker Steve Crisafulli for them to resolve.

In a joint news release, though, Gardiner and Crisafulli said the budget chiefs had made tremendous progress and that they would continue to meet during the weekend to hammer out unresolved issues.

“We anticipate one more meeting this evening (Friday) as well as meetings on Saturday and Sunday,” the leaders said in a joint statement. “We look forward to using this last week of the Special Session to finalize a balanced budget and deliver broad-based tax reform legislation. We look forward to an on-time finish.”

Amendment 1 funding remains unresolved though Crisafulli said the House has agreed to no bonding. The Education and Tourism and Economic Development budgets are proving problematic, also. Progress has been made in Criminal and Civil Justice as well as Health and Human Services. A “linchpin” of the budget, the Low Income Pool, was resolved early Friday.

A $30 million hospital issue could get tucked into Medicaid conforming bill

During the contentious debate over Medicaid expansion top Republicans in the Florida House railed against hospitals as special interests and part of the “health care industrial complex.”

Now the House is taking its battle against hospitals on multiple fronts, including trying to revive a little-noticed bill from the 2015 Regular session that cracks down on the ability for hospitals to challenge Medicaid reimbursement rates set by the state.

A staff analysis of SB 322 noted there were a number of hospitals that were challenging their rates and, if successful, the state could be on the hook for upward of $30 million.

Though the issue was heard only in the Senate during the Regular Session, it was offered up by the House during the Special Session budget conference process. The Senate deferred acceptance which means the issue will be hammered out by the House and Senate’s chief budget writers.

The House proposal makes clear that if hospitals prevail in their challenges to the rates they must secure an appropriation from the Legislature in order to collect the money.

“The agency may not be compelled by an administrative body or a court or pay additional compensation to a hospital” the language offered by the House in the Medicaid conforming bill, SB 2508 A, reads.

The offer also would change the rules with regards to rate challenges to make clear that written notification of the audited rates is a “final agency action” and that the hospitals may request and administrative hearing to challenge the rates by filing a petition with the agency within 180 days. Hospitals could challenge the methodologies set forth in the rules used to calculate the rates for a retroactive period of three years from the date of the challenge.

Sen. Kelli Stargel filed the bill during the 2015 regular session and it was heard by the Health Policy and Fiscal Policy committees and was passed unanimously.

Daniel Tilson: Florida's uninsured left standing in the shadow of hopelessness

Shirley dragged long and hard on her lipstick-stained cigarette. She alternated between shaking and nodding her head while listening to new friend Toni talk trash about politicians.

“They did it again, threw us under the bus. They don’t know us, they don’t give a damn about us, we’re just bugs on their windshield, that’s all, just as long as we get wiped out of the way, don’t matter whether we live or die, now does it?”

“To hell with them,” spit out Shirley, peeling the cigarette filter off her lower lip and throwing the barely still-smoking bit of a leftover butt to the ground below. “Life and death matters to me, matters to my momma, matters to my God, my sisters and brothers…maybe even to my nieces and nephews…” That made her stop and smile a second before her lips curled back down.

”Staying alive matters to me and mine,” she said, patting at her chest.

Amen, Sister,” said Toni. “Poor colored people’s lives mean just as much as those rich white men making and breaking the rules up in Tallahassee.”

The two black women stood huddled together in darkness near the hospital Emergency Room entrance. Toni had introduced herself as “Tiny Toni” when asking for a cigarette – five-feet-one-inches of skin and bones surrounding oversized, searching eyes, full of emotion. When she looked up at six-inches-taller and severely obese Shirley squinting down at her, you might have thought they really were sisters.

But the two women were strangers until fate took them both by surprise this night.

Shirley woke up in a sweat, heart pounding, out of breath. She’d spent the first half of the day looking for work at local restaurants and stores, the second half watching her sister’s three kids…and the night feeling physically worse and worse. With no health insurance or doctor of her own, no medicine and almost no money…she ended up waiting 25 minutes for a bus to the local ER. Now she was waiting for care.

When Toni saw and approached her, it was an hour into her own wait for word on her boyfriend Ron. She and Ron, both stuck in poverty-wage jobs with no health insurance or other benefits, had spent the afternoon fishing in a canal near the rooming house where they lived. When they finally caught one big enough to want to keep, Ron couldn’t gut and clean it. His hands were numb and tingling. Eight hours later and barely any better, Toni got him to the ER. Now she waited and worried.

It was after midnight but still 82 degrees and steam-bath humid in this South Florida tourist town. Most residents were fast asleep in their condo colonies and HOA communities, secure in the knowledge they were covered by private insurance or Medicare. But in the far corner of town where most of the low-income black folks lived, there was rampant insecurity, there was restlessness, sleeplessness…and ever-growing hopelessness.

Shirley lit another pair of cigarettes for her and Toni, talking between puffs and coughs. “You know…I had a little hope, when I heard Obamacare was going to get us all health insurance. Should’ve known the powers-that-be and the crackers that put them there would never let that happen…not in Florida.”

Toni laughed as Shirley handed her a lit cigarette. “But look how polite they are now when they’re stabbing us in the back, no more calling us ‘welfare queens,’ or worse. Now, we’re ‘able-bodied childless adults!’ ”

Shirley looked down at the ground. “Still their victims, by any other name…”

Both women were startled by the sound of the ER doors sliding open nearby. An orderly stuck his head out and shouted. “Toni Livingston?”

Toni’s already-fading smile was swallowed up by anxiety in a heartbeat as she hurried to him. “I’m Toni, you have news on my man, Ron Wilford? Has he got feeling back, is he – ?”

Shirley watched them walk inside, calling out, “Good luck, I’ll say a prayer…hoping for the best.” Then she threw her cigarette down and stomped on it for several extra seconds, before taking a long, deep breath and heading back inside to wait for help.

Daniel Tilson has a Boca Raton-based communications firm called Full Cup Media, specializing in online video and written content for non-profits, political candidates and organizations, and small businesses. Column courtesy of Context Florida.     

“It really is a dire situation,” say advocates for state’s uninsured

As Florida legislators try to iron out their differences over the state’s major budget items, advocates for Florida’s nearly 1 million uninsured are speaking out about Friday’s House vote rejecting  the Senate’s Medicaide expansion compromise.

“It really is kind of a dire situation,” said Sarah Sullivan, director of Florida Coastal School of Law’s Disability and Public Benefits Clinic. The clinic works with the disabled and their caregivers who have trouble accessing health care benefits. Sullivan spoke during an appearance on WJCT’s First Coast Connect.

“We help the uninsured and underinsured. We’re problem-solvers, and try to refer people to safety net services,” she said.

“And the feedback we’re getting from people after this vote is the fear that now, the uninsured will go to the emergency room even more. That means a rise in costs; that means a rise in premiums for the insured, so it’s going to cost one way or another.”

FCSL law student Jenny Rose is employed but uninsured, and also studying for the bar exam. Rose said she and her family are among the 900,000 Floridians who fall into the so-called “doughnut hole” of coverage: They cannot afford health insurance but are not poor enough to qualify for Medicaid.

‘I was very disappointed,” she said. “I have a large family. My 6-year-old has asthma, and my husband suffers from congestive heart failure, so this affects us in a very bad way.”

“Right now we call and negotiate with our doctor. We pay out-of-pocket for actual office visits. We also have to cover for meds and if we need blood work that’s a big problem too. Those are all separate bills that we cannot afford.”

Because the way forward for health care coverage remains in flux, state House lawmakers such as Rep. Paul Renner of Palm Coast say they’re concerned about the long-term effects Medicaid expansion might have on the state budget.

“It’s really not a free proposition for us to expand coverage here,” Renner told The Florida Times-Union. “We’re going to have to give up things that are very important, like education.”

Gov. Rick Scott, who changed his mind several times about the issue of Medicaid expansion, has also expressed concern about the expense, estimating it would cost the state $5 billion over the next decade.

Rose says she understands the concerns but hopes legislators hear her point of view, too.

“I just hope that people understand that it’s not a Republican or Democratic problem, it’s a people problem. And we all should be concerned about the health of our fellow humans.”

Rick Scott demands mediation in Medicaid lawsuit with feds as lawmakers craft budget

As lawmakers work on a 2015-16 spending plan with a $1 billion Low Income Pool for health care spending, Gov. Rick Scott continues to push for more money and is looking to the courts to help him get it.

On Monday, attorneys for the governor filed a five-page motion with the federal court in Pensacola that, if granted, would require the state and federal governments to go to mediation. Scott’s lawyers argue that the mediation is allowable under “home rule.”

“Under the circumstances court-ordered mediation would be appropriate to faciliate a decision within a timeframe that allows the Florida Legislature to pass a budget that ensures that state healthcare providers, ranging from trauma centers to children’s hospitals receive the funding necessary to provide critical medical services to needy residents,” the motion reads.

“By introducing a neutral mediator and insulating the process from extraneous influences, court ordered mediation could facilitate a long overdue conclusion to these negotiations quickly, equitably, permanently, and–perhaps most importantly–constitutionally, and do so in a timeframe that respects, rather than deliberately frustrates, the state’s impending budget deadline.”

The federal government advised Florida in late May that the state could expect to receive a $1 billion supplemental Low Income Pool program for the 2015-16 fiscal year and, additionally, a $600 million program for the 2016-17 year. The tentative green light for a $1 billion program returns LIP funding to prior year levels but would cut it in half from current year spending.

Because of the reductions the Florida Legislature agreed to use $400 million in recurring general revenue to backfill the loss of federal dollars and budget conferees have been meeting over the weekend in hopes of hammering out not just an agreement on the health care budget but the entire spending plan for the upcoming fiscal year which begins July 1.

The decision by legislators to put $400 million in general revenue means Scott’s priorities won’t be funded at the level he requested. When asked how the governor felt about the general revenue being used to backfill the loss of federal dollars his staff over the weekend said the governor was watching the process.

Despite using the $1 billion figure in the budget, the governor’s attorneys argue that the Legislature finds itself in the midst of a special session on the budget but does not have a resolution of LIP.

“The state cannot possible anticipate at this point whether any semblance of its LIP program will continue to exist or how it will be funded if it exists at all,” attorneys for the governor wrote.

“Each day that passes without a resolution to this matter heightens the tension at the state Capitol …. (and) (d)efendants appear determined to leave the fate of the LIP program in limbo until long after that date–presumably in an effort to coerce the state into expanding Medicaid or to punish the state for failing to ultimately do so.”

The federal government advised Florida last April that the supplemental Medicaid program called Low Income Pool, which was $2 billion in 2014-15 year, would expire this summer. In preparing his budget for the upcoming fiscal year Scott assumed the full $2 billion would be available. Scott’s proposed budget included record increases for education funding as well as more than $600 million in tax reductions.

In spring federal officials from CMS reiterated at an Associated Industries of Florida-sponsored health summit in Orlando that the LIP would not be extended in its current form. The Legislature did not know how much LIP money it could expect to receive for the 2015-16 year and. as such, was not able to pass a budget and adjourn the session on time.

Scott sued the federal government in court and also requested a temporary injunction that, if approved, would require the feds to keep funding LIP at $2 billion.

A hearing on that has been set for July 19 in Pensacola.

Rick Scott’s office on health care funding: “We are continuing to watch the process”

After making quick progress early on Saturday, legislative health care budget writers announced at 4 p.m. they won’t meet again until Sunday.

House and Senate legislative leaders have agreed to pour $400 million in recurring general revenue into hospitals in an attempt to absorb the loss of $1 billion in supplemental Medicaid funding known as the Low Income Pool.

It’s a move that could put the Legislature at odds with Gov. Rick Scott who has said he doesn’t want to “backfill” the loss of federal funds with state general revenue.

Scott’s spokeswoman Jackie Schutz, said the governor  is “continuing to watch the process,” when asked how Scott felt about the move.

Matt Hudson, chief of the House health care budget, said legislative leaders agreed on the approach. The GR was allocated to “make sure we are keeping our system solvent and making sure we are being responsible to our hospitals as well. I think everybody is allowed to have different approaches. This is one our presiding officers agreed on.”

When pressed about Low Income Pool details Hudson said his committee would “take a deep-dive look later today” on how to disperse the LIP funds among the hospitals.

The Senate agreed to back off its commitment to graduate medical education. Both Hudson and his counterpart Sen. Rene Garcia said after the meeting that the issue is not “off the table.”

The $400 million is about $30 million less than what the hospitals wanted to offset the LIP reductions.

There have been no public discussions to date about so-called “rate relief” for Medicaid HMOs participating in the Statewide Medicaid Managed Care program. The HMOs sent a letter to Agency for Health Care Administration Secretary Liz Dudek pressing for a rate increase but Dudek shot back telling the medical plans that the rates aren’t warranted.

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