obamacare – Florida Politics

Darryl Paulson: The forgotten voices in the opioid debate

Anyone who follows the news knows that opioid abuse and drug deaths are a national problem; 63,000 Americans die of drug overdoses in 2016, an increase of 21 percent over 2015. Opioid deaths in Florida increased to 5,725 in 2016, a 35 percent increase over the previous year.

It is important to remember that opioid abuse covers a range of things, including street drugs and prescription opioids.

Of the 63,000 drug deaths in 2016, most were not related to prescriptions from doctors.

Fentanyl, which attracted national attention due to the death of Michael Jackson, accounted for 19,000 deaths. Most of these deaths came from illegally made pills or powder which was then mixed with heroin or other drugs. Most of the fentanyl was illegally imported from China.

Heroin accounted for 15,500 of the drug deaths. No physician prescribed this for their patients. Pain meds accounted for 14,500 deaths, but less than one-third of opioid abusers got their drugs from a doctor.

Everyone wants to reduce drug deaths, but the legislature must adopt a plan that focuses on the real problem. Most drug deaths do not come from doctor prescribed pain meds, so the plan to attack drug abuse must concentrate on the real source of the problem.

Gov. Rick Scott and the Legislature are focusing on abuse of prescription opioids. This is important, but the Legislature must realize that this is not the primary source of drug abuse. They must also be careful not to impose burdens on Floridians who need the pain meds prescribed by their doctor.

We all want to eliminate illegal drug use and limit the over-prescription of drugs to those suffering from temporary pain. At the same time, we must realize that individuals suffering from a terminal illness, chronic pain or major surgery should not be denied access to pain meds that will allow them to function with minimal pain.

That decision should be made by the doctor, not the Legislature.

It is estimated that 11 percent of Americans suffer from chronic pain. This is a particular problem for the elderly, and Florida has more elderly citizens than any state. I have had chronic pain since age 12. When I was 20, I could no longer sit in my University classes because of the pain.

I was forced to withdraw from classes and had my first major back surgery. My physician wrote the draft board, which had just requested I appear for my physical, that I was unfit to serve due to “chronic discogenic back pain.”

That surgery would be the first of three major back surgeries. I have had seven surgeries total, and five were major surgical procedures. This does not include more than a dozen other medical procedures ranging from numerous epidurals to a procedure where surgeons attempted to thread a wire up my spinal canal. Nor does it count the osteoarthritis that led to a total knee replacement.

I worry about the proposed three and seven-day limits on pain meds. This means that many Floridians will no longer be able to travel to visit friends and family because they won’t be able to get their pain meds. Vacations, especially overseas, will no longer be possible.

Many pain patients are elderly and will have difficulty seeing a doctor every 3 to seven days. Instead of one visit to a pain specialist a month, patients must now visit the doctor as many as 10 times a month. The cost will be prohibitive for many patients. Then imagine the difficulty of going to the pharmacy every three to seven days. Prescription costs will skyrocket.

Many in need of pain meds will likely go days without their meds because of the new guidelines. Withdrawal will happen.

Melissa Sanders-Self, a teacher who suffers from neuroendocrine cancer who must have radiation treatments every three weeks, describes her withdrawal symptoms because she often cannot get the pain meds the doctor has prescribed.

Sanders-Self writes: “Without medicines, I begin to vomit, shake and cry. I cannot concentrate.” Every chronic pain patient can relate to her experiences.

A final issue is that the Legislature is attempting to become the doctor. Remember when Republicans across the nation opposed “Obamacare” because they said it interfered with the doctor/patient relationship. Isn’t that precisely what the Legislature is now doing by dictating what medicines we may have and in what quantity?

We can cut down on illegal drug use, but we must realize that most problems do not come from doctors prescribing pain meds for their patients. The Legislature does have a responsibility to see that Floridians who have documented pain needs can get the medicines they need.

Imposing additional time and financial costs on those who are already suffering from severe medical problems is hardly compassionate.


Darryl Paulson is Emeritus Professor of Government at USF St. Petersburg specializing in Florida politics and elections.

HMO group slams bill, likens it to Obamacare

In an attempt to kill a bill that would limit its members from retroactively denying claims, the Florida Association of Health Plans issued a statement Tuesday calling a House proposal (HB 217) “nothing more than a codification” into state law of a federal Obamacare policy.

Filed by Rep. Bill Hager, a Delray Beach Republican, the bill would prevent HMOs and insurance companies from retroactively denying claims after patient eligibility has been confirmed and authorization numbers have been provided.

The limitation on retroactive denials would apply to any group or individual HMO policy issued on or after Jan. 1, 2019. It would not impact Medicaid managed-care plans.

The House Appropriations Committee is slated to take up the bill Wednesday, and the Senate also is poised to pass its version (SB 162), filed by Sen. Greg Steube, a Sarasota Republican.

“This legislation is nothing more than a codification into Florida law of a controversial policy created by the Affordable Care Act,” Audrey Brown, president and CEO of the Florida Association of Health Plans, said in a prepared statement.

The Affordable Care Act, better known as Obamacare, gives insurance customers a three-month grace period before their policies are canceled, so long as the customers previously paid at least one month’s premium. During the first month, the insurer must pay all appropriate claims for services. For the second and third months, insurers can notify health-care providers that payment of claims may be denied.

In her statement, Brown said the bill would allow people who do not pay premiums to game the system and would require health plans and employers to absorb the costs.

The bill has been a priority for the Florida Medical Association and other medical organizations for several years in the Legislature. It generally has been supported by the Senate but has faced an uphill battle in the House.

Report says loss of health care mandate would hit South, Central Florida hard

Three South Florida congressional districts represented by Republicans would be among the hardest-hit in the country according to a new report assessing how many people would lose or drop health care coverage if the final tax reform bill in Congress includes the U.S. Senate’s provision to repeal the individual coverage mandate in Obamacare.

A report “Estimates of the Increase in Uninsured by Congressional District Under the Senate GOP Tax Bill” from the Democratic-leaning Center for American Progress calculated the prospects for people dropping insurance in all 435 U.S. congressional districts, based on numbers produced by the Congressional Budget Office, if the Affordable Care Act’s individual mandate is repealed. The report, first produced earlier this week but revised late Wednesday, found the districts of U.S. Reps. Mario Diaz-Balart, Ileana Ros-Lehtinen and Carlos Curbelo all would be among the top seven in the country in the numbers of people dropping health care coverage.

Districts of Democratic U.S. Rep. Debbie Wasserman Schultz, Val DemingsAlcee HastingsDarren SotoTed Deutch, and Frederica Wilson would not be far behind.

Only one Florida member of Congress, Republican U.S. Rep. Dan Webster, could expect to see his district among the 100 in the nation that are least-affected by projected health care coverage reductions, according to the center. Florida’s 11th Congressional District in west-central Florida could expect to lose 24,100 people from health care coverage, the 18th-least among the nation’s 435 congressional districts.

The fate of the mandate is in the hands of the congressional conference committee, as the tax reform bill approved by the Senate includes the mandate repeal, while the bill approved by the House of Representatives does not.

Overall, Florida could see 873,000 people drop their health care coverage by 2025 if the mandate is eliminated the center estimated, according to the center. Nationally, state-by-state numbers pretty much rank the same as a state’s population size, and Florida would expect to have the third-highest number of people losing or dropping health care coverage, behind the only two states with higher populations, California and Texas.

With congressional districts, however, the variances range more widely, dependent on how many people in each district now are enrolled in Medicaid, or in health insurance policies purchased through the individuals’ market, or in insurance packages purchased through employer-sponsored plans.

The CBO projected that 5 million of those people dropping health care coverage would be dropping from Medicaid, another 5 million from the individuals’ market, and about 3 million from employer-sponsored health insurance.

“Mandate repeal has two effects on the individual market,” Emily Gee, a health economist at the Center for American Progress, explained in her report. “First, some healthy enrollees would drop out of ACA-compliant plans and become uninsured or underinsured. Second, because the remaining enrollees in the risk pool would be sicker on average, insurance companies would need to raise rates about 10 percent to cover the increased average cost. The resulting higher premiums would discourage even more people from obtaining coverage through the individual market.”

With those factors, Diaz-Balart’s district could become one of the most vulnerable in the nation to reductions in health care coverage, a phenomenon expected to not just affect individuals, but also the financial pressures on hospitals, other health care entities, and local governments, the report notes.

The center’s report says that Florida’s 25th Congressional District could expect to see 41,000 people drop or lose insurance, the fourth-highest number of any congressional district. Ros-Lehtinen’s district is projected to lose 40,800, the nation’s sixth-highest total; in Curbelo’s district, 39,900, seventh-highest among the 435 congressional districts, according to the Center for American Progress.

Diaz-Balart’s, Ros-Lehtinen’s, and Curbelo’s offices did not respond Thursday to a request from Florida Politics to comment on the center’s findings.

Several Democrats, already opposed to either version of the tax bill, responded, including Demings, whose 10th Congressional District was projected to lose 37,700 health care enrollees.

“After much debate, the facts are in: the president’s tax bill will raise your healthcare costs, putting your right to manage your own health further out of reach. Without a second thought, donors came first,” she said in a written statement. “The GOP’s proposal would mean nearly a million Floridians would lose their healthcare over the next eight years. Floridians have done their part by turning out in record numbers during the open enrollment period. However, the people seem to have been forgotten in a tax bill that was supposed to be all about the people.”

Soto, whose Florida’s 9th Congressional District in Central Florida is projected to lose about 35,400 enrollees, declared that “Florida’s hardworking families should be troubled by the current GOP Tax bill. As it stands, it is disastrous for our state’s health programs. In Central Florida alone [including his, Demings’ and Democratic U.S. Rep. Stephanie Murphy‘s districts,] approximately 103,000 people would face a reduction in health insurance coverage due to the individual mandate repeal.”

The other four Florida districts projected to be among the nation’s 50 hardest-hit nationally are Wasserman Schultz’s 23rd Congressional District in South Florida (expected to lose 37,700 health care enrollees); Hastings’ 20th Congressional District in South Florida (36,300); and Deutch’s 22nd Congressional District and Wilson’s 24th Congressional District, both in South Florida, both 35,200.

Across the country, the average congressional district would lose about 29,800 enrollees from health care plans, the center reported. Eighteen of Florida’s 27 congressional districts would exceed that average.

Joe Henderson: Would you vote for Donald Trump again?

Today’s question, class: If you voted for Donald Trump in the last election, would you vote for him again knowing what you know today?

If you didn’t vote him then, would you do so now?

Yes? No?

Wednesday will mark one year since Trump turned the world upside down with his shocking, stunning, unexpected – oh, you know what I mean. But we’ve had time to get used to him and his management style, so what do you think?

Since the election, he has been an extension of the person he was during the campaign –  frequently crude, loose with the truth, addicted to Twitter, and always ready to attack someone he perceives to be an enemy. Some people see all that as a strength.

But my question to you is this: Does that bother you more now than it did during the campaign? Or did you think, as a lot of people appear to have done, that he would put on big-boy pants when he got into office and conduct the affairs of state with proper decorum?

He promised to make America great again – “again” being the linchpin of his campaign. That seemed to be the word that resonated most with supporters.

He did appoint Neil Gorsuch to the Supreme Court and that made supporters happy, but so far, he has no significant legislative wins – despite Republican control of both houses of Congress.

He has warred with Senate Majority Leader Mitch McConnell and Secretary of State Rex Tillerson, belittled House Speaker Paul Ryan, trashed Attorney General Jeff Sessions, and when backed into a corner he tries to shift the focus to Hillary Clinton (and, by extension, Sessions and the Justice Department).

Pssst. The campaign is over, Mr. President. You won.

He hasn’t made much of an attempt to unite the country, preferring to appeal to a (cough) carefully targeted audience (cough) – although I guess we’ll find out from special counsel Robert Mueller if it was a little too carefully targeted, if you get my drift.

Remember in the campaign when Trump dismissed any suggestion of hacking from Russia by saying it “could be somebody sitting on their bed that weighs 400 pounds.”

Yeah, if that bed is in Vladivostok.

Back on point: Would you vote for him again?

Does it bother you that many top people have either left his administration voluntarily or were fired?

It’s quite a list: Chief of Staff Reince Prebius, HHS Secretary Tom Price, National Security Advisor Michael Flynn, Press Secretary Sean Spicer, Ethics Director Walter Shaub, FBI Director James Comey, and on and on.

Did it make America great again to insult important allies like Germany, Australia, Japan, France, Great Britain, and Mexico? Does that type of leadership make you want to vote for him again?

The economy is going gangbusters and he is trying to get a tax plan through. Sure, if adopted as written, rich people will benefit the most but my guess is most supporters won’t care so long as they get a sliver of the pie.

But Obamacare still hasn’t been repealed or replaced, and at this point it looks like the president and his party doesn’t have a clue how to do that. There is no border wall under construction to keep Mexicans on their turf.

His clumsy remarks after the white supremacist clash in Charlottesville, Va. made look like he was offering excuses for bigotry. He assumes he can continue to label any news story he doesn’t like as “fake” and people will continue to believe him.

We had two of the worst cases of mass murder in this country – Las Vegas and Sutherland Springs, Texas – occur since Oct. 1. And on Halloween night, eight people died in New York City during what has been called a terrorist attack.

Donald Trump, obviously, could not have stopped any of those attacks. No president could. But what he sold to enough Americans to win the election is that he “alone” – his words – could fix things.

Thus, he alone must be held accountable for the results.

Has he fixed things to your satisfaction? You’ve had almost a year to judge him.

Would you vote for him again?


Kathy Castor optimistic about bipartisan health care proposal

A potential breakthrough in health care legislation broke out this week with the announcement of a bipartisan deal in the Senate proposed by Tennessee Republican Lamar Alexander and Washington Democrat Patty Murray.

The deal would include funding through 2019 for the Affordable Care Act’s cost-sharing program, which President Donald Trump cut last week. It would allow states to use existing Obamacare waivers to approve insurance plans with “comparable affordability” to Obamacare plans. And it would not allow states to duck the law’s minimum requirements for what a health insurance plan must cover.

The House of Representatives are not in Washington this week. Tampa Democrat Kathy Castor says that it would behoove her colleagues on both sides of the aisle to speak with the public on what they think of the proposal.

“I think it would be fair to allow people to go through it and understand what it means,” she said Wednesday in Tampa. “I also think it’s important to hear from folks at home, doctors, hospitals, a lot of our neighbors. I’m going to check in with our state insurance commissioner, because here we are and open enrollment is going to start quite soon and people need to know is it going to be affordable for me and my family.”

Open enrollment for the Affordable Care Act is scheduled to start November 1 and run through December 15. Those “navigators” will attempt to sign up as many people as they can, despite the fact that the Trump administration is reducing their funding, some by as much as 90 percent.

The Alexander-Murray proposal comes a week after Trump finally followed through with his months long threat to yank the funding for subsidies to insurance companies as part of the ACA. Those subsides reduced deductibles and co-payments for low-income Obamacare enrollees. Analysts say the move did not have that significant an impact since many insurers already raised their rates in anticipation of the move. Regulators in several states that didn’t price in the funding loss announced rate hikes soon after the president’s announcement last week. Insurers must continue to offer the cost-sharing subsidies since they are required by law.

Castor says it’s important to let the public “digest the details.”

“We should be cheering on a bipartisan effort to help fix things for families,” she said. “If this bill will really lower costs and provide affordable care to our neighbors, then we need to pass it and the leadership needs to allow a vote.”

Meanwhile on the other side of Tampa Bay, Pinellas County Democratic Representative Charlie Crist is calling on his constituents to sign a petition calling on congressional leaders to demand a vote on the Alexander/Murray proposal.

Donald Trump issues warning to John McCain after senator’s tough speech

President Donald Trump on Tuesday issued a warning shot after Republican Sen. John McCain questioned “half-baked, spurious nationalism” in America’s foreign policy, saying “people have to be careful because at some point I fight back.”

McCain, a former Navy pilot who spent 5½ years in a Vietnam prisoner of war camp and is battling brain cancer, offered a simple response to Trump: “I have faced tougher adversaries.”

Trump said in a radio interview with WMAL in Washington, “I’m being very, very nice but at some point, I fight back and it won’t be pretty.” He bemoaned McCain’s decisive vote this past summer in opposition to a GOP bill to dismantle Barack Obama’s Affordable Care Act, a move that caused the failure of GOP efforts to repeal and replace “Obamacare.”

In Philadelphia on Monday night, the six-term Republican senator from Arizona received an award for a lifetime of service and sacrifice to the country. In addition to recalling his more than two decades of military service and his imprisonment during the war, McCain took a moment to go a step further than the night’s other speakers, who lamented what many described as a fractured political climate.

“To abandon the ideals we have advanced around the globe, to refuse the obligations of international leadership for the sake of some half-baked, spurious nationalism cooked up by people who would rather find scapegoats than solve problems,” he said, “is as unpatriotic as an attachment to any other tired dogma of the past that Americans consigned to the ash heap of history.”

AP Photo/Matt Rourke

He continued: “We live in a land made of ideals, not blood and soil.”

Former Vice President Joe Biden presented McCain with the Liberty Medal. Though members of opposing parties, the two men worked together during their time in the Senate. Former President Barack Obama, who defeated McCain in his bid for the presidency in 2008, congratulated the senator on the award in a tweet Monday night.

“I’m grateful to @SenJohnMcCain for his lifetime of service to our country. Congratulations, John, on receiving this year’s Liberty Medal,” Obama wrote.

Another political foe, 2012 GOP presidential nominee Mitt Romney, said on Twitter: “Ran against him, sometimes disagree, but proud to be a friend of @SenJohnMcCain: hero, champion of character and last night, Lincolnesque.”

Pressed on Trump’s threat Tuesday morning, McCain told reporters he has had tougher fights, and then smiled.

Trump said in the radio interview that McCain’s vote against Republican efforts to dismantle the 2010 health care law was a “shocker.”

McCain and Trump have long been at odds. During the campaign, Trump suggested McCain was not a war hero because he was captured in Vietnam.

Republished with permission of The Associated Press.

Gus Bilirakis ‘thrilled’ with Trump’s new health care executive order

President Donald Trump took the first steps toward fulfilling his vow to dismantle Obamacare, and Tarpon Springs Republican Gus Bilirakis is thrilled.

Trump signed an executive order Thursday that calls on his administration to develop policies to increase health care competition and choice with the intent of improving the quality of health care and lower prices.

Specifically, the president’s order directs the Labor Department to study how to make it easier for small businesses, and possibly individuals, to join together and buy health insurance through nationwide association health plans, CNN reported. The department could give employers in the same industries more flexibility to offer group coverage across state lines, providing them with a broader range of policies at lower rates.

Virginia Democratic Senator Tim Kaine tweeted that the executive order might be complicated, so he’d break it down in simpler terms.

“It’s sabotage,” he tweeted, adding later that “it would allow cheap low-quality plans onto the market that could discriminate against people with pre-existing conditions, seniors,” ultimately pushing healthy people onto “junk plans,” which leave only the sick or at-risk on the Affordable Care Act, essentially destroying the insurance market.

Bilirakis, on the other hand, applauded what he termed the President’s “bold action.”

“This is great news, especially since the Florida Office of Insurance Regulation recently announced that individual health insurance plans available on the Florida exchange are likely to increase by an average of 44.7 percent, effective January 1, 2018,” Bilirakis said. “Additionally, there will only by 9 companies participating in the Florida exchange next year, with 42 out of 67 counties only having one provider, Florida Blue.”

Bilirakis added that he’s always been a proponent of allowing individuals to purchase health insurance across state lines and expand the reach of Association Health Plans, “because I believe it will drive down prices through increased competition.”

Earlier this year, Bilirakis held three town hall meetings on health care in his district, by far the most by any Republican in the Tampa Bay area. Angry Democrats dominated all three, demanding he does not support dismantling the Affordable Care Act.


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.

Political committee attacks Florida Republicans in new ad campaign

A liberal political committee put out digital ads this week painting the GOP as dysfunctional after Senate Republicans failed to pass a “skinny repeal” of the Affordable Care Act.

American Bridge said it would run the ads in four states, including Florida, and will focus on targeting swing voters through social media.

“The Republican Congress isn’t working. It’s time for new leadership in Washington,” the ad reads.

The ads lead to a signup page asking viewers to add their name to a list of people who “demand new leadership in Washington.”

“Every Republican in Washington should be ashamed for spending the better part of 2017 pushing a plan to gut health care for the middle class in order to cut taxes for the rich,” the page reads.

American Bridge Vice President Shripal Shah said in a press release announcing the ads that D.C. Republicans “are mired in dysfunction, unable deliver on their campaign promises and beholden to a toxic legislative agenda. They are offering the country chaos when we need competence.”

“Kicking millions off of their insurance in order to cut taxes for the rich was a recipe for disaster from the start, and in the aftermath of last night’s failure, we’re going to hold Republicans accountable. Their failures underscore the need for new leadership in Washington that will work in a bipartisan fashion to address the country’s challenges,” he continued.

Senate Republicans were primed to pass healthcare legislation Thursday night, but Arizona Republican Sen. John McCain joined 48 Senate Democrats and longtime Republican holdouts Sen. Lisa Murkowski and Sen. Susan Collins in voting down the repeal bill.

An example of the ad running against Florida Republican U.S. Rep. Carlos Curbelo is below:

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