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Medicaid

Marco Rubio still undecided on health care bill, but liking what he sees

In a new video he released through his office through social media, Florida’s Republican U.S. Sen. Marco Rubio said he still is undecided about the Senate health care bill, but is still studying how it might affect Floridians and sounds generally encouraged, especially about Medicaid.

Last week when the Senate bill was released, Rubio issued a video in which he said he was undecided and would spend however much time it takes to make a decision, and would base that decision on how the bill might affect Floridians.

On Tuesday, in his new 16-minute video released through Facebook Live, Rubio defended the bill’s Medicaid provisions – nationally universally criticized by Democrats, some Republicans and many major health care advocates for cutting Medicaid money – because he argued the cuts are not uniform across all states, and that he believes Florida actually could wind up with more money than before, while other states take the big hits.

He expressed less confidence in what the bill could do to overhaul the individual marketplace for health care insurance, saying that remains uncertain, and he is still studying it.

“I did not decide if I can support it yet,” Rubio said of the Senate bill.

Rubio said he’s been meeting with Florida state leaders from Senate President Joe Negron to state health officials trying to analyze how the bill would affect Florida’s Medicaid program and its insurance and health care laws and regulations, and would be meeting with Gov. Rick Scott in Washington over the next couple of days. Some Florida officials have dome to Washington to work side-by-side with his staff, he said.

He cited what many critics of Florida’s health care programs might take as an irony, that the Sunshine State’s Medicaid programs, without Medicaid expansion and with a federal waiver, by state design, are so relatively small compared to other states that Florida likely would benefit from some of the Medicaid redistribution he says is in the Senate bill.

“We still need to run the numbers. We still need to see what this actually means for Florida. But there is the potential, we should know more later today, that for Florida, with this proposed change, that could actually mean more money, not less money. Maybe not a lot more, but certainly not a cut,” Rubio said.

The individual marketplace issue, he said is complicated because Florida does not have a “functional individual marketplace” now, outside of the highly-structured exchange set up under the Affordable Care Act. So there is more uncertainty how the changes proposed in the Senate health care bill might affect Florida.

“That’s the part we’re going to dig into a little deeper,” he said.

He said he is not operating under any deadlines. He alluded to statements and signals from Senate President Mitch McConnell and other Republican leaders in the Senate that a vote could come this week, and that a bill must be passed this summer, “artificial deadlines.”

“Look, here’s the bottom line: I was elected in 2010 on the promise of repealing ObamaCare. I was re-elected in 2016 on the promise of repealing ObamaCare. I am going to vote to repeal ObamaCare,” Rubio said. “But it has to be done in a way that makes things better.”

 

Andrew Gillum proposes constitutional amendment declaring affordable health care ‘a fundamental right of all Floridians’

Andrew Gillum is calling for a constitutional amendment declaring affordable healthcare is a fundamental right for all Floridians.

Gillum, one of three Democrats running for governor in 2018, announced Tuesday he was proposing a constitutional amendment to declare affordable health care a “fundamental right of all Floridians.”

The proposed amendment, according to a ballot summary provided by the Gillum campaign, would add “a new section to Article 1 of the Florida Constitution.”

“The following language shall be added to Article 1 of the Florida Constitution,” reads the draft text of the proposed constitutional amendment provided by the Gillum campaign. “Affordable health care is a fundamental right of all Floridians. In weighing priorities and allocating available resources, the Legislature shall afford the highest consideration to securing this right.”

The announcement comes as the U.S. Senate prepares to consider a health care bill that, according to the nonpartisan Congressional Budget Office, would leave 22 million more people uninsured by 2026 than the current health care law.

The Senate plan would end the tax penalty that law imposes on people who don’t buy insurance, in effect erasing the so-called individual mandate, and on larger businesses that don’t offer coverage to workers.

It would also cut Medicaid, which provides health insurance to over 70 million poor and disabled people, by $772 billion through 2026 by capping its overall spending and phasing out Obama’s expansion of the program. Of the 22 million people losing health coverage, 15 million would be Medicaid recipients.

“It’s time for Florida to finally enshrine healthcare as a right for all,” said Gillum in a statement. “There is a public trust for the government to care for its citizens, and our state can no longer be ambiguous about that moral obligation. When healthcare is under attack in Washington, we’re going to lean into the challenge of healthcare in the Sunshine State and live our values.”

In Florida, amendments can be proposed to the Constitution through an initiative petition process. According to the Division of Elections, in order for a proposed amendment by initiative to get on the 2018 general election ballot, a petition must be signed by 766,200 voters. Signatures must come from at least 14 of Florida’s 27 congressional districts.

Gillum faces Gwen Graham, a former U.S. representative from Tallahassee, and Orlando businessman Chris King.

_The Associated Press contributed to this report, reprinted with permission.

Bill Nelson blasts Senate health care plan, Marco Rubio says he’s looking at it

Florida’s Republican U.S. Sen. Marco Rubio released a video statement Thursday saying he won’t judge the new Republican Senate health care bill until he has studied it, while Democratic U.S. Sen. Bill Nelson blasted it.

“Now we know why they tried to keep this secret,” Nelson said in a statement issued by his office a couple of hours after the bill, which was drafted under closed doors for weeks, was released.

“This bill is just as bad as the House bill, taking coverage away from millions of people and making huge cuts to Medicaid,” Nelson added. “If that weren’t enough, it also allows insurance companies to hike rates for older Americans. Fixing our nation’s health care system shouldn’t be a partisan issue. We should be working together, not plotting behind closed doors to make it worse.”

Rubio released a video statement in which he said he made it clear that if Sen. Majority Leader Mitch McConnell wants to have the bill passed by the end of next week — 4th of July weekend — that might or might not be possible.

“It may take me one day; it might take me a week,” Rubio said. “I think it’s really important that we do it the right way. I think it’s important that we know clearly what we’re voting on, what its implications are, and every question is answered.”

Rubio’s nine-minute video laid out several points he’ll be looking for, all having to do with Medicaid and the individual buyer’s marketplace.

He said he wants a bill that protects pre-existing conditions, yet provides flexibility so that if someone wants to purchase only catastrophic health insurance, that will be available as an acceptable option. He also wants health insurance tax credits tied to age and income.

His other issues dealt with how the federal legislation could impact Florida uniquely, particularly dealing with Medicaid. In particular, he noted that Florida has a “low baseline” for Medicaid payments, and he does not want the state penalized by a system that builds from a baseline forward in coming years.

 

Budget panel sends schools, economic development, Medicaid bills to the floor

The Senate’s versions of legislation pumping money into public schools, hospitals, Enterprise Florida, and Visit Florida — and establishing a regulatory framework for medical marijuana — cleared the Appropriations Committee Thursday.

The votes — either unanimous or nearly so — sent the measures to the Senate floor. They also augured confrontations with the House involving oversight of economic development grants, and spending on Medicaid and public schools.

Chairman Jack Latvala appeared determined to hold his ground. For example, of a provision allowing use of local tourist tax dollars for Visit Florida projects in small counties — forbidden statewide in the House bill — he said: “I plan on sticking with that. If we have a bill, that ability is going to be in it.”

That bill — SB 2-A — includes more stringent review of the Florida Job Growth Grant Fund projects it would authorize.

For example, Enterprise and Visit Florida projects more than $750,000 would need approval by a special legislative committee. Those worth more than $500,000 would need to be posted on the organization’s website for 14 days before they take effect.

Legislation preferred by the House and Gov. Rick Scott would “vote a blank check with no accountability,” Latvala said. By contrast, in the Senate, “we’re not just talking the talk; we’re walking the walk.”

House Speaker Richard Corcoran defended the House bill.

“The oversight already exists,” Corcoran told reporters.

“He (Scott) is elected. The Legislature is elected. We go in every single year. All those things can looked at,” he said. “But they’re broad-based benefits to the entire state.”

The full Senate began the special session Wednesday by voting to override Scott’s veto of the $11 billion budget for public schools, plus $75 million in the higher education budget.

SB 2500-A, approved by Latvala’s committee Thursday, adds another $215 to the schools budget.

Besides serving as an “insurance policy” to keep the schools open after the new fiscal year begins on July 1 — and against procedural tricks by the House — the Senate’s procedural posture “gives us flexibility on 72 hours.” That’s the three days legislators must wait before voting on budget bills — “at $70,000 a day for the taxpayers,” Latvala said.

For the record, the House doesn’t believe the cooling off period applies during the special session.

Sen. Dennis Simmons withdrew amendments that would have raided the House’s Schools of Hope program to provide $100 million in social services for students at underperforming schools. He indicated he might offer them on the Senate floor.

He argues the program can’t spend the money during its first year anyway, given the time needed to enlist charter operators.

Sen. Anatere Flores conceded SB 4-A, her bill to restore $100 million of the $200 million the Appropriations Act cut from Medicaid reimbursement rates to hospitals, has provoked indifference — even hostility — in the House.

Counting federal matching money, the cuts would be reduced by $260 million.

“Hope springs eternal,” Flores told reporters.

“It is completely within the Senate’s purview to say hospital cuts were a major issue. Forget about it being important to the Senate. It’s important to the state,” she said. “This is an opportunity for us to get that right.”

Senate’s proposed hospital budget cuts, unlike House, spreads pain equally

With the end of the Legislative Session mercifully (hopefully?) in sight, the discrepancies between Senate and House budgets on various issues are becoming more heightened.

At times like these, the two sides need to learn how to swallow their pride when it’s clear one chamber has the better plan.

This lesson would serve them — and the people of Florida, the ones they are supposed to be serving — when the subject turns to funding of our state’s hospitals. The Senate and House have agreed on a whopping $651 million in cuts for hospitals, but they differ significantly on how those cuts should occur.

It really seems this is an issue where the House needs to step aside and make room for the Senate’s entirely more reasonable approach.

The Senate has proposed a comprehensive budget model that applies cuts to supplemental fees across the board, phasing the $651 million in cuts evenly. The House plan, on the other hand, complicates the budget cuts with a four-tier system that favors safety net hospitals.

With the House plan, hospitals in the first two tiers would receive the least cuts, based on their higher percentages of Medicaid and charity care. While this may initially seem like a reasonable idea, it actually creates redundancy in the funding process — and that means a waste of taxpayer money.

The House’s tier structure for Medicaid and charity care made a lot more sense before Gov. Rick Scott and AHCA received a commitment from the federal government for $1.5 billion in Low Income Pool (LIP) funding. The whole point of LIP funding is to reimburse hospitals for Medicaid and charity care.

It makes no sense to do the same thing through the House plan.

These same hospitals being spared the full impact of the cuts because of their Medicaid and charity services will receive reimbursement for those same services through the Low Income Pool (LIP). This means these hospitals, but only these hospitals, would receive both an exemption from cuts AND additional funding for the same reason.

Just as these hospitals are doubling up on benefits, hospitals in the lower two tiers would be doubled up on punishments in the House plan. These hospitals wouldn’t receive the same amount of reimbursement for patient care from LIP and would also experience the most burdensome cuts, leaving them and the patients they care for to make up the costs. This threatens the care of patients, as the hospital they depend on for treatment suffer a disproportionate level of cuts to funding.

The Senate plan, while still painful, at least spreads the pain around equally. If hospitals are going to be cut no matter what, it’s better for them to share the burden and buffer the effects of the cuts, rather than having it all dumped on only select hospitals and their patients.

The Senate’s plan takes into account the well-being of the patient and as well as the efficiency of the cuts, two factors that are missing in the House proposal.

As the session careens toward a conclusion, it’s inevitable that there will be plenty of issues where the House has the better plan. When that happens, the Senate should recognize it and act accordingly. But on the issue of hospital funding cuts, the Senate budget is clearly the way to go.

It’s time the House agreed.

Federal budget bill deal offers $296M for Puerto Rico Medicaid

The $1 trillion stop-gap budget deal congressional leaders have struck to keep the federal government open through September includes $295.9 million to shore up Medicaid in Puerto Rico, U.S. Rep. Darren Soto‘s office said Monday afternoon.

That’s a little less than halfway between the $500 million congressional Democrats such as Soto were pushing for, and the $146 million opening offer from Republican negotiators.

There is no indication that there are any strings attached to the money that would threaten, through delay or repeal, provisions in last year’s PROVESA Act creating debt relief mechanisms for the island government, “as far as we know,” according to Soto’s Communications Director Iza Montalvo.

That point is critical for many Puerto Ricans in pushing for relief for the island. Many throughout Central Florida reacted with angst last week to reports that additional Medicaid money could come only with a trade-off of reduced debt relief.

Puerto Rico is suffering from separate but related crises. The money in the budget deal replenishes a dwindled Puerto Rico Medicaid fund. It’s a key part of the commonwealth’s struggling, federally under-funded [compared with states] health care system, which has led doctors and other medical professionals to flee the island in droves because they can’t get paid. But the other crisis arises from $75 billion in government debt the commonwealth has declared it cannot pay, which has led to widespread cutbacks and even closures of schools, hospitals, utilities, police, fire, and other public services.

State budget deal struck? Jack Latvala says, ‘no,’ but…

Updated 2:45 p.m. — The House has sent over an offer and the Senate is reviewing, according to staffers in both chambers.

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After teetering toward a late-session meltdown, the bones of a roughly $83 billion 2017-18 state budget are in place, according to three sources close to Gov. Rick Scott‘s office and several lobbyists familiar with the negotiations.

Senate Appropriations Chairman Jack Latvala, however, early Tuesday morning said to “not believe the rumors.”

The budget framework, as it stands now, gives legislative leaders Richard Corcoran and Joe Negron their top priorities while delivering a likely-fatal blow to Enterprise Florida (EFI), the public-private economic development organization Scott wants full funding for.

Latvala even told Enterprise Florida interim CEO Mike Grissom Monday evening that a deal was coming together and Grissom “would not like it.”

Flexing their muscle, future Senate Presidents Bill Galvano and Wilton Simpson played pivotal roles in shaping the compromise plan, sources said.

There was bound to be horse-trading: The Senate agreed to fund the House’s “Schools of Hope” charter-school proposal and backed down on increased property taxes, while the House will go along with the Senate’s plan to revitalize Lake Okeechobee.

Negron’s $1.5 billion plan to help Lake O and stop overflows of toxic “guacamole water” into the state’s rivers and streams earlier passed the Senate 36-3. The Senate wanted to leave mandatory local property tax levels (“required local effort,” in Capitol parlance) where they are, to capture rising property values for school funding; the House sees that as a tax increase. Negron also gets more money for higher education.

But the deal also sets up a showdown with the Governor’s Office: Funding for Enterprise Florida, which gets far more public than private dollars, would be zeroed-out.

And VISIT FLORIDA‘s budget would be capped at $50 million, and House accountability measures for the public-private tourism marketing agency also would be put in place, including pay caps and limiting employees’ travel expenses.

The sticking point in all of this may be the torpedoing of EFI, explaining Latvala’s resistance to saying there is a deal. He’s carried Scott’s water in the Senate, but at this point he may willing to go along with a deal if, as those close to the negotiations suggest, the hundreds of millions of dollars in projects that his committee has shepherded get funded.

Unable to reach a deal over the weekend, the House offered a “continuation” budget that would have kept state funding intact at current levels in many places.

That would have allowed legislators to end the session on time and avoid the need for a costly special session. But it would have meant that there would be no money for any new projects.

The Senate rejected this idea. Negron, in a memo to senators Monday morning, called it a “Washington creation where Congress is habitually unable to pass a budget,” adding he had “no interest in adopting this ineffectual practice.”

Despite Senate opposition, Corcoran announced late Monday the House would pass a second budget that would freeze most spending and allow for some growth in Medicaid and public school spending. He said this budget would prevent a possible government shutdown later this summer.

“We remain hopeful that we will be able to reach an acceptable compromise,” Corcoran said in a memo to members. “It is our responsibility to pass a budget that continues the functions of state government.”

Material from the Associated Press was used in this post.

Bill Nelson presses Tom Price on Florida’s opioid crisis, Medicaid’s ability to fight it

In a letter sent today to U.S. Health and Human Services Secretary Tom Price, Florida’s Democratic U.S. Sen. Bill Nelson called attention to Florida’s heroin and opioids crisis and sought answers on how Medicaid can do more.

In his letter, Nelson declared that the heroin and opioid epidemic is “devastating Florida” and he encouraged Price and his agency to continue the fight against opioid abuse and misuse in the United States.”

“Addiction to heroin and opioids has reached staggering levels, and the situation is only getting worse. In 2015, more than 33,000 Americans died from an opioid overdose. That’s 15 percent more people who died from opioid overdoses than in 2014,” Nelson wrote. “The state of Florida is no exception to the national trend. More than 2,200 Floridians died of opioid abuse in 2015.”

He noted that Palm Beach County Vice Mayor Melissa McKinlay‘s effort to get Gov. Rick Scott to declare a public health emergency, and Congress’s efforts to push a comprehensive approach and provide additional funding to approach opioid abuse.

Now Nelson challenged Price to consider Medicaid’s role, and to support efforts to retain Medicaid’s opportunities, even against proposals pushed by Republicans in Congress and in Tallahassee.

“As the single largest payer for substance use services, Medicaid plays a critical role in the fight against the opioid epidemic,” Nelson wrote. “Changing the Medicaid program through block grants or caps will shift costs to states, eliminate critical federal protections, and hurt the more than 3.6 million Floridians who rely on the program, including those struggling from opioid disorders.

“If those cuts are made, how do you propose states like Florida provide the necessary services to help individuals with substance use disorder?” Nelson inquired.

Then he turned to the Medicaid expansion program included in the Affordable Care Act, noting that Florida declined it, leaving an estimated 309,000 low-income Floridians with mental health or substance abuse disorders without easy access to affordable health care.

According to a study by Harvard University and New York University, Medicaid expansion provides drug treatment to nearly 1.3 million Americans,” Nelson wrote. “If Florida expanded its Medicaid program, would it be able to increase access to treatment for those with opioid use disorder? And would expanding Medicaid help the state avoid the rising costs associated with the opioid crisis and mental health needs?

Rick Scott, feds agree to $1.5B commitment for low income pool in Florida

The Trump administration is coming through with $1.5 million in new health care money for Florida, Gov. Rick Scott announced Wednesday as the House and Senate debated their rival spending plans for 2017-18.

The money will finance Florida’s Low Income Pool, which reimburses hospitals that provide charity care.

The infusion would “truly improve the quality and access to health care for our most vulnerable populations,” Scott said in a written statement.

“It is great to have a partner in Washington who is willing to work with us to help our state,” the governor said.

“Florida was on the front-line of fighting against federal overreach under President Obama, and it is refreshing to now have a federal government that treats us fairly and does not attempt to coerce us into expanding Medicaid.”

“This is great news — good news all around,” said Sen. Anitere Flores, chairwoman of the budget subcommittee on health care, who’d included $600 million in LIP money in the Senate budget in hopes the feds would provide it.

“This is a much larger amount of LIP funding than we ever have received. We were not expecting this level of funding. But I think that’s a testament to our congressional delegation being more involved and aware of the importance of this.”

House budget chairman Carlos Trujillo was more circumspect. His committee never counted on the federal money.

“I don’t think there’s a place to spend that much money,” he told reporters.

“It’s good. Florida was punished for years by the prior administration. It’s good that the current administration is recognizing that Medicaid expansion and LIP funding are two separate conversations,” Trujillo said.

The money would allow the House to find other uses for money it would have put into charity care, he said. “We would probably like to use it either for tax cuts or put it straight into reserves, and shore up some more reserves for the out years,” he said.

“From day one, we have been committed to working with our state partners to ensure they have the flexibility they need to make decisions that best reflect the unique needs of their populations,” U.S. Health and Human Services Secretary Tom Price said.

“Today’s announcement reflects that commitment on the part of the Trump administration. We look forward to continuing to work with Gov. Scott as well as governors across the country to make sure Americans have access to quality health care.”

The Obama administration started withholding the money after Florida refused to accept the Medicaid expansion under the Affordable Care Act.

Senate Appropriations Chairman Jack Latvala informed the Senate of the news during debate on the chamber’s $82.3 billion budget for 2017-18.

The House was debating its own $81.2 billion budget Wednesday.

A group of hospitals that spend heavily on charity care welcomed the news.

“The LIP funding helps our safety net hospitals carry out their mission of providing highly specialized, expensive and primary care to all citizens, regardless of their ability to pay,” said Tony Carvalho, president of the Safety Net Hospital Alliance of Florida.

State officials have long complained that Florida draws less than its fair share of federal health care dollars.

“A state like Texas would get almost double what we would get in LIP. This is something that has been needed for a long time,” Flores said. “There has definitely been a disparity.”

It was too early to say how the cash would affect budget negotiations with the House, she said.

“I would hope that, No. 1, that the House would be open to receive this funding,” Flores said.

“Does it open the door for other health care issues? It might. But at the very minimum … it’s for our hospitals. This is great news in a year where, initially, even in the governor’s budget, they had been looking at close to $1 billion in cuts,” she said.

Also party to the announcement were Centers for Medicare & Medicaid Services Administrator Seema Verma and Justin Senior, secretary of Florida’s Agency for Health Care Administration.

“Centers for Medicare and Medicaid Services is working toward a new era of state flexibility and leadership,” Verma said.

“For too long states have been sharing in the cost but have not been allowed to have a meaningful role in decision-making. We want to provide states the flexibility to make health care decisions that best meet their citizens’ unique needs, and support states covering access to health care services.”

“We truly feel like our federal partners are listening to our state and our needs and we know that Florida will have the flexibility we need to run our Medicaid program as efficiently as possible while providing the highest level of care in our state’s history,” Senior said.

Emmett Reed: Who best entrusted with senior care – caregivers or insurers?

Emmett Reed is executive director of the Florida Health Care Association.

In an effort to protect their turf, the health plans behind Florida’s managed care program for Medicaid recipients keep saying they help many older Floridians move from nursing homes to live in community settings. What they fail to tell you is that these elders are just a small fraction of nursing home residents – the reality is that some frail elders simply cannot be properly cared for outside a skilled nursing center.

These health plans, along with the state Agency for Health Care Administration, are basing their assessment on seriously flawed calculations. While they say it would cost taxpayers $200 million to remove skilled nursing centers from managed care, such a carve-out would actually save taxpayers $68.2 million per year.

Florida has a long-standing commitment to helping elders stay in their homes or community settings for as long as possible. But we must also recognize that for more and more of the frailest residents, a nursing home is the best, and perhaps only, realistic option.

The state’s erroneous cost estimate is based on an assumption of what it would cost if certain individuals who received home- and community-based services had instead been cared for in a nursing center. But the proposed carve-out focuses solely on exempting long-stay nursing center residents, not those who could otherwise live in community settings. There are no savings to be realized for these individuals because their health and medical needs can only be addressed in a nursing center – they cannot be safely cared for in a home or community setting.

Official state figures show that managed care companies transition only about 4 percent of nursing center residents into home- and community-based care. That means the other 96 percent continue to receive their care in skilled nursing centers. The huge savings touted by the managed care companies simply cannot be realized.

Florida’s system of managed care doesn’t work effectively for long-stay nursing center residents, who can’t take care of themselves or be safely cared for in the community. With those residents stuck in the managed care system, taxpayers are paying approximately $68.2 million in unnecessary fees each year for management services that are not needed, according to a study for the Florida Health Care Association.

In the final analysis, managed care companies are more like insurance companies than like health care providers – if it doesn’t work for their bottom line, they’re not interested. So when your loved one needs the kind of care that can only be offered in a skilled nursing facility, who would you rather entrust with their care: their insurer or their trained caregivers?

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Emmett Reed is executive director of the Florida Health Care Association.

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