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CNN reports political favors led to 13K kids losing coverage; Chris King calls for probe

Democratic gubernatorial candidate Chris King is calling for an independent investigation after CNN report Friday alleging the Florida Department of Health used faulty processes and political motives to kick 13,000 chronically sick children out of the state’s Children’s Medical Services program.

“I’m calling for an independent investigation into the Florida Department of Health and the administrative actions that led to this systematic decision to rip CMS health coverage away from more than 13,000 sick children and what influenced this decision,” King said in a news release issued by his campaign.

The Florida Department of Health responded Friday by contending the cable news network used misunderstanding and outdated information to inaccurately characterize the program, and that the claims that politics  played any role “is 100 percent false.”

“CNN’s reporting demonstrates a misunderstanding of Florida’s Medicaid system, the health insurance industry and the ethical standards of the State of Florida,” the DoH statement said.

Yet the department’s response largely defends what has happened since 2015, not responding much to what happened in 2015. What appears to not be at issue is that in 2015 Florida removed more than 13,000 children from the Children’s Medical Services program, a state-run Medicaid program set up for chronically-sick children, and referred them to other, private, Medicaid insurers.

The CNN report contends that the CMS program was nationally respected and designed to handle the sickest of kids, but claims those transferred off included many children with serious health problems including birth defects, heart disease, diabetes and blindness. It network reports that many of them were unable to find services under the new insurance plans which did not specialize in severe and chronically-sick children, which and which were not accepted by certain pediatric specialists.

CNN then cited experts and researchers in children’s health programs who said the data analysis, screening tools, and processes the Florida Department of Health used to decide which children would be dropped from CMS were deeply flawed, “completely invalid” and “a perversion of science,” in two comments.

The report then cites experts, including Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics, who allege the children were switched to the private Medicaid insurers to reward Republican contributors. CNN also breaks down campaign contributions from the private insurance carriers to the Republican Party of Florida and other Republican political committees.

“Local and national experts in the medical field have expressed concern that this may have been done for political reasons, which, if true, would be deeply troubling,” King stated, first on Facebook, and then in a news release from his campaign. “The bottom line is that these children went without critical and oftentimes life-saving medical treatments and services because the state of Florida dropped them from CMS.”

King, a Winter Park developer, faces former U.S. Rep. Gwen Graham of Tallahasse and Tallahassee Mayor Andrew Gillum for the Democratic nomination to run for governor in 2018. Agriculture Commissioner Adam Putnam of Bartow and state Sen. Jack Latvala of Clearwater are running for the Republicans.

The Department of Health addressed CNN’s allegations one-by-one, dismissing them all. Yet the DoH’s overriding concern is the argument that the processes and tools used in 2015 were discarded and in 2016 new and better tools were used. The department said all of the families of children removed from the program in 2015 were sent letters encouraging them to re-screen their kids for possible re-enrollment in CMS.

The department argued there would be no benefit to the private insurers to pick up the chronically sick children, so it clearly was no reward for anything.

“According to the state’s Medicaid agency [Agency for Health Care Administration,] it is not true that health insurers benefit from having higher risk patients on their plans,” the DoH statement said. “This is a claim CNN makes and then contradicts with the fact that sick children are costlier for insurance companies because of the care they need. There was no financial impact or plan profit from any change. Plans do not receive an individual rate for each enrollee, but rather one overall rate for the entire plan.”

At least since early 2016, the screening tools CNN reported on, which were used for about two years, were no longer in use, the department stated.

“Beginning on January 11, 2016, the department resumed clinical eligibility screening using the process defined by Rule 64C-2.002, Florida Administrative Code. The process includes a two-part approach to clinical eligibility screening – a physician-based, auto-eligibility process using diagnostic codes for chronic and serious conditions and a parent-based survey to ensure that all financially eligible children with special health care needs are given the option to enroll in the CMS Plan,” the DoH reported. “At any time, a parent or physician can request that a child be screened or rescreened for the CMS plan – a fact CNN omits from their story.”

And finally, the department contended, “Since the time CNN is speaking of, more than two years ago, there have been multiple changes in department and CMS Plan leadership.”

Florida’s cost for losing lawsuits keeps growing

Florida’s price tag for losing legal battles – which has included courtroom fights over drug testing, voting rights and gay marriage – continues to grow under Gov. Rick Scott.

Scott recently agreed to pay $1.1 million to cover the legal bills of physicians and medical organizations in their successful challenge of a law that restricted doctors’ ability to talk to patients about guns. The law had been pushed through the Florida Legislature at the urging of the National Rifle Association.

In early July, the state also agreed to a $2 million payment that will go to lawyers who sued on behalf of disabled inmates.

A review of records by The Associated Press shows that since Scott took office in 2011 the state has paid at least $19 million to cover expenses and fees for lawyers who have sued the state. Many of those lawsuits took aim at policies put in place by Scott and the Republican-controlled Legislature.

The Scott administration has defended the legal expenses in the past, saying the governor will “vigorously defend” Florida’s laws.

In February a federal appeals court ruled that Florida doctors can talk to patients about gun safety, declaring a law aimed at restricting such discussions a violation of the First Amendment’s right to free speech. The state did not appeal the decision and in late June reached a settlement to pay $1.1 million for attorney fees and costs.

One of the firms involved in the lawsuit – Ropes & Gray – announced it would donate $100,000 of its fee award to the Brady Center to Prevent Gun Violence.

“This award is a message to states to think twice before enacting or defending laws that put lives at risk just to boost the gun industry’s bottom line,” said Dan Gross, president of the Brady Center to Prevent Gun Violence, in a statement.

John Tupps, a spokesman for Scott, defended the state’s fight over the law. He said the governor was a “strong supporter” of the 2nd Amendment and that he signed the bill “after it was approved by a large, bipartisan majority in the Florida Legislature.”

Earlier this month, the state agreed to pay $2 million to cover the fees and costs for groups that sued the state in 2016 over its treatment of inmates with hearing, vision and mobility disabilities.

Randall Berg with the Florida Justice Institute said the money will go to reimbursing the institute, Disability Rights Florida, Jacksonville Area Legal Aid and the well-known personal injury law firm Morgan & Morgan. John Morgan is a frequent Democratic donor and has been speculating about running for governor next year.

In the last six years, the state has agreed to pay attorney fees of lawyers who have sued the state over everything from employee discrimination to drug testing of welfare recipients.

The total includes $12 million paid to attorneys who represented pediatricians in a more than 10-year legal battle over whether Florida violated federal mandates by failing to deliver critical health services to 2 million children on Medicaid.

The state also paid more than $800,000 to lawyers working for the American Civil Liberties Union and nearly $513,000 to lawyers who defeated a state law targeting businesses doing business in Cuba.

An AP review found that between 2011 and early 2017 that Florida had spent more than $237 million on outside lawyers hired to defend the state.

Republished with permission of The Associated Press.

Rick Scott: DC needs to start rewarding efficiency, not inefficiency

Ed. Note: Gov. Rick Scott‘s office sent the following op-ed regarding “the national healthcare debate.”

I recently traveled to D.C. to fight for Florida as the U.S. Senate debated repealing and replacing Obamacare. For far too long, D.C. politicians have focused only on the grand bargain of repealing and replacing Obamacare, ignoring the opportunity to make incremental changes to get rid of the taxes and mandates and roll back the federal welfare state. 

For decades, the federal government has been willing to spend more than it takes in. We all know this is not sustainable, leaving debt for our children and grandchildren – more than $19 trillion in debt and counting. The inaction we’ve seen on repealing Obamacare shows that hasn’t changed.

Throughout this healthcare debate, a lot of people have been advocating for bigger government, and not a lot of people have been advocating for taxpayers. I will always advocate for Florida’s hardworking taxpayers.

While a new bill has been introduced this week, it has taken far too long to get rid of the disaster of Obamacare, and I fear the politicians in Washington will never find common ground on this critical topic. There is absolutely no question that Obamacare must be repealed immediately so Americans can actually afford to purchase health insurance.

To lower costs, fundamental reform to the Medicaid program is needed. Obamacare encouraged a massive expansion of Medicaid to cover able-bodied, working-aged adults, even as 600,000 elderly Americans and individuals with disabilities nationwide sit on waiting lists to access services through this program.  

States like Florida that have run increasingly efficient Medicaid programs, and have not expanded Medicaid, must be rewarded and treated fairly under any bill. What’s concerning is that under the most recently proposed Senate bill, tax and spend states like New York will continue to be rewarded for running an inefficient Medicaid program.

Long before the Obamacare debate, New York ran a terribly inefficient Medicaid program for decades which ran up their state’s deficit and hindered their economy. Florida is the exact opposite. We have been efficient with our dollars while providing quality care to those who truly need Medicaid. 

As a reward for its fiscal irresponsibility, for every dollar New York pays in federal income taxes, they receive a quarter back from the federal government for Medicaid. In comparison, Florida only receives 16 cents for every tax dollar that is sent to Washington. Current Congressional bills lock in past federal spending, which would make this inequity permanent.

That makes absolutely no sense. If Florida is going to get a smaller rate of return on its federal taxes, shouldn’t our federal taxes be cut? New York, with fewer residents than Florida, receives more than $33 billion per year for Medicaid while Florida receives less than $15 billion.

How is permanently locking in these spending levels fair to Floridians when New York has been terribly inefficient with their taxpayers’ dollars? The federal government should cut income taxes for Floridians by 30 percent. This would put our share of federal Medicaid funding as a percentage of taxes paid on par with New York. This reduction would save Floridians thousands each year.

The federal government must start rewarding efficient states like Florida and stop rewarding inefficient states. Our taxpayers deserve nothing less. 

Rick Scott on GOP efforts to repeal and replace Obamacare: ‘They can’t stop’

Gov. Rick Scott said federal lawmakers need to keep their word, and continue their efforts to repeal and replace the Affordable Care Act.

“They can’t stop,” said Scott following a stop in Fort Myers on Monday. “They all promised they were going to repeal and replace Obamacare, and they got to do it.”

The Naples Republican’s comments come as Congress returns to an unresolved debate over GOP proposals to roll back much of former President Barack Obama’s health care law. Senate Majority Leader Mitch McConnell called off a pre-recess vote on the Senate’s measure, when it appeared it would fail.

Scott has been vocal in his opposition to the current health care law, and has made several trips to Washington, D.C. to talk with federal lawmakers about repealing and replacing the law. He was last in the nation’s capital to talk with lawmakers about health care on June 27, the same day McConnell announced he would be delaying a vote on the bill.

“The way I always look at it is … until you get results, you’re just working hard every day,” said Scott when asked whether he thought his discussions with federal lawmakers were productive. “It’s like the legislative process this session. We worked hard to get the money for Visit Florida, Enterprise Florida, the money for schools. You work every day. Until it’s all done, you always wonder.”

The future of the GOP health care plan remains unclear. The Associated Press reported that at least 10 Republican senators have expressed opposition to the initial bill, drafted by McConnell. Republicans hold a 52-48 majority, and Democrats are united against the bill. That means just three Republican votes against it will doom it.

Last week, McConnell said he would introduce a fresh bill in about a week, but he also acknowledged that if the broader effort fails, he may turn to a smaller bill with quick help for insurers and consumers and negotiate with Democrats.

The governor said what is important to him is that “Florida is treated fairly” under whatever legislation ultimately clears Congress. Scott also said it’s important that, whether someone has a pre-existing condition, they have the right to buy the plan they want.

The state, he said, should also have “flexibility in our Medicaid program to figure out our own benefits, reimbursement rates and things like that.” The federal government also needs to “reduce the amount of regulations” states need to deal with.

David Bergstein, a spokesman for the Democratic Senatorial Campaign Committee, said criticized Scott’s call for lawmakers to pass a bill, saying Scott is “only ever looking out for himself.” Scott is largely believed to be mulling a 2018 U.S. Senate run.

“First Scott bragged that he helped craft the toxic GOP health care plan that spikes costs by 20 percent, imposes an age tax on older Floridians and strips coverage for pre-existing conditions — all to give himself a big tax break. Now he’s demanding to ram this unpopular plan through Congress, even though the consequences for middle-class Floridians would be expensive and horrific,” said Bergstein in a statement. “It’s just another reminder that Scott is only ever looking out for himself — while Floridians who actually work for a living are paying the price.”

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

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.

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