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The Governor and Medicaid expansion

If the Florida Legislature’s annual session can seem distant and meaningless, this year the session is anything but that for Roger Kirk and Joanne Aquilina.

Kirk is president and CEO of Bethesda Hospital in Boynton Beach. Aquilina is vice president and chief financial officer. Bethesda provides most of the charity care in southeastern Palm Beach County. Like Boca Raton Regional Hospital, Bethesda is community-based and not-for-profit. Publicly traded Tenet Healthcare Corp., owns Delray Medical Center and West Boca Medical Center.

The big issue this year in Tallahassee—one of the biggest in recent memory—is the refusal of Gov. Rick Scott and the Florida House to accept the Senate’s plan for expanding Medicaid. Technically, the Senate’s label is Florida Health Insurance Affordability Exchange Program (FHIX), because Medicaid expansion is part of the Affordable Care Act. All Republicans must publicly condemn the health care law, even as Senate Republicans try to pull down billions through the law for FHIX.

Numerous credible studies show that expanding Medicaid could bring coverage to roughly one million Floridians who make too much to qualify for Medicaid under current rules but not enough to buy private insurance. New to this year’s Medicaid debate is the possible end of another source of federal health care money for the state’s working poor: the Low Income Pool, or LIP.

Kirk said Bethesda receives $4.5 million of the $2.2 billion that Florida receives from the Low Income Pool. Combined with other Medicaid-related money, he said, Bethesda could lose about $8 million if the Legislature doesn’t expand Medicaid and the Centers for Medicare and Medicaid Services ends the LIP money.

Medicaid expansion, Kirk told me in an interview Monday, “has become a political football.” He and other hospital CEOs are frustrated because “the explanation for not expanding Medicaid is confusing. It doesn’t add up.”

Actually, it does add up—but not in a way that says anything good about Tallahassee.

In 2012, when the U.S. Supreme Court upheld the Affordable Care Act, the justices did not require states to expand Medicaid. A year later, the Florida Senate presented its first plan for Medicaid expansion by another name. The House refused. Scott briefly expressed support for expansion, but he never pushed it.

The House remains opposed. So Scott is the key player. Despite that opposition, he could force the House to accept the Senate’s plan. Among other things, he could threaten to veto every budget item dear to House GOP leaders. The Florida Chamber of Commerce and Associated Industries of Florida have given Scott political cover by supporting FHIX.

The sense in Tallahassee, though, is that Scott intends to run for the U.S. Senate in 2018 against incumbent Democrat Bill Nelson. Scott would run as the anti-Washington, anti-Obama candidate, even though Obama would have left the White House more than two years earlier. But Scott couldn’t use that campaign theme if Florida expanded Medicare—under whatever name—because it to would amount to acceptance of the Affordable Care Act. In a non-presidential election year, the conservative Republicans most opposed to the law have outsized importance because the turnout is low.

Last week, as criticism of his opposition grew, Scott announced that he would sue the federal government. He claims that the potential loss of Low Income Pool money is designed to “coerce” Florida into expanding Medicaid.

In fact, the Centers for Medicare and Medicaid Services warned Florida a year ago—Kirk confirms this—that the state’s Low Income Pool program in its current form would be ending. Florida got an extension through this budget year —which ends June 30—only because the state agreed to an independent evaluation of a new payment plan. As the Orlando Sentinel reported, a federal health official recently told an Associated Industries of Florida conference, “Florida’s payment system is complicated, and far more so than the payment system in either Medicare or payment systems in other states. That complexity leads to huge variation within the state in terms of the ratio of Medicaid payment to the cost of care.”

As testimony last week before a Senate committee revealed, however, the governor has made no contingency plans if the LIP money ends. The witness was Elizabeth Dudek, seeking Senate confirmation as secretary of the Agency for Health Care Administration. It supervises the Medicaid program in Florida.

Under questioning from Sen. Don Gaetz, R-Niceville, the past Senate president, Dudek acknowledged that the Scott administration had no fallback plan of its own for the loss of Low Income Pool money. Indeed, Dudek said the administration’s only plan was. . .the Senate plan for expanding Medicaid—a plan the governor opposes. Not until Monday did Scott send the federal government a new plan for the Low Income Pool money.

How weird has this debate become? Democrats on the Ethics and Elections Committee fist-bumped Gaetz as he left for a meeting of another committee after questioning Dudek. Gaetz rarely raises his voice, but he is a full-throated Republican. His questioning shows that there is bipartisan frustration with the governor over his intransigence on expanding health care coverage.

The federal government would cover 100 percent of Florida’s costs for FHIX or any other version of Medicaid expansion for the first three years. Washington would pay 90 percent of the costs annually after that. According to the Health360 project of the Brookings Institution, states that don’t expand Medicaid will give up $37 billion in matching federal money and $14 billion in hospital reimbursement next year.

And for those who worry about additional cost to Florida, the Brookings researchers believe that expanding Medicaid eligible for children could bring in enough revenue to pay for the expansion. The researchers wrote, “The study found that childhood Medicaid raise cumulative taxes paid, reduced government Earned Income Tax Credit transfers and increased cumulative wages among females.”

Rather than help the state, Scott threatens yet another legal fight. Given his record in the courts—he has lost on the Affordable Care Act itself, drug-testing state employees and welfare recipients, as well as election laws and prisons—his chances are slim. Worse, a lengthy lawsuit wouldn’t help Roger Kirk and Joanne Aquilina.

If Bethesda loses that $8 million and the state doesn’t act on Medicaid expansion, “It would severely impact our operation,” Kirk said. “We would have to reduce services and programs.” Among them: The program Bethesda uses to qualify new mothers for Medicaid. Many don’t know they are eligible. Kirk said about 80 percent of Bethesda’s free care is for obstetrics and pediatrics.

Many hospitals would be in much worse shape. It is safe to say that Florida faces a potential health care crisis. The session ends in nine days. The House and Senate are $4 billion apart on their budgets, all because of health care. The governor is looking to his next job. Everyone expects a special session, but added time won’t help unless there’s a change in one side’s position. The change needs to come from the governor.

Meanwhile, Bethesda and many other hospitals in Florida wait, wonder and fume.

Sober House update

More hopeful news from Tallahassee is that the House has passed legislation that would require state certification of “sober houses,” residential facilities for substance abusers who have completed treatment.

Sober houses have popped up all over Boca Raton and Delray Beach, in some cases degrading neighborhoods of single-family homes. The legislation seeks to drive out bad operators by requiring treatment centers to send patients only to certified sober houses.

Rep. Bill Hager, R-Boca Raton, sponsored the House version. Democrat Jeff Clemens is the Senate sponsor. He told me that he expects a full vote on the Senate version late this week. Since the bill has received only yes votes in committee, overwhelming approval seems likely.

Assuming the governor signed the legislation, relief for cities and neighborhoods still would be months off, if it came. Real progress will come only when the federal government changes rules that classify addicts as disabled, and thus prevent any regulation of where they live.

Police Advisory Board

Ten years ago, a 23-year-old Delray Beach police officer shot 16-year-old Jerrod Miller as the youth drove a car through a school breezeway. The incident led to soul-searching among city officials, and Delray Beach formed a Policy Advisory Board as a result.

The Jerrod Miller case was different from recent police shootings that have drawn so much attention. Miller had no driver’s license, yet an uncle lent him a car to drive to a dance. Miller drove off to avoid a police license check. But the officer, Darren Cogoni, acted irresponsibly by firing at a car that was moving away from him. Cogoni said he fired to protect other kids at the dance. In fact, the shot put all the children at risk. The city settled with Jerrod Miller’s estate for $1 million.

In the wake of what happened in Ferguson, Mo., and other places, having a civilian conduit to the police department is a good idea. It can do its most important work before trouble happens. On tonight’s Delray Beach City Commission agenda is an item that would allow the Police Advisory Board to continue. Especially given new Chief Jeffrey Goldman’s support for community policing, the commission should keep the board.

Working Floridians on the uptick

On many occasions, Gov. Scott has expressed his wish to make Florida as business-friendly as Texas. For the moment, however, the comparison favors Florida.

In March, according to Wells Fargo, the state added 30,600 jobs while Texas lost 25,400 jobs. Regarding that Florida number, keep in mind that the entire country added just 126,000 jobs last month.

These reports, though, come with lots of asterisks. The drop in oil prices has hit Texas hard, as companies cut back on drilling. Florida especially has benefited from the tough winter in the Northeast and Midwest, which slowed economies in those states and sent more tourists here seeking warmer weather. The West Coast also still is feeling the effects of the long port strike, which just settled.

Still, Florida’s year-over-year, private-sector job growth is roughly twice that of the nation as a whole. Whatever the reasons—which have much less to do with the governor’s policies than he would argue—it’s good for the state. At this rate, the number of working Floridians soon will be higher than the pre-recession record.

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You can email Randy Schultz at randy@bocamag.com

For more City Watch blogs, click here.About the Author

Randy Schultz was born in Hartford, Conn., and graduated from the University of Tennessee in 1974. He has lived in South Florida since then, and in Boca Raton since 1985. Schultz spent nearly 40 years in daily journalism at the Miami Herald and Palm Beach Post, most recently as editorial page editor at the Post. His wife, Shelley, is director of The Learning Network at Pine Crest School. His son, an attorney, and daughter-in-law and three grandchildren also live in Boca Raton. His daughter is a veterinarian who lives in Baltimore.

Randy Schultz

Author Randy Schultz

Randy Schultz, a native of Hartford, Connecticut, has been a South Florida journalist since 1974. He worked for The Miami Herald until 1976 and for The Palm Beach Post from 1976 until 2014, where he served as managing editor and editorial page editor. Since 2014, he has written a politics blog, commentaries and other articles for Boca magazine. His writing has earned first-place awards from the Florida Magazine Association and the Florida Society of Newspaper Editors. Randy has lived in Boca Raton with his wife, Shelley Huff-Schultz, since 1985. His son, daughter-in-law and their three children also live in Boca Raton.

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