Never say die

It was a far cry from the bombastic barnstorming that characterized last summer's heated health-care debate, but when incoming Florida Senate president, Mike Haridopolos, R-Melbourne, rolled his bus into town on Aug. 5 for the second stop on his three-day Health Care Solutions Tour, vestiges of Republican resentment to impending federal health-care reform were glaringly apparent. In a cramped conference room on the second floor of a downtown Primary Care Access Network Clinic, Haridopolos was flanked by a predominately conservative sampling of Florida's legislature (plus State Sen. Gary Siplin, D-Orlando; tellingly, "Welcome to the hood!" was all he said) and armed with a presentation that started with the bullet point "Patient-centered care, not government-centered care."

In meetings across the state, Haridopolos has been hosting fact-finding discussions in which he invites health-care stakeholders (mostly hospital representatives), to address the state's struggling Medicaid program. The message he has been touting has been one of efficiency and independence from ponderous federal regulations. In fact, though, the meetings are just another attempt by conservative Florida legislators to play politics against the vast federal health-care reforms signed into law in May — specifically the Affordable Healthcare Act, which features a strong Medicaid component. Haridopolos and his compatriots want to tell Washington that Florida can find its own solutions to the health-care problem.

As the wireless microphone was passed around the conference table during the bus tour, most of the medical professionals in attendance decried the same things: inadequate Medicaid reimbursements, poor access, overuse of hospital emergency rooms, prevention, lawsuits. Meanwhile, most of the legislators — save Haridopolos — remained relatively quiet.

The most deafening silence in the room, though, was from the public. That's because no public representatives were invited to attend. They, said Haridopolos, were free to send concerns via e-mail. "We don't intend this to be the meeting to end all meetings," he said.

That message rankled public advocates; just a day before Haridopolos' stop in Orlando, Florida Community Health Action Information Network e-mail blasted a press release in which executive director Laura Goodhue said, "Unless critical stakeholders participate in these discussions, any policies developed out of these meetings will be poorly informed, and therefore fatally flawed."

Initially, the group invoked Sunshine Law in response to the bus tour's apparent exclusion of public voices from the event; but several members of public-advocacy groups who showed up were reluctantly granted entry, so that concern drifted to the bottom of Florida CHAIN's agenda. The organization then refocused its energy on what it said were untruths being bandied about to sell the legislature's message.

"The rhetoric is that `health-care reform` is going to further bust Florida's budget," Goodhue said in an interview about the tour. "But the Kaiser Foundation did a study that found that Medicaid expansion in Florida will only increase state spending by 1.9 percent to cover 1.2 million Floridians. That's not even factoring in the savings from covering people and uncompensated care."

Florida spends about $20 billion annually on Medicaid, though at least $12 billion of that is federal money, according to State Rep. Scott Randolph, D-Orlando. Last week, it became a near certainty that Florida would receive an additional $700 million for its Medicaid program when U.S. Senate Democrats were able to finally overcome Republican opposition to a bill to provide $16 billion in additional funding for Medicaid programs (though opposition exists in the state's legislature to even apply for the cash). But only some of that money will actually go into the Medicaid program; some could be used to bolster the state's flagging reserves.

This isn't the first time the state has tackled reform of its Medicaid system. In 2005, the legislature convinced the Bush administration to sign a waiver to allow Florida to implement a pilot program in five counties in which HMOs administered Medicaid payments to doctors. Each legislative session since 2005, lawmakers have attempted to extend the program across the state. One Medicaid HMO contractor, WellCare Health Plans, has recently been accused of defrauding the state of somewhere between $400 million and $600 million.

According to CHAIN, the federal government's new Medicaid law is offering multiple new programs — and funding opportunities — to improve Medicaid administration. The organization says the Florida legislature is allowing numerous grant opportunities to pass it by, including millions available to help citizens connect with their benefits. Rather than take advantage of this new federal money, Haridopolos wants the state to get a waiver to allow it to handle Medicaid on its own. He's also considering a push for tort reform to prevent malpractice claims.

"Under the new plan, 159 new federal programs will be started," Haridopolos told a Fox 35 News reporter on Aug. 5. "That means a lot more money will go to hiring government workers instead of providing health care."

According to Randolph, what Haridopolos is doing is standard Republican practice. Republicans are not interested in lowering your taxes by cleaning up Medicaid, he said; rather, they want to shift money to the private contractors they count as friends. They want the cash without the regulations that would ensure quality care.

"Here's my left hand out for the money," he said, "while my right hand is jabbing you in the jaw."

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