HNF Stories
7:43 am
Fri November 22, 2013

FL Seen as Unlikely to Expand Coverage to Poor in 2014

Consumer groups, hospitals and insurers are clamoring for Florida to take the $51 billion in federal funds that have been offered to the state over the next decade to provide health coverage to the working poor. But those who are tuned in politically --  even those who desperately want it to happen -- say it’s very unlikely in 2014.

Alan Levine
Alan Levine

“I think the right decision financially and morally is for Florida to take the money,”  Alan Levine, a Naples hospital executive and Republican insider, told reporters Thursday.  “But I would say (the chances) are very low, less than 30 percent.”

He said there are multiple reasons, including political rancor and misunderstanding of Medicaid financing. Also, 2014 is an election year.

Most other speakers at the three-day workshop in Miami were similarly dubious.

“I don’t think they’re going to do it in this session,” said Linda Quick, president of the South Florida Hospital and Health Care Association. She spoke to the journalists attending the seminar on Wednesday night.

Timing is part of the problem, she said, given the disastrous launch of the enrollment site, Healthcare.gov.

“We had almost convinced (House Speaker Will Weatherford) he looked stupid, turning down $51 billion, and then came the Obamacare website,” Quick said. “Now they can say (the federal government) is incompetent.”

“I think it may be five years” before Florida lawmakers relent and cover adults whose income is under the poverty level,  said Drew Altman, president of the Kaiser Family Foundation. “Florida may be one of the last states” to act.

Several lobbyists and others who work for hospitals and insurance companies, unwilling to be quoted,  just shook their heads when a reporter asked them away from the microphones if the matter had a chance in the 2014 session.

The Kaiser Family Foundation -- which has no relation to Kaiser Permanente Health Plan, but is the parent organization for Washington-based Kaiser Health News  -- served as host to more than a dozen journalists from national and in-state publications for the seminar Monday night through Thursday. The foundation invited prominent speakers from the private sector to brief the journalists on the rollout of the Affordable Care Act in Florida.

The group included Sarah Boseley, health editor for The Guardian newspaper from London, who created a major flap in Florida by writing an article posted Thursday with the headline: "Florida in secret talks to accept funding for Medicaid from Affordable Care Act."

Boseley pegged her story on comments from two of the speakers: Donna Shalala, president of University of Miami, and Patrick Geraghty, president and CEO of Florida Blue (formerly known as Blue Cross Blue Shield of Florida).

To be sure, during their talks both Shalala and Geraghty sounded upbeat about the likelihood that Florida's Legislature will pass some substitute for Medicaid that would enable the state to accept the funding. The Senate did just that in this year's session, but House Republicans led by Weatherford voted it down.

Shalala, who served as Health and Human Services Secretary under President Bill Clinton, said she thinks Florida Republican leaders will find a way to get past the politics and take the money.

“When people say to me, is Florida ever going to come around, my answer is yes, because a billion dollars is on the table and the stakeholders are big contributors to the Republicans – to the party," she said. Stakeholders include those who stand to benefit: hospitals, insurers and to some extent big business.

"They understand that it will be a major economic investment in the state and they are just trying to figure out a way around the ideology in the conversations that are going on,” Shalala said.

Later at a Florida Blue retail center in Kendall, Geraghty said he shared Donna's optimism. "It doesn't have to be Medicaid, but we should take the funds. We don't think that money should be left on the sidelines. It's a more rational way to move money through our health care system, and nearly 1 million people should benefit."

But neither Shalala nor Geraghty said exactly when they thought the House would act. Most of the other speakers said they expect a delay of at least a year, maybe longer.

Shortly after The Guardian posted the article, several state officials issued statements saying it was mistaken. Rep. Richard Corcoran, R-Land O'Lakes, called the Guardian story "incorrect on multiple levels.

Corcoran, chairman of the House Health and Human Services Committee, said it appears that the reporter confused talks relating to the Low Income Pool payments with Medicaid expansion, which is part of what he called Obamacare. The pool payments are federal funds for hospitals that treat a great many uninsured patients.

Corcoran concluded by saying the House "would welcome any talks providing Florida the flexibility to spend tax dollars more wisely and has no interest in expanding Obamacare under its current inflexible and irresponsible terms."

During his presentation, Levine said he thinks it's possible for Florida's House leaders to accept an alternative to Medicaid that would give the state to design its own program, using all the federal funds (besides Medicare or military spending) that are now a patchwork of programs -- from KidCare to Medically Needy to food stamps.

But such a radical transfer of power would require the federal government to waive a host of rules, and even when waivers aren't controversial, the process of applying, negotiating and approval takes months -- usually a year or more.

Levine said the billions in federal funding that are being offered to Florida would cover nearly 1 million low-income adults who will not be eligible for the Health Insurance Marketplace because their incomes are below the federal poverty level -- about $11,500 for an individual.

Covering those adults would provide income to hospitals that they are losing through other parts of the Affordable Care Act, Levine said. So by turning down the money, Florida officials are dooming hospitals to financial hardship, which could hurt both staff and patients.

Hospitals in the chain where he works, HMA, have already laid off 700 staff members, he said, and other hospitals are being forced to do the same.

Levine served as Secretary of Florida's Agency for Healthcare Administration under former Gov. Jeb Bush and as Secretary of Health and Hospitals for Louisiana Gov. Bobby Jindal before moving back to the private sector. He is leaving HMA to become president and CEO of Mountain States Health Alliance in Johnson City, Tenn., in early January.