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Senators Rake Medicaid Official Over Coals

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Agency for Health Care Administration
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

 A Senate committee tore into a high-ranking official from Gov. Rick Scott's administration Tuesday in a sign of mounting frustration with the governor's role in the legislative battle over health care.

During a Senate Appropriations Committee meeting held to approve a proposal (SB 2-A) aimed at helping lower-income Floridians get health insurance, committee members from both parties spent more than an hour grilling state Medicaid director Justin Senior over a perceived lack of respect for the Senate.

The confrontation was the latest episode in an ongoing test of wills between the Senate, which wants to use Medicaid expansion dollars to help lower-income residents purchase private coverage, and an alliance of Scott and House Republican leaders, who oppose any use of funding from the Affordable Care Act, commonly known as Obamacare.

Senators were particularly incensed about Senior's remarks Monday to the House Health & Human Services Committee in which the Medicaid director said the question of whether more or fewer people would have insurance if the Senate plan was approved "would be a very close call."

The Senate has touted the fact that as many as 800,000 Floridians would meet income limits for health care under the plan, though work requirements likely mean that only 400,000 to 500,000 people would actually be eligible.

Speaking to the Senate, Senior reiterated his doubts about whether the program could meet its goals.

"So, as I said to the House yesterday, it is uncertain whether the net effect of this would be a reduction in the uninsurance rate, or an increase," he said.

"Well, it seems to me that you brought nothing but confusion, then," shot back Senate Appropriations Chairman Tom Lee, R-Brandon. "Because you don't know anything. You just bring questions and you don't know what you don't know, but you're going to offer it up as testimony nonetheless. You're not much help, are you?"

Senators also slammed Senior for showing up to the meeting late, and only after several pointedly noted the absence of anybody from the Florida Agency for Health Care Administration. Some held out the prospect of denying confirmation to agency Secretary Liz Dudek, who must get Senate approval by 2016 to keep her job, or issuing a subpoena.

Sen. Don Gaetz, R-Niceville, said the agency had only recently produced an analysis of the Senate bill --- an updated version of an earlier proposal --- despite being asked for comments 10 days ago.

"You chose not to be responsive, you chose instead to go to the House hearing yesterday, without giving the Senate any information about input and your analysis on the Senate bill, and cast all sorts of aspersions on the Senate bill, and you sort of had to be nudged into coming here today at all," Gaetz said. "Why is that the case?"

Senior said the agency's staff worked "very hard" to produce an analysis of the bill, which was finished Monday, and said he wasn't invited to the Senate meeting until Tuesday morning.

"Unfortunately, I was only asked about 14 minutes before it began, and I had a prior obligation," Senior said. "I made it as soon as I could, and I apologize that I couldn't get here sooner."

The lack of an invitation didn't satisfy Lee, who said the agency should have planned to have someone at a meeting dealing with its responsibilities.

"To suggest here today that you needed some invitation here, that we had some obligation to invite you into a discussion that you have refused to participate in is disingenuous," Lee said, his voice rising. "And I will listen to all this gobbledy-gook with respect to your policy and subject area, but I won't listen to it with respect to this process. I have been around here too long."

After the meeting, Lee suggested that AHCA officials, who answer to Scott, and the House were joining forces to undermine the Senate's plan for the so-called Florida Health Insurance Affordability Exchange, or FHIX.

"(The officials) want to hide behind an invitation and, truly, they're doing the bidding of our colleagues in the House of Representatives," Lee told reporters. "That's their role in this process. And not just to own up to it and be honest about it, to me is like, 'Be a man, and stand up here and be truthful about what it is you're doing. It's OK. We get that we're trying to do policy here, we've got other people trying to do politics, and we're going to try to do our best to advance some solutions.'"

The committee unanimously approved the FHIX bill after trying to make another concession to the House. Under an amendment offered by Senate Majority Leader Bill Galvano, R-Bradenton, the plan would expire on July 1, 2018, unless it gets renewed by the Legislature.

Before being renewed, the program would be examined by a nine-member commission that would consider patient outcomes, the financial impact of the plan and whether it increased coverage.

The House has rejected any previous efforts to reach a compromise, and there are signs that the Senate's unity might be fraying. Sen. Alan Hays, a Umatilla Republican who left the meeting before the final vote was taken, asked tough questions about the plan.

Hays said the state was already short 753 primary-care physicians compared to what it needs to care for its population.

"With that kind of shortage, who is going to take care of these 800,000 new patients --- or who's going to take care of even half a million?" he asked.

Sen. Aaron Bean, a Fernandina Beach Republican sponsoring the FHIX bill, said many of the patients were currently getting treatment, just in a different setting.

"We're seeing these people already," Bean said. "They're coming. We're paying for it. This is a different way of paying for those people that are already, when they're sick, they're coming to the emergency room, and it's coming out of the taxpayer's wallet to pay for them."