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May 13, 2008
Florida’s 2008-9 Budget “Glass:” ¾ Empty or ¼ Full?
Most observers of the Legislature agree that relatively little was accomplished during the 2008 Session, and that this lack of productivity was largely due to unprecedented budget woes. The leadership’s refusal to consider the need to tap new revenue sources to compensate for volatile and depleted sales tax revenues left no option other than passage of a budget of $6 billion less than the one the same Legislature passed only a year ago.
Perhaps the only consolation is that the cuts to health and human services were not as deep as had been considered earlier in the budget process, although the Governor’s budget recommendations, which the Legislature largely ignored, had pointed the way to balancing the budget with few cuts. Both House and Senate ultimately proposed an array of painful (though differing) cuts, and in the end, less was cut than either chamber’s starting point (though total cuts still exceeded a half-billion dollars).
In one of the most important developments, agreement was reached to tap $300 million from the Lawton Chiles Endowment (Tobacco Settlement) Fund on a one-time basis, sparing the funding for the Medically Needy and MEDS-AD (Aged and Disabled) Waiver programs to continue Medicaid coverage for some 44,000 of the most vulnerable Floridians.
In the end, Medicaid coverage was not eliminated for anyone, and far fewer services were directly cut than originally feared. Nevertheless, painful cuts remain in the final budget, which passed mainly along party lines.
The effect of the cuts has been obscured to an extent, as they will mainly be absorbed by hospitals, nursing homes, Medicaid HMOs, health departments, etc. The impact to consumers will be felt as these entities are forced to reduce costs, in a number of cases on top of previous cuts. The final budget (HB 5001) includes (or in some cases, omits) funding for health-related programs of key interest as follows:
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PROGRAM OR SERVICE
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FINAL 2008-09 BUDGET |
NOTES |
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Medically Needy – short-term Medicaid coverage for persons with catastrophic medical expenses |
NOT CUT |
Program was fully spared for consumers (the same group remains eligible for same services) in 2008-09 due to one-time use of Tobacco Settlement funds. The program currently serves about 16,000 adults and 4,000 pregnant women and children. (But see the Medicaid article on this topic re: 2009-2010.) |
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MEDS-AD Waiver – Medicaid coverage for seniors and persons with disabilities not eligible for Medicare, all with incomes below 88% of poverty level |
NOT CUT |
Program was fully spared for 2008-09 due to one-time use of Tobacco Settlement funds. The program currently serves about 24,000 consumers. (But see the Medicaid article on this topic re: 2009-2010.)
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Healthy Start Coalitions |
NOT CUT |
Had faced a potential 15% funding cut. |
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Medicaid Payments to Hospitals |
CUT BY $191 million |
7.3% reduction in both inpatient and outpatient payments. |
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Medicaid Payments to Nursing Homes |
CUT BY $164 million |
6.5% reduction, not including cuts to hospice rates and savings associated with diverting more seniors from nursing homes. Minimum staffing levels were also reduced in light of the cuts |
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Payments to Medicaid HMOs |
CUT BY $145 million |
6.5% reduction. In the case of for-profit HMOs, the bulk of the impact will almost certainly be felt by consumers and health care providers, not shareholders. |
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Payments for Prepaid Behavioral Health |
CUT BY $9 million |
4% reduction for mental health and substance abuse services provided under Medicaid Managed Care. |
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Payments to Pharmacies |
CUT BY $10 million |
Reduces the amount the State pays for the ingredients used to make pharmaceuticals. |
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Payments to Healthy Kids Corporation (KidCare) |
CUT BY $17 million |
Most of the cut comes from freezing reimbursement rates. Administrative cuts also. |
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Payments to Health Departments |
CUT BY $7 million |
6.5% in the already severely inadequate funding level. |
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Medipass (Effective alternative to Medicaid Managed Care, where physicians receive small case management fee for coordinating care.) |
CUT BY $12 million |
Cuts are in the form of cost savings associated with: 1) forcing consumers who do not choose to re-enroll in Medipass into Medicaid HMOs and 2) reducing case management fee from $3 to $2. |
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Non-emergency transportation services |
CUT BY $3 million |
Reduces this already woefully under-provided service. |
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Medicaid coverage of adult dentures, hearing aids and eyeglasses |
NOT CUT |
Eyeglasses were restored prior to budget negotiations. Dentures and hearing aids were restored early in budget negotiations |
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Medicaid hospice services |
NOT CUT |
Though there is a rate reduction resulting from nursing home cuts |
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Medicaid podiatry and chiropractic services |
NOT CUT |
Restored late in the negotiation process. |
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Medicaid coverage for pregnant women between 150 -185% of the poverty level |
NOT CUT |
Never seriously considered in either House or Senate |
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Specialized Medicaid services for children such as repairing cleft lips and palates |
NOT CUT |
Restored prior to either House or Senate budget adoption |
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Additional KidCare (Healthy Kids component) enrollment slots |
INCREASED by $29 million |
Funds an additional 38,400 KidCare slots. These funds |
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Increased Medicaid reimbursement rates for physician and dental services |
NOT FUNDED |
The Governor originally proposed $37 million as a small step towards fixing a crisis in the Medicaid program. |
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Governor’s “Cover Florida” affordable health coverage initiative |
NOT APPLICABLE |
The Governor’s proposal was adopted, but will not cost the State (directly). |
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Governor’s proposed partnership-based access expansion initiative |
NOT FUNDED |
The Governor’s proposed $61 million pilot program aimed to expand the safety net “through hospital and county health department partnerships” was an early budget casualty. |
The budget is now in the hands of Governor Crist, who has the final word in the process. And although he has the power to veto individual budget line items, that’s not expected to significantly affect these health care programs and services.
(Submitted by Greg Mellowe, Florida CHAIN) |
May 13, 2008
Some Questions & Answers About the New Health Insurance Legislation
What was in the health insurance coverage bill that passed on the last day of the Session?
The bill, CS/CS/SB 2534, consists of several parts, but most significantly, it includes BOTH the Governor’s Cover Florida initiative to provide affordable health insurance coverage for uninsured Floridians, and a version of the House’s Florida Health Choices proposal to create a “single, centralized market” for the sale and purchase of health insurance, insurance-related products and insurance alternatives.
Why are these two significant but quite different experiments incorporated into the same bill?
Cover Florida was Governor Crist’s top legislative priority, and he was determined to get it passed. The concept behind Florida Health Choices (Choices) was one of “100 Innovative Ideas for Florida’s Future” published by House Speaker Rubio and was initially presented this Session as an alternative to the Governor’s plan. The House later attached Florida Health Choices to the Cover Florida bill, so that they would pass or fail together.
How do Cover Florida and Choices differ from one another as well as from public programs like Medicaid?
They really aren’t very similar. Cover Florida requires the State to work with insurers to develop a form of pared down coverage that is both affordable and available to uninsured consumers regardless of medical history.
Choices, by contrast, authorizes insurers to develop myriad never-before-seen types, levels and forms of insurance and insurance-like products, and then advertise and sell them in a “competitive marketplace”. The marketplace will be overseen by a new public-private corporation. Medicaid is comprehensive, publicly financed, State-administered coverage, but Medicaid eligibility is very restricted in Florida.
Is there another way to clarify what the differences are?
Imagine that, instead of discussing the State’s response to the uninsurance crisis, without being flippant, suppose we’re discussing a company addressing the problem of workers who don’t eat lunch. Under that analogy, Medicaid actually provides lunch, but it’s only available to workers who literally have no money with which to purchase it otherwise, and most of whom have conditions that require that they not miss meals.
Cover Florida aims to get more people who don’t eat lunch already to the table by accepting bids from a few vendors that they know will skimp on the nutritional value and amount of food. But at least they’ll provide a low cost (and hopefully at least marginally appropriate) lunch.
Choices, by contrast, will hire a hospitality management firm, which in turn will allow a potentially unlimited number of vendors to set up questionable carts, buffets, vending machines, refrigerators and grills all over the cafeteria, each serving different types of often deficient meals, in a confusing array of containers and sizes, with different pricing systems (but posted menus).
Vendors will hawk deals where, depending on how much change you have and in which corner of the room you happen to be, you’ll get an uncertain number of calories promising to hold you over until dinner. The company can recommend that a particularly suspicious “special” not be sold, if it finds it, but the management firm is free to ignore it. Admittedly, some who would otherwise have had nothing will benefit.
Who will be able to obtain coverage through Cover Florida or Choices?
To qualify for coverage made available under Cover Florida, an individual must be: 1) between the ages of 19 and 64; 2) without private health insurance coverage; 3) ineligible for coverage through public health insurance programs like Medicaid; 4) uninsured for at least 6 months, unless there are extenuating circumstances. Extenuating circumstances include losing a job along with the health coverage it provided, exhausting COBRA benefits, reaching the age limit for prior coverage, and loss of job-provided coverage caused by the death of/divorce from a spouse. There is no income limit.
Only certain individuals are eligible to purchase from the “market” under Choices, but eligibility has very little to do with need. Coverage is limited to (though this is a huge group) employees of participating small businesses (i.e., 50 or fewer employees) or certain local governments with unique challenges, State employees ineligible for State health coverage, State retirees, and the (until now, virtually non-existent) group opting out of Medicaid for private coverage under Medicaid Reform.
There are no income limits or eligibility restrictions relating to current or prior health coverage. In fact, coverage (or the like) obtained through Choices seems likely to replace existing coverage for some small business employees. The coverage is intended to be portable, however (i.e., you may be able to keep it if you leave the job through which you obtained it.)
Why aren’t children eligible under Cover Florida?
Another part of SB 2534 bill removed the limit on the number of families that can “buy in” to KidCare coverage for their children by paying the full premium, without State assistance. This is how families with uninsured kids (and incomes above 200 percent of the poverty level) can purchase less expensive coverage.
The bill was significantly changed on the last day of the Session without almost no advance notice. What were these 11th hour amendments?
The House’s original version of Choices was even more free-wheeling and devoid of consumer protections, and drew fire from the State Insurance Commissioner and others. A compromise was struck to allow limited oversight by the Office of Insurance Regulation, make the board of the new corporation more independent from the insurance industry, and impose more requirements on insurers.
(Submitted by Greg Mellowe, Florida CHAIN)
For KidCare, Session Brings More Slots, But No Core Improvements
This article provides an initial report on the fate of KidCare-related issues this Session. A more complete report and discussion of next steps will follow in the next issue of Chain Reaction.
As many of you are aware, the “core” KidCare improvements to assure that more eligible children successfully enroll in and maintain their coverage did NOT pass again this year. The outcome was still uncertain even heading into the Session’s final day, however. In fact, the proposed changes had been part of the final bill heard before the Legislature adjourned.
Nevertheless, some positive things were accomplished on the KidCare front:
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Funding to expand KidCare coverage to approximately 38,000 more children eligible for State-supported coverage remained in the final budget. This is a “win” considering the erosion of so many valuable and essential health programs and services this year.
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Many more legislators and the public have been educated about the complexity of the Florida KidCare program and understand how to make it a more cost-effective and efficient program.
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The affordable health insurance coverage legislation promoted by Governor Crist expands eligibility and enrollment by eliminating the cap on enrollment by children with family incomes above 200 percent of the poverty level in the Medikids or Healthy Kids components of KidCare. Currently, the number eligible to buy in to KidCare coverage (“full pays”) is limited to 10 percent of total enrollees.
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A related victory: health insurers must now cover services for children with autism, a change sought for many years in Florida. (The KidCare improvements and autism coverage had been included in the (same) House autism bill late in the Session. The Senate autism bill, however, included neither the KidCare improvements nor the addition of benefits addressing developmental disabilities to KidCare coverage.
A very special thanks is due to the many organizations and individuals in the Florida Child Health Care Coalition who responded to the advocacy alerts and sent messages through their networks. Your efforts created a ground swell of phone calls, e-mail messages and personal visits with members of the House and Senate throughout the session.
It was disappointing not to pass meaningful changes to KidCare again this year. However, we can be grateful for the strong bipartisan leadership from several members in the House and some other victories.
Stay tuned for a more in-depth review of the lessons learned this Session as well as next steps for moving ahead. We look forward to working with you on many more important maternal and child health care policy issues in Florida and in Congress.
(Submitted by Greg Mellowe, Florida CHAIN; and Florida Child Health Care Coalition Conveners: Linda Merrell 386/295-3651 , Karen Woodall, Diana Ragbeer)
Prepaid Therapies for Children Survives Session with Mandated Utilization Management
Efforts to eliminate the Prepaid Therapies Program didn’t get far during the 2008 Legislature that ended May 2.
Bipartisan legislation filed by Rep. Yolly Roberson (D-North Miami Beach) and Sen. Rudy Garcia (R-Hialeah) would have repealed a state law that requires the Agency for Health Care Administration to develop a utilization management program for therapy services. Neither bill received a committee hearing during the legislative session.
Statewide organizations representing pediatric therapy practices as well as occupational, speech and physical therapists worked hard during the 60-day legislative session to reach a compromise that would not put therapists out of business and would prevent service reductions for children.
Lobbyists and representatives of the companies under contract with the state to carry out the Prepaid Therapies Program fought to preserve the program as developed by AHCA.
AHCA officials have indicated that the program will go into effect later this fall. They have developed a website with information
The program will require Medicaid-eligible children enrolled in Children’s Medical Services, MediPass and other fee-for-service Medicaid programs to also enroll in a health plan in order to obtain therapy services.
Children who reside in Pensacola to Tampa/Orlando will enroll in a health plan called Care Access to obtain therapy services. It has subcontracted with American Therapy Administrators.
Children from Sarasota to Miami will enroll in Companion Life, which is partnering with Therapy Review Systems (TRS).
(Submitted by Alisa Snow,
Alliance for Pediatric Therapies)
Legislature Rethinks, Rejects Reform Expansion
The Medicaid Reform Implementation Plan, finalized by AHCA in November 2005, calls for expansion beyond the five counties in the Pilot area to begin as early as this summer. Specifically, for the period beginning July 1, 2008, AHCA’s stated aim is “statewide implementation of Medicaid Reform for mandatory and voluntary populations.” But given the events of the recently concluded 2008 Regular Session, expansion of Reform should instead be at least two years further down the road.
Despite the now well-known set of concerns identified throughout implementation, and despite AHCA’s own acknowledgement that expansion in 2008 would be premature and ill-advised, it was unclear whether the Legislature would back away from the clearly over-aggressive timetable.
House Speaker Marco Rubio had named the expansion of Reform as one of his legislative priorities, as had House Healthcare Council Chair Aaron Bean. Both were in their final session due to term limits, and both were insistent that expanding Medicaid Reform without further delay was essential to preventing Medicaid from overwhelming the State budget.
Yet in spite of Rep. Bean’s efforts, first promising significant changes to “reform Reform” to placate critics, and later emphatically singing the praises of Reform’s accomplishments, however, the speeding train of expansion was about to grind to a halt.
Other Miami-Dade legislators, particularly Reps. Juan Zapata (R-Miami) and Dan Gelber (D-Miami Beach), actively opposed expansion, with reinforcement provided by several Broward legislators whose constituents are already grappling with Reform, particularly Rep. Elaine Schwartz (D-Hollywood). Editorial boards of major newspapers across Florida echoed the concerns and cautioned against moving forward.
Eventually, House Healthcare Council leaders relented on expansion in 2008. So the first official proposal to emerge in the House (March 30th) called for expansion into Miami-Dade and the Keys by September 2009, with expansion into 7 other counties, including the Tampa Bay area, to follow by September 2010. By April 10th, the version of the budget-related Medicaid bill passed by the full House had pushed the deadline for expansion into all 9 counties back to September 2010.
As an ominous counterpoint to that reassurance though, the House budget itself included instructions allowing AHCA to use “unobligated surplus” Medicaid funds in 2008-09 to prepare for expansion into Miami-Dade and the Keys. The notion of adopting a health care budget that exacts more than a billion dollars in cuts for 2008-09, yet somehow yields surplus funds to be diverted for use in expanding Reform in 2010-11, was one of the more surreal concepts floated this entire Session.
The budget and related bills passed by the Senate, however, included no authorization or even mention of Reform expansion whatsoever, and so the expansion timetable was one of the differences between House and Senate negotiated as part of the budget conference process.
The final budget conference report concerning HB 5085, which the House and Senate passed on May 1st and 2nd, respectively, completely removed all language pertaining to expansion. Consequently, at the end of the day, Pilot expansion that seemed imminent for 2008 was in fact pushed back to 2009, then to 2010, and then taken off the table altogether.
Nevertheless, the expansion discussion will certainly resurface and the fate of Reform in 2009-10 and beyond will be debated all over again, begging the question as to whether anything other than term limits prompted the sustained drive for some commitment to expand this year. But by the 2009 Session, some real data will be available that, although limited and perhaps flawed, will for the first time provide a glimpse of how Medicaid Reform is actually working as a system of care. At some point, the questions about what is not known will give way to questions about what is known. The answers to those questions and the extent to which they satisfy the next Legislature may ultimately determine the future of the Reform experiment.
On a related note, what turned out to be weak improvements to Reform proposed by Rep. Bean, nor stronger ones proposed by advocates, were approved by the Legislature either. However, a provision that authorizes the Governor, House Speaker and Senate President to form workgroups to explore alternative health care reforms, particularly including alternatives to Medicaid Reform, did pass.
Many thanks are due to the consumers, advocates and others who worked prior to and throughout the Session to educate decision-makers about the serious risks associated with expanding Reform as well as the need for meaningful improvements. Thanks especially to Florida Legal Services and AARP for all their efforts inside the Capitol.
(Submitted by Greg Mellowe, Florida CHAIN)
Busy Session for Medicaid Could Have Been Worse
Given the intense pressure to trim the State budget this Session, and the bullseye placed on health care in particular, it’s hardly surprising that the Medicaid program was the subject of a number of filed bills. Although the consumer-friendly bills failed and several very problematic proposals passed, the Medicaid program could certainly have been harmed more deeply and permanently than it was. Among the significant Medicaid-related issues the Legislature took up include:
Medicaid Reform: Unimproved
Two initiatives aimed at addressing longstanding concerns with the Medicaid Reform experiment both died in committee, and were likely doomed to failure from the outset because they were non-starters in the House (see related article on Reform expansion). The bill of likely greatest potential benefit to consumers in Reform, Senate Bill 1570, did not even have a House sponsor. Senate Bills 1570 and 1566 passed successfully through one and two committees, respectively, however, but advanced no further. Efforts to place parts of SB 1570 into the Medicaid-related budget bill were also unsuccessful. A third Reform-Related bill, HB 691, did pass the House 105-7 but died in the Senate. That bill would have allowed the creation of specialized health plans serving only consumers with psychiatric disabilities, diverting many out of general Reform plans, where they have faced significant barriers to access.
Medically Needy and MEDS-AD: BOTH Saved Now AND Scuttled Later
These two desperately needed but somehow not federally mandated components of the Medicaid Program seem to be on the chopping block every year. As discussed in the budget article, legislators spared the programs for 2008-09 by tapping the Lawton Chiles Fund on a one-time basis. Seizing on the last-ditch nature of this fix, the Legislature approved along party lines another change to the actual law that established these programs. Even though the funding was spared for the coming year, the use of these “non-recurring” funds was used as a justification for making the programs themselves “non-recurring”. House Bill 5035, the bill making budget-related changes to Medicaid, simply tacks on this deceptively simple sentence twice: “This subsection expires June 30, 2009.” But if not removed later, this will have the effect of eliminating Medically Needy and MEDS-AD beginning in 2009-10! (Presumably with election year implications in mind, however, another paragraph was added that restored the Medically Needy program for pregnant women and children only.)
What does all this really mean? Although a voter-approved amendment to the Florida Constitution limits the amount of General Revenue that can be used for recurring programs, that limit is on TOTAL spending, and isn’t applicable in this case anyway. So the elimination of the programs was completely unnecessary. Further, this change doesn’t affect the 2008-09 budget, and it is the next (2009) Legislature that will make the real decisions about 2009-10. The budget process goes one year at a time, and funding for programs can be reduced or eliminated each year. The real fate of these vulnerable consumers will be decided in 2009.
But there is a difference. In past years, the Legislature has started the budget process with the assumption that these are ongoing programs for which funding might need to be reduced. Next year, the starting assumption will be that these programs will soon no longer exist, and the hope may be that it will therefore be easier for the Legislature to avoid funding them. It should also be noted that the Legislature passed up a chance to secure a dedicated funding source for these programs, namely the proposed increase in the cigarette user fee.
Medicaid Managed Care: ‘No’ Will Now Mean ‘Yes’
Although it won’t save that much money next year, the Legislature also included in House Bill 5085 a provision that will expand Medicaid Managed Care and erode the Medipass program, which is viewed as a preferred and effective alternative to Medicaid HMOs. Medipass is a primary care case management program, where physicians receive a small fee for coordinating consumers’ care. Most Medipass consumers who live in counties with 2 or more Medicaid HMO options will be automatically reassigned from Medipass to an HMO, unless they specifically choose to remain in Medipass during their annual open enrollment period. Currently, there are 29 such counties in Florida, but they are home to almost 90% of the State’s population. The State estimates that this change will save $5.7 million next year, but that’s apparently in case management fees only. Over time, the savings associated with shifting people into HMOs will compound, and that is the primary reason for the change. Again, the silver lining is that advocates had worried earlier in the Session that something closer to the elimination of Medipass altogether might be in the works.
The “auto-assignment” has been defended on the grounds that it does not actually mandate that anyone switch. However, all Medicaid consumers face significant resource and time constraints, and many must contend with literacy or English proficiency barriers as well. During the INITIAL open enrollment process (i.e., when choosing between Medipass and an HMO for the first time), only 53% of consumers actually made a selection. That low rate would seem to indicate that many consumers, despite being satisfied with Medipass, might nevertheless encounter an unwelcome HMO surprise at the end of their open enrollment period.
Medicaid Buy-In: Legislature Opts Out
Finally, a bill that would allow certain Medicaid consumers with disabilities (SSI recipients) to try to work without jeopardizing their essential Medicaid coverage by paying a monthly premium (on a sliding scale) died in committee. The Senate version (SB 2684) did receive on favorable committee hearing.
(Submitted by Greg Mellowe, Florida CHAIN)
“CIGARETTE USER FEE:” In spite of widespread public support, lawmakers say “NO” to over $1 billion for health care AND incentives to decrease number of smokers
Lawmakers Say “No” to Funding Health Care and Decreasing Smoking Rate
It was a session of very difficult decisions. Some of them, however, didn't need to be.
This session, the legislature refused to consider the “Cigarette User Fee” (CUF) which, by the state’s own estimates, would have generated over $1 billion for health care, not including federal matching dollars.
The solid editorial support, widespread media coverage and formidable efforts of the Healthy Florida Alliance, American Cancer Society, Safety Net Hospital Alliance of Florida and others were not enough to overcome one unsurpassable obstacle. Many Republicans simply would not vote for a tax in an election year – not even a tax that many of them personally supported and most Floridians, including Republicans, wanted.
A March 2008 poll showed 79% of Floridians support the $1 increase in the cost of a pack of cigarettes to pay for health care for low income families and others hit with catastrophic illnesses. The poll, conducted by Republican pollsters, also revealed that a solid majority of Republicans polled said they would vote for a Republican legislator who voted for the increase. There was no evidence to justify fear of retribution at the polls yet the bill was still only heard in one of the eight combined House and Senate committees to which it was assigned.
Late in the session, the Senate Health Policy Committee passed SB 2790 with only one “no” vote to a room packed with supporters wearing stickers proclaiming “Don’t let Florida’s Health Go Up in Smoke- Vote Yes on SB 2790”. (See this issue’s Partner Story on the March of Dimes’ powerful participation.)
Please take a minute to thank our bill sponsors, Sen. Ted Deutch (D- Delray Beach) at deutch.ted.web@flsenate.gov and Rep. James Waldman (D-Coconut Creek) at jim.waldman@myfloridahouse.gov for their leadership in this effort.
It is important to keep in mind that just a few months ago we were at “square one” and today we have thirty sponsors, including seven Republicans, and have built a foundation for success in the 2009 legislative session. There are indications that next year’s leadership will be much more supportive of the cigarette user fee. There is also the advantage that it will not be an election year.
During the month of May, the Healthy Florida Alliance will seek to double its membership and recruit additional Republican sponsors for next year’s legislation. To sign on as a member, visit www.healthyfloridaalliance.org, click on “Endorsement” and follow the instructions, or contact Linda Vaughn at lindav@floridachain.org or 850-294-2285 .
A current list of co-sponsors and additional information on the bills can be viewed at:
http://www.myfloridahouse.gov/Sections/Bills/billsdetail.aspx?BillId=37607&SessionId=57 and http://www.flsenate.gov/session/index.cfm?BI_Mode=ViewBillInfo&Mode=Bills&SubMenu=1&Year=2008&billnum=2790
(Submitted by Linda Vaughn, Florida CHAIN)
March of Dimes Puts in More than their Ten Cents, Marching on the Florida Legislature
When the “Cigarette User Fee” (CUF) was finally heard in the Senate Health Policy Committee (please see “CUF” article, this issue) over sixty March of Dimes volunteers filled the seats, lined the walls and created a mighty show of support for the proposed $1 increase on cigarettes to fund health care. What a sight! Although time did not permit their testimony, their presence was eloquent. The bill passed with only one “no” vote!
MOD’s “Legislative Day” was all about telling lawmakers that “Babies Need Champions, Too!” Their message was one of strong opposition to proposed cuts to the healthcare budget, particularly the DOH-Children Medical Services (CMS), and the county health departments’ service delivery programs that provide maternity care services to pregnant women. They emphasized the CMS newborn screening program, birth defects registry program, and maternity services provided through the Healthy Start Coalitions, Healthy Families, and the regional perinatal intensive care centers.
Due in significant part to MOD’s advocacy, funding for the Children’s Medical Services, the birth defects registry program, and the Healthy Start Coalitions was eventually fully restored and funding for Healthy Families was partially restored (although steep cuts were proposed).
Penelope Tiam-Fook (State Public Affairs Director) said she was “?very pleased with the outcome of our efforts. Ultimately, legislators listened to our concerns and pleas to help kids in Florida. Healthcare budget cuts affect every baby born in the state. It is only responsible to invest in our children early rather than later.”
To demonstrate to legislators how small and vulnerable premature babies are and the importance of state-provided programs that help to ensure a healthy start for these babies, the March of Dimes volunteers brought “mission boxes” containing: (1) a tiny diaper to represent the alarming size of a premature baby; (2) a coffee stirrer straw to illustrate how difficult it is for a premature baby to breathe with such small, underdeveloped lungs; and (3) a tiny ring representing the size of small, delicate limbs of babies born too early.
University of Florida and Florida State University students provided training on MOD’s “Legislative Day” priorities: newborn screening, birth defects, and access to healthcare coverage for pregnant women, premature babies, and children with special healthcare needs. Chapter staff, volunteers, students, and mission families met with legislative leaders and staff throughout the day to draw attention to their priorities.
It was indeed a day of high impact that continues to resonate.
(Submitted by Linda Vaughn, Florida CHAIN)
The March of Dimes is dedicated to improving the health of babies by preventing birth defects, premature birth, and infant mortality. MOD provides programs of research, community services, education and advocacy to save babies' lives. For more information, visit www.marchofdimes.com
Parent Education: Learn more about having healthy babies and get free one-on-one, confidential answers to questions about pregnancy, preconception, newborn screening and related topics by clicking here: Pregnancy & Newborn Health Education CenterSM
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Diluted Transparency Bill May Not Clear Up Much
Health Care Consumer’s Right to Information Act Watered Down Despite Widespread Support
Medical debt is the #1 cause of personal bankruptcy in the United States. Much of the burden of such medical debt is incurred during expensive hospital stays. Hospitals are the often overwhelmed and financially strained anchors of our health care system.
However, when uninsured and under-insured consumers lack access to information that could help them avoid crushing medical debt-related problems, the heavy burden placed on hospitals is instead shifted onto low-income patients and their families. That can’t be the answer.
The extent to which a hospital (or any health care provider) makes information available regarding the cost of and billing for medical care, discount or charity care policies, and financial assistance programs for which patients may be eligible is known as “transparency.” There have been consistent but largely unsuccessful legislative efforts to increase transparency in the Legislature in recent years. The last change of any significance enacted prior to this Session was 2004.
Senate Bill 1488, filed by Sen. Charlie Dean (R-Inverness), and related House Bill 1435, by Rep. Juan Zapata (R-Miami), dubbed the “Health Care Consumer’s Right to Information Act,” was backed by a broad coalition of business, health care provider and consumer groups. The original version of the bill included some ambitious proposals for boosting transparency.
Unfortunately, although the bill passed, the requirements were significantly diluted over the course of the Session. CS/CS/SB 1488, the version sent to the Governor, includes only three components. The changes, contrasted with what is currently required by law, are:
NOW: Under Florida’s Patient Bill of Rights and Responsibilities, health care providers and facilities are already required, upon request, to furnish all consumers with a reasonable estimate of charges for medical services prior to treatment.
ADDED: A requirement that when an uninsured consumer is scheduled to receive non-emergency medical care, the estimate must be written (in plain language). The estimate must be accompanied by information about discounts or charity care for which the consumer may be eligible. The uninsured consumer is apparently still required to directly request the estimate.
NOW: Hospitals (and other inpatient facilities) are also already required to provide all consumers with an itemized bill detailing the specific nature of charges for services received within 7 business days, again upon request.
ADDED: A requirement to provide an uninsured consumer scheduled for admission (but only in the case of non-emergency, elective care) with a “good faith” estimate of “reasonably anticipated” charges. Even then, the estimate is subject to revision and is non-binding.
Presumably, an actual request need not be made, but the consumer must notify the hospital that she or he is uninsured, and then the hospital has 7 business days after confirming that lack of insurance to provide the estimate. And after all that, the estimate provided could simply be the hospital’s average charge for the procedure or group of related procedures.
On a more promising note, the hospital must also provide each such consumer confirmed as uninsured with a copy of any potentially relevant discount or charity care policies. A notice indicating the availability of this information must also be posted in the patient reception area.
NOW: The law requires hospitals to provide and AHCA to post certain data related to patient hospital charges on its health-related data website (www.floridahealthstat.com).
ADDED: Clarification about what kinds of data are to be posted, and a requirement that a ranked list of undiscounted charges for at least 150 of the most commonly performed procedures be posted.
Even with the limited changes that were enacted, the extent to which they will increase transparency may be further constrained by the fact that they apply only to uninsured and not under-insured consumers. In general, there will likely be some ambiguity regarding who is required to provide what to whom when the dust settles. The extent to which it will help uninsured consumers avoid unnecessary medical debt is uncertain.
(Submitted by Greg Mellowe, Florida CHAIN) |
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