Monthly Archives: March 2010

The Rape of Florida Medicaid


The other day, in my post Without a Doctor, I claimed that the Medicare system here in Florida had been raped by the gubernatorial administrations of Jeb Bush and Charlie Crist; thus decimating their effectiveness as originally envisioned.

In the comments section of The VSJ, in ekg’s post They Really Will Stop at Nothing…our sparring partner lilMike, in a reply to me, asked:

Medicaid in Florida is trashed because Republicans have ruined it?

The short answer: YES! ABSOLUTELY!

In 1965, President Johnson signed the law establishing Medicare and Medicaid. The original purpose of the Medicaid program was:

The Medicaid program, authorized under Title XIX of the Social Security Act, was enacted to provide health care services to low-income children deprived of parental support, their caretaker relatives, the elderly, the blind, and individuals with disabilities.

Going way back to the days of Gov. Claude Kirk (whom I had the pleasure to know personally, regardless of his political leanings), Medicaid has been a prime target of Republican Death Squads.

Gov. Bob Martinez (whom I worked under while with the Florida Board of Nursing) cut, sliced, and pared Medicaid at an alarming rate, especially with regards to our elderly.

But it wasn’t until the reign of Jeb Bush (for whom I billed Medicaid and Medicare at a home health agency) that Medicaid in this state went under the greatest change.

One of Jeb’s first actions upon taking office was to kill his predecessor’s, Lawton Chiles (the only Florida governor in recent history to actually care about health care for children, the disabled and the poor) health care initiative for individuals and small businesses, the Florida Health Care Purchasing Alliance.

But that wasn’t Jeb’s first foray into the rape of Medicaid. In 2003:

Governor Bush is proposing to drop health care and long-term care coverage for about 26,000 seniors and people with disabilities, although they would retain prescription drug coverage.  The governor also is proposing steep increases in co-payments for prescription drugs, which likely would make it harder for some poor patients to afford their medications.  The state already implemented modest cuts in the Medicaid eligibility of elderly and disabled people last year.

In 2005, Jeb had the bright idea (not!) to be among the first to follow his brother George’s edict to make state Medicaid coverage over modeling it like (get this!) a health insurance company, complete with limits on coverage:

Gov. Jeb Bush of Florida and Gov. Mark Sanford of South Carolina, both Republicans, have proposed radical changes intended to inject market forces and competition into Medicaid. Under their proposals, the state would give Medicaid recipients a fixed amount of money to buy health care or private insurance.

Under Governor Bush’s proposal, Florida would contribute a fixed amount toward coverage for each Medicaid beneficiary. Patients could use the money to “opt out of Medicaid altogether and purchase health care insurance in the private market,” Mr. Bush said.

(Ironically, today Jeb is on the board of Tenet Healthcare, the same company required to repay the government over 900 million dollars in Medicare and Medicaid overpayments and is plagued by scandal after scandal.)

Even today, Jeb Bush’s failed Medicaid managed care decisions are affecting the State negatively:

”We’ve done the experiment. It has failed,” said Durell Peaden, the Senate’s health care budget chief. “The reports are unsettling. People couldn’t get to specialists, couldn’t get adequate care. And they couldn’t do it cheaply.”

I’m sure Lawton Chiles, the only Florida governor in 40 years to care about it’s citizens, is rolling in his grave right now
 
The son of Gov. Lawton Chiles said today Gov. Charlie Crist has “betrayed” needy children and old people by raiding a tobacco-funded trust fund for $700 million needed to balance Florida’s budget.
 
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Is Health Care Reform Constitutional?


Is it a right? Are the American people guaranteed good health?

That’s a question I’ve seen a lot over the past year or so. Many of those opposed to health care reform often cite the Constitution; usually with the rally cry,

WE THE PEOPLE

Perhaps they should read a little further…

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

Here’s the definition of “Welfare” from Merriam Webster: “of, relating to, or concerned with welfare and especially with improvement of the welfare of disadvantaged social groups…”

From The Free Dictionary: “Health, happiness, and good fortune; well-being.”

We The People, Indeed!

Compassionate Conservatives?


Yesterday, over at the VSJ, my friend ekg stated:

They really will stop at nothing…

She’s right. This, my friends, is the Republican Party/Tea Baggers response to Americans in need:

Meanwhile, the right wing front group for the health insurers, Americans for Prosperity, has this commercial running in the district of Rep. Kathy Dahlkemper, (D) PA:

Obviously it’s false and indicative of the mass of lies we’ll be seeing in the next few days.

The truth? From PolitiFact:

A new TV ad from Americans for Prosperity, a group opposing the health reform bill, suggests that screening mammograms for women under 50 would be in jeopardy if the health reform bill passes…There’s an awful lot of misinformation and distortion packed into to these few sentences, and we’ll have to take them one at a time.

More from PolitiFact…

From Rep. Dahlkemper:

These attacks from a Washington-based front group are false, tasteless, and shameful,… “In the past month, I’ve lost both my parents to cancer. It’s truly disgraceful for outside groups to then attack me for not being tough enough on cancer.

Like millions of Americans, my family and I have lost loved ones to this horrible disease. This is personal for me; I’ve been a strong proponent of the Kanzius Cancer Research Foundation and the work they are doing to find a cure, and I’ve encouraged more cancer screenings, particularly for women. My record and dedication are clear.

Without a Doctor?


(The following commentary of mine was published in the Daytona Beach News-Journal today.)

There’s been a lot of talk in our state about health care reform, Medicare, Medicaid and so on. There’s one side who believes health care is a right, and another believes government intervention in health care is wrong.

We are seeing the penultimate example of why health care reform is so urgently needed in our country. For six years, I witnessed first-hand the rape of Medicaid and Ryan White funding at the hands of Florida’s Republican governors Jeb Bush and Charlie Crist. What were once viable programs providing health care to people in need became bureaucratic jungles of unpaid claims and unmanageable care based upon rigid guidelines designed not to provide the best health care possible, but to deny payment for health care.

Faced with decreasing payments caused by further cuts to these programs, physicians have been forced to quit seeing patients they care for, thanks to political appointees bogging down the system to “save taxpayers money.”

Ten years ago, this area had five physicians handling HIV patients. Today there are none. Now that Dr. Daniel J. Warner has been booted as “the area’s only certified HIV doctor,” can someone out there explain where the hundreds of patients he’s seen over the years are supposed to go? Many of these patients lack the funds and transportation to go out of our area to see a capable physician. Will they have to see a physician who (most likely) is overwhelmed already? A physician untrained in the complex and ever-changing scope of care these patients need? How does the Health Planning Council of Northeast Florida plan on ensuring proper care for these patients?

Here’s a message to Jim L. Mayo, chairman of the Health Planning Council: Instead of donating money to Republican political candidates and health insurance PACs, how about spearheading real reform to health care by supporting our president? Or will Mayo be content with the knowledge that his actions might very well lead to the death of so many patients?

We, The People…


In a letter today to Democrat and Republican leaders of Congress, President Obama pointed out several points of agreement with issues voiced by Republicans during last week’s Health Care Summit.

“No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit,”

From The Washington Monthly:

The GOP ideas include:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

The President should be commended for continuing to pursue a bipartisan health care reform bill. However, such overtures are worthless. It’s obvious the Republicans are against health care reform in any way, shape or form, and are adament in their refusal to work with the President:

“We fundamentally disagree with a comprehensive proposal to reform health care.”

I’ve always thought members of Congress were elected to represent the people. The constituents. Too many times over the past few months we’ve heard of Republican, and Blue Dog Democrat members of Congress state they are opposed to health care reform. The silly reality of all of this posturing is that they’re not concerned about the constituents they serve – they’re more concerned about getting reelected!

Note to the Republicans and Blue Dog Democrats: You are in office to serve us. We really don’t give a damn if you remain in office if you don’t serve us.

We, the People, are in favor of health care reform. In fact – We, The People, favor health care reform with a Public Option.

Now. Get off your asses and pass the damn bill!