Medigreed Expansion: Taxpayer-fueled corporate profits are the goal
This page has been saying for a while that the billions in Medicaid expansion dollars will enable the Affordable Care Act (ACA) to prevail as cash conquers kooky ideology. That money-money-money theme still holds true, only the audacity of taxpayer theft has been expanded to monstrous proportions.
It has never been about health care for needy citizens, in case you were under some delusion that the GOP majority in Tallahassee gives a rat’s heinie about the “health care” part of “health care dollars.”
Since the US Supreme Court decided ultimately to uphold the ACA (Florida led the legal fight), and then the election victory of Barack Obama (even in Florida), Florida’s GOP has been hinting that it was giving serious consideration to playing ball on federal health care reform [ahem] given the billions of dollars that could flow into the coffers of their corporate sponsors. The billions of federal dollars would be part of an expansion of Medicaid to reach uninsured citizens with low incomes, directly and fully paid by the US government for the first 3 years and then 90% of the cost until 2020.
When Gov. Rick Scott recently allowed that he would sign a Medicaid expansion bill in an apparent quid pro quo exchange for the US Department of Health and Human Services (HHS) permission to privatize Medicaid statewide, the gauntlet was then thrown down to the Florida House and Senate. (By the way, Medicaid privatization is a profoundly bad idea that has been costly and performed terribly in trials in a 5 county test program in Florida. Despite the evidence, HHS catered to Scott, a profoundly stupid move by HHS.)
Without the privatization permission, it’s still a really sweet deal. How sweet? States get the uninsured covered, but as was stated earlier, only a few seem to care about health care for citizens. More importantly to GOP legislators, health care providers get a huge pot of new money to help with their profitability, and in the case of hospitals, some payment for the millions of dollars in monthly losses from providing care to the uninsured. Such losses have been a huge burden for community hospitals like Munroe Regional Medical Center in Ocala, and have been a primary driver in the negative fiscal forecasts. These billions of federal dollars would help not only hospitals but also medical practices which have taken losses, and generally provide a generous boost for the entire state economy. This infusion of cash may end up having greater economic benefit than the billions in high speed rail money that Rick Scott cavalierly tossed back to DC.
Add in the Medicaid privatization permission that HHS gave Scott in an apparent quid pro quo for his acquiescence on Medicaid expansion, and you can see a whole new string of companies, private insurers and their HMOs, cashing in on the deal. What seems to be the theme is that every corporate interest is getting bought off to provide health care at taxpayer expense, meaning the corporations get big profits and citizens get nickled-and-dimed on their health care plus, as taxpayers, fund their leveraged profits. Giving citizens less health care becomes the corporate goal, subsidized by taxpayer’s health care dollars. What? Is something wrong with this picture?
But now it gets worse.
HHS recently gave permission to Arkansas to take federal Medicaid expansion dollars and hand them directly to private insurance companies to pay for private policies for the uninsured. Why is this idea even worse than privatized Medicaid?
According to Congressional Budget Office estimates, it will cost about $9,000 to buy a person private insurance on the health insurance exchanges created by the law, compared with about $6,000 to add the person to Medicaid.
That would be a 50% increase in cost for the Arkansas plan! It certainly doesn’t bother Arkansas legislators since they won’t be paying much of anything for it.
(Despite the obscenely hysterical rhetoric about state costs to administer expanded Medicaid, everyone knows it amounts to chump change and it’s a great deal for the states. Funny how that noise has evaporated these days, isn’t it?)
With this 50% increased cost, will there be more health care, more people covered, more generous or comprehensive benefits? No. NO! It’s the exact same health care, but with a 50% profit premium for corporations. This is why corporations spend what amounts to a pittance to buy some legislators; their return on investment is mammoth … and shameful.
If legislators and their corporate sponsors ought to be ashamed, it is hard to think of the appropriate punishment for HHS Secretary Kathleen Sibelius and her administration for handing out such an absurd and useless gift to GOP dominated state legislatures since water-boarding really is torture. It certainly wasn’t necessary since privatization permission – again, a terrible mistake – had already been granted. Now a key lever for cost containment has been eliminated. There will be no incentive to responsible management, just the vast sucking sound as taxpayer dollars are transferred to corporate profits and shareholder equity. Remember W’s Medicare prescription drug bill? Deja vu all over again!
Clearly insurers like Florida Blue (Blue Cross/Blue Shield – the biggest campaign donor in Florida; sorry, hospital association) and others are upset at the thought of having to provide coverage without guarding against pre-existing conditions, i.e. cherry picking the “healthy ones.” They don’t believe they will benefit sufficiently, and, let’s not kid ourselves, their corporate benefit and bottom line are the primary concerns, not health care.
Expect our state legislators to come up with disgustingly transparent spin as they pivot toward an Arkansas plan. Try these code phrases, like Senate President Don Gaetz (R-Niceville):
… they seek a Florida solution, not a Washington solution….
or summa cum weenie Mark Wilson of the Florida Chamber:
If it’s a take Washington’s mandate or nothing question, the Florida Chamber stands in opposition to Washington’s version of a one-size-fits-all Medicaid expansion. While we are against what Washington passed in its current form, we are for a flexible Florida solution.
or House Speaker Will Weatherford (R-Wesley Chapel) trying to stay on message with the Chamber – okay, Wilson told him what to say and he memorized it:
Like the House, the committee gathered the facts and decided that Washington’s inflexible approach to force Florida to take a ‘one-size fits all’ policy choice is not in our state’s best interest.
Obviously it isn’t a one-size-fits-all policy, and they know it. The GOP/Chamber spin doctors should be convicted of malpractice and incompetence for that pathetic line.
There is some other nonsense about personal responsibility and other window dressing you may hear like the Chamber’s 11 prerequisites for expansion (LOL!), but you, wise reader, understand that the real ambition of GOP legislators is unfettered profits for their corporate sponsors, not minding at all that it comes at taxpayer expense … again.
Medicaid expansion in Florida: A sweet deal for whom?
In a reversal of his longstanding contempt for and condemnation of the Affordable Care Act (ACA) known as Obamacare, Gov. Rick Scott endorsed Medicaid expansion. His hasty press conference came immediately on the heels of an announcement by the US Dept. of Health and Human Services that Florida could largely proceed with its scheme for privatizing Medicaid statewide.
Ah-ha! The fix was in, you think – a quid pro quo. The feds and the guv say, ‘No way.’ But you, smarty pants progressive, Daily Marion reader, “You’re right!” You have read our posts on this subject.
Following the Supreme Court decision on the ACA, it seemed to us like ideology would remain Scott’s guiding light, but then in considering the amount of money involved, it was recognized that billions of dollars can motivate remarkable turnarounds in attitude. While Scott is alienating his Tea Party base and other (former) allies by betraying them on Obamacare, he exposes himself to a challenger from –hold your breath – a worse conservative who will continue to demonize Obamacare. Still, the possibility of a quid pro quo seemed in the works to us:
Did Gov. Scott manage to pull a quid pro quo from HHS Secretary Kathleen Sibelius that will have Florida as more cooperative participant in the ACA Medicaid expansion in exchange for this scandalous profit-from-the-poor scheme?
A huge concern is oversight of this privatization scheme. Those are the details that should be of paramount concern. The feds need the ability to apply close scrutiny, intervene, and have the authority to cut off poor performers swiftly since dismal performance has plagued the pilot program in a variety of ways. In general, Florida has a terrible history of compliance with federal rules.
Florida CHAIN, a health care advocacy group, stated:
Consumer health advocates have fought hard to ensure that access to care and consumer protections remain a top priority. We are encouraged by the inclusion of those protections and the movement toward a more transparent, inclusive process and more robust independent monitoring. We are hopeful that the final language and implementation will reflect what is most important – full access to quality health care for Medicaid beneficiaries with proper oversight.
There has been an expected push back from the legislature since they don’t like it when governors act independently. House Speaker Will Weatherford (R-Wesley Chapel) released a statement:
“Governor Scott has made his decision and I certainly respect his thoughts. However, the Florida Legislature will make the ultimate decision,” state GOP House Speaker Will Weatherford said in a statement Wednesday. “I am personally skeptical that this inflexible law will improve the quality of healthcare in our state and ensure our long-term financial stability.”
Don’t think that the legislature is likely to torpedo this deal. This is just turf defense. They have all been waffling since the SCOTUS decision, and got really shaky-bakey when Romney lost. Prime legislative health care leader, Sen. Joe Negron (R-Stuart) said this week:
Sen. Joe Negron, R-Stuart, chairman of the Senate panel reviewing the law, told the Palm Beach Post there is “clearly a nexus between the two … Without the waiver, we are not likely to move ahead with expansion.”
How likely is the Senate (and the House for that matter) to move ahead with Medicaid expansion? With Gov. Scott taking the lead, and the heat, it opens doors for the GOP legislative leaders to kick a little dirt, look down, and admit the federals dollars will make their best-est friends, the medical and insurance lobbyists, really damn happy. Um, what ideology?
Scott lamely tried to conjure a fig leaf to cover himself; a three year test drive of Medicaid expansion. Right. Once you let it in, it will be as entrenched as Medicare.
Now it would be a pleasant surprise to see the GOP leaders doing a bona fide, come-to-Jesus, on their knees expression of compassion for the poor souls who have no health insurance, who have suffered, who have been in pain, and who even stood to lose their lives. So, maybe a bit more emotive than the Governor:
Scott … said that he still had questions about the health care law but called the three-year Medicaid expansion a “compassionate, common sense step forward.”
Gee, that’s “gushing” for Gov. Scott who was also quoted as saying:
“I cannot in good conscience deny Floridians [healthcare].”
Okay, that last one made Snow White awaken and Pinocchio blush. Scott’s medical history indicates he has never been plagued with “conscience,” certainly not a good one, and is highly unlikely to be afflicted by one now.
Seriously, you know what’s going to make this a no-brainer: b-b-billions! How much are we talking about? Well,
Families USA released a report that said making more lower-income Floridians eligible for health coverage under Medicaid will yield 71,300 new jobs and pump $8.9 billion more in economic activity into the state.
Lawmakers have been getting an earful, like from the hospitals. You can imagine all the lobbyists who have been pressing legislators to figure a way to say “yes” to Obamacare’s Medicaid expansion billions. The Florida Chamber is among those cheering Scott’s decision – here the Miami Herald has a nice compilation of the wide variety of reactions.
With HHS okaying a privatization scheme for Medicaid, it’s definitely a done deal, not “compassion” at all. Health insurers and HMOs will be scrapping for a piece of the multi-billion dollar pie and market share, instructing the legislators that they’ve purchased to simply set the table for their taking.
It’s a sweet deal, alright. First and foremost, about a million Floridians will finally be getting health care. For them, it’s the sweetest deal – a genuine life-saver.
No matter how predatory the health insurers are likely to be (and rest assured, some will be true to form), it will still be better than no health care for the uninsured, and there will be recourse. Expect some shaky years for starters, but honestly, a competitive private marketplace for Medicaid could force insurers to do the job right or lose the contract to a competitor. But it’s definitely a sweet deal for the Florida health care industry, too.
Will everyone be happy? Not the Tea Party. The rest? Well, they certainly won’t admit to happiness … on their way to the bank.
Medicaid privatization approved for Florida: Watch out, Granny!
In a doubtful and discouraging move, it has been reported that on Friday the US Department of Health and Human Services (HHS) approved the State of Florida request to expand its Medicaid privatization, at least for its long term care patients. With the elderly consuming as much as 70% of the costs of Medicaid, this ruling focuses on a large section of the costs, but it also puts the most vulnerable cases in the hands of private insurers whose primary motivation is profits, not care.
Many of those who will be affected are known as “dual eligible,” covered under Medicare, but due to poverty and/or the circumstances of care are also thrust into Medicaid. As those who have cared for the elderly know, Medicare will not cover maintenance type care that is provided by nursing homes. With costs upwards from $5000 per month for nursing home care, few can afford it and Medicaid is sought to cover those expenses. Further, seniors are on reduced incomes and are prone to require assistance with medical expenses beyond what Medicare covers.
Florida has sought this approval for two years as an avenue to alleviate its rising Medicaid costs. For the current Medicaid program, expenses are roughly split between federal and state funding. The expanded Medicaid program which Florida has (so far) resisted that is part of the Affordable Care Act – Obamacare – federal funding provides at least 90% of the costs until 2020. Still, Florida is among the stingiest Medicaid states:
As a low-tax state, Florida has long tried to run Medicaid on the cheap. It now ranks fourth from the bottom (ahead of California, Georgia, and Alabama) among states in the amount spent annually per enrollee, a number that has declined steadily over the years.
The Florida experiment with Medicaid privatization has been fraught with problems in its limited 5 county service area. Private insurers were bailing out of the program because it wasn’t profitable for them, and patients were then left hanging:
Nearly half of the 200,000 patients enrolled in the pilot have been dropped from at least one plan, federal health officials previously said.
Patients would often complain about the lack of available medical services offered by the private insurers. The quality of care was also haphazard. Like the experience of many with private insurers, there seems to be greater interest in denying care than providing it. For a good examination of the program, well linked and referenced, click here. The topic has been covered on this page before as well, here and here and here.
The pilot program was touted as demonstrating how privatization would provide less costly and more effective services. Neither has been shown to be true.
HHS is allowing this expansion to occur statewide, but it is difficult to understand their reasoning. Did Gov. Scott manage to pull a quid pro quo from HHS Secretary Kathleen Sibelius that will have Florida as more cooperative participant in the ACA Medicaid expansion in exchange for this scandalous profit-from-the-poor scheme? If so, it was a really bad move since the prospect of billions in new federal revenue had unleashed the lobbying attention of the health care community, changing the ideologically idiotic minds in the Florida legislature as money tends to do.
Assisted Living neglect, abuse, death is no problem, says panel
Gov. Rick Scott has now had another panel investigating a lethal scandal conclude its work and determine that nothing really needs to be done. Again!
This panel was formed following excellent investigative reporting in 2011 by the Miami Herald called “Neglected to Death.” It revealed appalling neglect and abuse in lightly regulated Assistant Living Facilities (ALFs), and showed the death of 70 individuals from such abysmal conditions in about ten years.
Amid the furor, Gov. Scott directed a stern-sounding, vigorous response: empower citizens and crack down, form an investigatory panel and fix the problems! At the time, it seemed Scott was serious about disallowing more bad practices by the ALFs when he vetoed the facility owners’ desired deregulation that would have allowed complaints to be hushed up with secrecy. The law was sponsored by Rep. Matt Hudson (R-Naples) and scandal magnet Rep. Daphne Campbell (D-Miami Shores). Campbell got lots of attention last summer for her Medicaid fraud investigation and six figure IRS tax liens.
As is now evident, this was really short-hand for appearing to address the issue while things simmer down. Taking advantage of the issue being off the front pages and blogs for over a year, this industry-skewed panel produced yet another scandal whitewash, handing the powerful ALF industry and its lobbyists not so much as a wrist slap.
The former Florida Ombudsman for Long-Term Care who lost his state job for his advocacy against industry neglect and abuses, considering the panel’s conclusions, said this:
‘[Providers] are probably doing cartwheels right now,’ said Brian Lee, a resident advocate and director of Families for Better Care.
If this scandal panel whitewash has a familiar ring, it should.
In mid-November, the panel investigating the “Shoot to Kill” law (a.k.a. Stand your Ground) concluded that the law needed no real change, despite the tragic killing of unarmed teenager Trayvon Martin whose shooter may yet be fully protected from prosecution. Click here for the post examining this panel’s outrageous report.
Before November was over, another black teen, Jordan Russell Davis, had been shot and killed in a hail of bullets, and his shooter, Michael David Dunn, is expected to invoke immunity from prosecution thanks to the “Shoot to Kill” law’s shield. Click here for the post on this latest incident.
The Scott ALF panel was also stacked, just like Scott’s “Shoot to Kill” panel, indicating a pre-determined result. It included Rep. Matt Hudson, mentioned above for his industry coddling deregulation law that Scott surprisingly vetoed. The Assisted Living Workgroup was endowed with industry insiders and other political chums. One member was Larry Sherberg, an ALF owner cited for neglectful conditions and care. No surprise that Larry was upset by thoughts of reformist regulations:
A key member of the panel, Sherberg, 60, has argued that the push for stricter regulations — including harsher penalties — will hurt the industry.
Larry is not typically the kind of fellow who should be on this investigatory panel. But Larry wasn’t alone:
More than a dozen assisted living facility executives landed positions on the panel, a sign to advocates for residents that passing reforms will be a challenge.
Gov. Scott was able to channel “The Amazing Kreskin” by predicting the panel’s outcome by auto-suggestion over a year ago:
Governor Rick Scott called for the task force. Scott, who is for less regulations overall, says neglect by a few bad facilities may be making the whole industry look bad.
The panel’s failure to produce substantive reform follows on the legislature’s deeply disappointing failure to produce anything to protect senior citizens in its 2012 session, choosing instead to protect the industry.
The panel’s final report calls for keeping things just as they are for the most part, proposes some re-arranging of the oversight deck chairs, and reviewing existing processes. It seems audacious, but the recommendations include a proposal shielding ALFs from complaint disclosure, just like the law that Hudson sponsored and Scott vetoed, as described above. Yup, déjà vu all over again! This is what the report says:
Enable a public record exemption for AHCA complaints. Complaints filed with AHCA are currently not protected from disclosure. Consider adding confidentiality to AHCA complaints equivalent to that of the Ombudsman.
Remember, it took the Miami Herald’s investigation to get any kind of response to ghastly ALF problems, not Agency for Health Care Administration (AHCA) doing any watchdog activism. (As Long-Term Care Ombudsman Brian Lee’s case showed, advocacy that disturbs the owners will get you fired by Pink Slip Rick.) AHCA was asleep at the wheel as a rule, as described here:
… a drop in state inspections of homes by 33 percent, and a pattern of reducing penalties against bad homes. The Herald found that the state could have shut down 70 homes in 2008 and 2009 for such violations as abuse and neglect leading to deaths, but closed just seven. [bold added]
Now the panel recommends allowing owners to hide the complaints behind state-sanctioned secrecy! What could possibly go wrong?
Again, Brian Lee had nailed it nine months ago as the legislative session was wrapping up and nothing was happening:
‘The only reason they’re doing it [considering reform legislation] now is because they’re under the media spotlight. A year from now, or two years from now, when all the dust has settled, those facilities are going to go back to business as usual.’
If you were wondering who in Tallahassee was doing the work to protect the people, particularly vulnerable seniors (and even the unarmed getting shot and killed), you would be mistaken if you thought it was elected officials like Republican legislators or Governor Scott. Their collective indifference toward the exploitation, endangerment, and brutalizing of Florida citizens in order to protect powerful industry and partisan interests becomes more appalling by the week.
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Why Gov. Scott may change his mind about the health care law … someday
The decision by Florida Gov. Rick Scott to refuse Medicaid expansion following the Supreme Court ruling on the Affordable Care Act was predictable and swift. Yet there is good reason to believe that the struggle behind the scenes has just begun, and that there are compelling reasons to think Scott may, at some point, do an Olympic level gymnast flip.
Let’s be clear that any rationale that would compel normal, thoughtful, and compassionate people has no bearing with the governor, or for that matter with the GOP majority in Tallahassee. There continues to be complete indifference to the suffering of citizens, the fatal consequences of denied access to health care, the gross injustices generated by inaction, the exorbitant costs of inevitably treating basic health care as an emergency, and any other ethical, commercial, or common sense measure. It’s despicable and nuts.
Rather than rage at the wrongheadedness, consider that there are powerful forces that can turn the Governor’s mind, including those GOP Neanderthals in the legislature. For this focus, one must watch the money – it’s always money, and its sister, power – plus one must regard a powerful recent precedent.
First, the precedent. Think back to 2010 when the deep pocketed, creepy crook Rick Scott was the unwanted outsider upsetting Bill McCollum’s anointing as the GOP gubernatorial candidate in the primary. Scott relentlessly bashed McCollum for his “soft” stance on immigration, principally for failing to pursue Arizona-style toughness and to challenge the feds on undocumented workers.
Fast forward two years later on Scott’s key campaign issue:
“It would be foolish to put Florida companies at a disadvantage,” Scott told those at the Citrus Mutual meeting in Bonita Springs on Wednesday, according to a story in The Ledger of Lakeland.
Scott also told the growers group that he knows of no serious effort to revive legislation containing an E-Verify requirement, and wouldn’t support it, reiterating that it is the federal government’s responsibility to do something about the immigration problem.
Hey, what was that? A flapjack or a pancake? Either way, it’s totally flipped to the other side. E-Verify advocate, former FL Senate President Mike Haridopoulos will say, “Amen!” to that, given his inability to get endorsement of his plan from his GOP colleagues.
What happened? The reality of m-m-money. Scott’s observation was made at a gathering of Citrus Mutual, the citrus industry’s muscle group. Like most agricultural pursuits in Florida, it is labor intensive and dependent on immigrant labor to make its money. In Marion County, for example, a survey of horse farm managers will find few interested in knowing the exact immigration status of their labor force.
Besides agriculture, the same could be said for construction, landscaping, restaurants, nursing homes, hospitals, hotels, and other enterprises where there are “back room” areas of low skill jobs dependent on immigrant labor. Add it all up and you have a powerful political force, sufficient to make our “principled” governor roll over for the high and mighty like a dog begging a belly rub.
How does this pan out in the health care debate? Who are the big players that could roll Scott like bathroom tissue?
Health insurers, for starters. These guys have been in bed with Rick Scott since his attack ads with Conservatives for Patient’s Rights became familiar during the health reform backlash.
However, Scott’s “principled” stance currently puts him in a bit of a bind with his insurance pals. With the ACA upheld, insurers remain on the hook for the costly people with pre-existing conditions. The promise of an offset by getting lots of healthy people signing up has been sorely shaken, if not broken. The feds will set up the exchange for Floridians despite Scott’s refusal, but that isn’t the real stickler.
Medicaid privatization is. It has been a dicey deal for health insurers who really can’t manage the existing pool of Medicaid recipients better or cheaper than the state, and realize any profit unless they become even scummier scumbags than they already are. However, if you added a slew of mixed age, non-elderly people up to 133% of federal poverty, Medicaid privatization makes insurers drool. (That demographic factor is why the costs for the proposed expansion are not comparable to current expenditures; they’re far less.)
Medicaid costs are overwhelmingly for the elderly, with Kaiser putting the figure at 70%. Nursing home care is astronomically expensive and invariably Medicaid picks up the tab for long term maintenance care (not rehab, that’s Medicare (see “dual eligibles”)) unless you have Rick Scott-type wealth. Diluting those staggering numbers with a varied group of non-elderly folks is a big winner for insurers.
Hospitals, including the for-profits, would enjoy the added business from the billions that would be spent by the feds. Even doctors and the Florida Medical Association may get unglued from their whiny nit picking and ideological ambiguity, and realize that where there is money, there is money to be made. Less backward states expanding Medicaid will stoke the pressure to adapt and change in Florida.
Finally, it will become clear that the billions spent on health care in ACA Medicaid expansion states are creating jobs and boosting economies with relatively small net impacts on state revenues. Even NFIB, Associated Industries, and the Chamber may get an earful when their members see what they’re missing in Florida.
So, wait for it. The likelihood of an ultimate Scott/GOP somersault should not be discounted. Sadly, it may take a year or two.
Health care in Florida: What will Gov. Scott do?
Florida Attorneys General McCollum and Bondi have led the national fight against the Affordable Care Act (ACA) to the Supreme Court. Following the US Supreme Court’s decision that largely upheld the ACA, what’s next, as in what will the most unpopular governor in the USA decide to do?
With Florida second with 21% only to Texas with 25% (second again to Texas) in the number of citizens without health insurance, it would seem like the court decision would be cause for celebration, that millions of fellow citizens would be able to obtain health care. You may want to hold off on uncorking that bubbly beverage.
The Supreme Court’s decision included removing the Feds strong arm tactic with the states, requiring them to accept the new Medicaid funding or lose the existing Medicaid funding as well. With that ruling, the ability of Washington to compel the states to participate in the ACA was eliminated. Uh-oh.
It’s still an awesome deal for the states.
To be sure, states have a lot to gain by complying with the Medicaid expansion, since the federal government pays 100 percent of the costs for the first two years and tapers funding to 90 percent in 2020 and beyond.
The administrative costs are a 50-50 split, but it still sounds like a tremendous winner. Just think of all of those citizens who will have some form of health insurance, who can get better care, relieving some of the uninsured costs, and likely helping the economy as a whole.
It isn’t as if the ACA hasn’t paid dividends already. Extending family insurance to young adults, removing the onus of pre-existing conditions, closing the “donut” hole in the seniors’ prescription plan are just a few benefits so far.
And there are real cash dividends, too, as insurers have to cough up rebates, like $123.6 million for insurance companies failing to meet the 80/20 rule on health expenses versus administrative expenses mandated by the ACA. Plus, other money has come to Florida from the ACA – another $119 million for a variety of services. Finally, add $400 million more to the total – the just publicized funding for conversion to digital records. (How overdue is this?) Add it all up and it’s beginning to look like real money.
Yet with all of this talk of benefits, pluses, advances, cash, and progress, we have neglected the most important criterion in today’s Florida, the single factor that outweighs all practical considerations. That is ideology.
All of this leads us to our state’s Chief Ideological Officer, Gov. Rick Scott. That’s right, [expletive] head.
Although we’re only hours past the court’s announcement of its decision, at least we haven’t had the door slammed already (see Walker, Wisconsin/bandwagon), but you get a sense it isn’t far off, like maybe Monday. Here is some of what the Governor’s office said today:
“…The Justices have declared that the central provision of ObamaCare is a judicially mandated tax. A new tax pure and simple.”
Focusing on the “tax” angle is one big hint; taxes are bad, very bad, very, very bad, even evil, in case you had not heard.
“With the national economy struggling to recover, now is not the time to implement a massive social program that injects nothing but uncertainty and doubt into our economic system. By doing so, they have put up yet another major roadblock to efforts to get people back to work and forced the government into the important relationship between patients and their doctors.
He seems to be hitting all of the talking points, no matter how idiotic they are. Since we all know how the “Jobs Governor” is really the “Corporate Profits Governor” (he doesn’t see any difference), he is also focused on the business costs. You have been asleep since his election if you think for a moment that he cares one iota for people … well, who aren’t wealthy.
Then he drops the I-bomb:
“I stand with Justice Kennedy that the entire act should have been held invalid.”
Need we say anymore? This is the same governor who threw back billions – billions! – in Federal contracts while his state’s unemployment was in double digits, primarily for ideological reasons.
Rick Scott can do one better than Justice Anthony Kennedy. He can make it as invalid as he can in Florida with his executive authority and with the support of the knuckle-dragging GOP cohort in the legislature.
Scott will refuse the money, and Florida will resume its race with Texas to see who can have the most uninsured citizens.
Voters Will Decide on Hospital as Strack Attack Fails
In the end, the trustees decided to bring a referendum to the voters that would impose a one mil ad valorem property tax increase, but it was a long Monday night at the Munroe Hospital Auxiliary Conference Building on the corner of SW1st Avenue and SW 16th Street in Ocala. The room was packed full at 5pm, almost standing room only, but by the end at nearly 9pm, the crowd had dwindled to a passionate few dozen.
The meeting started with an alienating, one-sided Powerpoint by ideological hack, trustee Larry Strack. It was a broad attack on community hospitals as Strack
- tried to link US Rep. Paul Ryan somehow to the MRMC funding issue,
- made wild claims about hundreds of millions of dollars to be invested without ever explaining how a for-profit operator would get any return on their staggering investment,
- claimed that charges of expected diminished services and lower quality care by a for-profit hospital operator were simply “scare tactics,”
- called the hospital’s need for funding a “taxpayer bailout,” and
- actually stated that Marion County voters are uninformed and lazy, and may “just flip a coin,” and therefore should not be provided a referendum.
Strack seemed to leave a positive impression only on those dozen or so Tea Party faithful pre-disposed to his obvious privateering agenda, plus his fellow ideologue trustee, Joe Hanratty.
A parade of impressive public testimony followed as most called for offering voters the option to decide funding for the hospital, despite a few voices who parroted the usual tiresome drivel about how terrible taxes are.
A number of folks shared personal stories, but largely stayed away from emotionalism and instead probed the doubtful reasoning and head-scratching logic behind Strack’s grasping propaganda play. A consistent refrain in public testimony challenged Strack’s hundreds of millions of dollars coming into the hospital and the community from privateers, saying it “didn’t add up.” Short of severely cutting services, staff, and quality, there is no way that a private investment hospital corporation is going to see any return on its investment for shareholders. Strack insisted that services and quality standards would be guaranteed to remain in place. Other commenters pointed out that such guarantees only lasted 5 years.
After a break following public comments, the Marion Hospital District Trustees began deliberating the issue, finally focusing on the referendum proposal for a bond refinancing deal. In this plan, taxpayers repay the bond through a dedicated ad valorem property tax which frees up funds for the hospital to use at its discretion, whether for expected operational budget shortfalls or for capital investment.
Initially, the motion failed by a surprising 3-4 vote as Board Chairman John Kurtz and Dr. Ravi Chandra joined ideologues Strack and Hanratty in opposition to the affirmative votes by Dr. Mike Jordan, Kulbir Ghumman, and Dr. Srisha Rao.
Kurtz then advanced the sales tax proposal (a largely undefined indigent care sales tax to be managed by the County Commission) that provided an even less adequate and quite guess-timated sum to be received on rather difficult and uncertain terms. It also failed by a 3-4 vote as Strack and Hanratty were joined by Jordan and Ghumman.
Dr. Jordan asked about the reasoning for Kurtz, in particular, voting against the original proposal. Kurtz felt that the sales tax option was a preferable vehicle over a property tax, and that getting something, inadequate as it would be, would be better than nothing.
Time for another break. It’s well after 8pm by now.
After the return, the original referendum proposal for a bond refinancing deal, with an added stipulation that the referendum occur on the November general election day, passed by a 5-2 vote…at nearly 9pm. Unsurprisingly, Hanratty and Strack voted in opposition.
The details of the proposal will be worked out in subsequent Trustee meetings, dollar amounts, detailed terms, etc. As those details get defined, we will start organizing further.
We have a lot of work to do to inform our neighbors in the community. At least now we know that there will be a voter referendum on the ballot in November and it will ask voters to approve a new property tax to support Munroe.
A one mil tax ($1 per $1,000 of assessed value) would mean that a homeowner with a home assessed at $100,000 would pay $100 per year, unless the homestead exemption applies which would reduce it to $50 per year for a $100k home. So, for less than the cost of Netflix each month, we can keep one of the finest and most effective hospitals in the USA as a community asset and away from the privateer predators. What a deal!
Are We Going to Lose Munroe Hospital? The Taxing District Issue
Star Banner editor Tom McNiff devoted his Sunday (Oct. 15) column to the ongoing debate over Munroe Regional Medical Center (MRMC), our community hospital. Reviewing most of the concerns, he thinks everyone ought to chill out and see what the consultants say:
Here’s an idea: Everyone quit politicking and, instead, wait for the consultant’s report. Then, debate the options and choose a solution based on data and reason.
On the contrary, concerned citizens better get fired up fast or they will suddenly discover that Munroe is no longer the community’s public hospital. This is the first of three posts on how our community may lose its public hospital in a matter of months. Yes, months.
Munroe started in 1898 in the sleepy little hamlet that was Ocala. It has since grown into a leading regional medical center with over 400 beds. It is owned by the citizens of Marion County under the Marion County Hospital District and its Board of Trustees who are appointed by the Marion County Commission. The District has leased medical services from Munroe Regional Health System (MRHS) which adds non-trustee directors to the hospital district trustees in forming its own Board.
Across 1st Avenue is Ocala Regional Medical Center, a private hospital that is owned by HCA (Hospital Corporation of America), the same company that Gov. Rick Scott ran as CEO until he was forced to resign in 1998 as the company became subject to the largest case of Medicare fraud ever. Scott wasn’t directly implicated, but he also invoked 5th Amendment protection against self-incrimination dozens of times in a deposition.
Scott has had some strong views about public hospitals:
Seen through the lens of Rick Scott and his close associates, not-for-profits are competitors who pay no taxes because of a promise of public service, a promise that often amounts to little or nothing in practice. They call for a level playing field on which not-for-profits would be forced to prove that they provide free services beyond what a for-profit would, equal to the amount of taxes that they would have to pay, or that would allow any institution that set aside a sufficient percentage of revenue for research and uncompensated care to be tax exempt.
This view fits with the current ideology driving the Republican machine in Tallahassee which declares that public resources are best privatized and/or profitized, from the entire $69 billion state budget to the billions more in county, municipal and school budgets statewide, as well as public lands and natural resources from water to mining to oil drilling, etc. You get the idea.
If it’s public, then it’s bad. Privatize it.
If it makes no profit, it’s bad. Profitize it.
Reason, practicality, and even constitutionality be damned; ideology rules, and corporate profit is the purpose and highest good of government.
Munroe is in only one hospital district, and is only one of several kinds of “special taxing districts” statewide, water management districts being among them. Scott lowered the boom on the state’s regional water management districts, slashing their tax revenues from property taxes – about $5 per year per home – thereby crippling their operations and forcing a radical curtailment of their operations. Scott applauds himself (usually no one else applauds him so he has to do it himself) for cutting taxes and eliminating excessive government regulations. Others take a very different, rather dim view of the same subject.
Scott convened the Florida Commission on Review of Taxpayer Funded Hospital Districts presumably to study the state of these taxing districts with an eye to certain unspecified reforms … presumably.
It was interesting that Scott picked for this commission Ocala developer and anti-tax hawk Brad Dinkins who has been notorious in his antagonism toward having a public hospital district at all much less one that might levy a tax, repeatedly. Any notion that this isn’t a matter of ideology was dismissed by news of Dinkins’ rejection of comments by Mike Sizemore when Dinkins realized Sizemore was a Democrat and not “on our side.”
However, as a spreadsheet describing Scott’s draft agenda for the 2012 Legislative Session indicates, the commission will determine that “public hospitals are less efficient and have worse outcomes than private [hospitals].”
That’s right. There is no need to wait for the actual report; the outcome to be detailed by the commission has already been defined. Thank you very much for being shills, commissioners.
According to the Scott plan, the legislature is to carry this ball – not the Governor – ensuring that “legislation to create a transparent process for making public hospital [sic] private, tax paying entities” because this “will be result of task force.”
The range of abilities of taxing districts gets remarkably specific in statutory definition with regard to what can or cannot be done, and by whom. It is fully within the realm of expectation that a friendly legislator would champion a new rule or statutory amendment that suspends, infringes on, or terminates the authorization of taxing districts to levy any taxes. Surely there would be a handsome reward for the proxy who carries out the Governor’s will.
The effect could be a comprehensive sell-off of public hospitals to for-profit entities, not unlike the massive privatization schemes for Medicaid and for state prisons. One can almost see the drool sliding down the chins of for-profit hospital execs.
The next legislative session starts on January 10, 2012. It may be time to start asking our elected officials – state reps and state senators – whether they are going to serve the people or the corporations. The ability for a public hospital like Munroe to continue functioning and offering a high level of services to the community without options afforded a public entity seems to be in real jeopardy.
Next: Stan McClain and the Trustees
Tampa GOP Debate: 5 Scary Responses
While CNN took the unusual route of partnering with the Tea Party Express in this Monday night debate in Tampa, FL, this seemed most like a debate rather than a forum of question answering. It meant TX Gov. Rick Perry took the most heat and former MA Gov. Mitt Romney came in a close second as candidates tried to distinguish themselves at the expense of the front runners.
This was Tea Party through-and-through, and the level of crazy was off the charts. Sanity was in such short supply, I was thinking of calling law enforcement to Baker Act all the candidates as well as the whole crowd. Here are 5 scary moments that literally make me worry about our nation and its citizens, that it has elected most of these candidates to responsible leadership positions, and that a group of citizens could be so horribly ugly.
5. Applause for gutting social security.
The big flap on social security remains Gov. Perry’s having termed the plan a “Ponzi scheme,” claiming that it is conning young people into believing that their contributions today will be returned to them with interest when they retire when it supposedly won’t. Perry and Romney have gone a few rounds on this topic with Romney taking the far more affirmative stance in valuing social security.
The crowd was unimpressed by Romney’s comments and cheered Gov. Perry’s response which has now been walked so far back that it mirrors most of the other candidates’ positions. They believe social security needs to be privatized in some way and ended, although none have shown how to do so.
The crowd cheered Perry’s “courage” in insisting social security is irreparably broken and his call to end it for young people. The crowd, most of whom had either contributed their entire working lives or were collecting checks themselves cheered for social security’s dismantlement. The incredible ability of people to enthusiastically support the candidate who will screw them over the worst never ceases to amaze. It is downright scary.
4. Have EPA reviewed and overseen by those who were abused by EPA
This came from Herman Cain, the only candidate who has not been elected to any office. The question concerned what would be done in the first 100 days to progress toward attaining national energy independence. Cain’s response entirely focused on the EPA which apparently explains and simplifies everything in the complex energy equation. He said that we have “the EPA gone wild” which naturally caused me to think of variations of “Girls Gone Wild” about supposed college girls exposing themselves before cameras. What would the EPA be exposing? Now stop that; leave poor Lisa Jackson out of it. Obama left her exposed enough.
The line that achieved this position on the list was that Cain would appoint regulatory reviewers who had been “abused” by the EPA. Clearly some sort of revenge was Cain’s ambition. The crowd loved it. The truly bloodthirsty nature of this crowd was clearer elsewhere, but this was right up their alley. These folks would make a perfect lynch mob.
3. Cancer and death is better than a required government inoculation.
This has been a topic before, but it remains stunning. Gov. Perry had issued an executive order requiring HPV vaccinations to prevent cervical cancer. Perry has expressed regret over using an executive order rather than legislative action, but he insists it was the right thing to do.
Most prominently, MN Rep. Michele Bachmann (along with TX Rep. Ron Paul) has been passionately opposed to such forced government treatment on “innocent 12 year old girls.” Bachmann makes it sound like rape. She is clearly saying that this government mandate, like with the health care reform mandate, is itself a criminal and unconstitutional violation of personal rights.
Former PA Sen. Rick Santorum stood out by saying that unless Texas had something weird in its curriculum, the state of Texas had no business even getting involved in the matter. Since the HPV virus is transmitted through sexual intercourse, Santorum checks out of the discussion altogether.
Either way, young girls die, but at least they die free which is better than living cancer-free. Bachmann got huge applause.
2. Islam is guilty until proven innocent.
Ron Paul had made the statement at the last debate, and apparently had it on his web site over the weekend, that the US was responsible for the 9-11 attacks (mentioned in a closing note on the last debate post) because government regulations prevented effective resistance. Rick Santorum who was chief pugilist of the night bitterly attacked Paul for the statement.
Paul then began explaining why the USA was attacked, and was actually doing a remarkably good job of it. Meanwhile former GA Rep. and House Speaker Newt Gingrich turned, stared and smirked mockingly at Paul, and Santorum openly shook his head and guffawed at what Paul was saying. Paul tried to explain how Muslims had been beset and oppressed and attacked, and the more the USA acted militarily against them, the greater the resentment. Twice the crowd loudly booed Paul for having the audacity to suggest that there was any need to understand Islam, or the difference between Islam and terrorism, or understand how extremism is bred. If you are a Muslim in America and you vote for a Republican, this is the kind of ignorant hate that you will be voting for.
1. Yeah, let him die.
On the subject of health care, CNN’s Wolf Blitzer posed a hypothetical to Ron Paul on the practical propriety of a health care mandate. A man in his mid-30s is healthy and doesn’t purchase health insurance. Something befalls the young man and he needs 6 months of care that he can’t possibly pay for. What do you say?
Rep. Paul maintained that the approach should demand personal responsibility. Blitzer pushed the issue; should we let him die? Paul stammered a bit, but the crowd filled in for him; “Yeah!” they said.
Paul recovered to say that churches and other charities and even neighbors helped make it work in the past. Paul obviously hasn’t seen a hospital bill in many decades.
Former FL Rep. Alan Grayson is once again proven absolutely correct. His bold exposure of the Republican health care plan as ultimately meaning “Die Quickly” was affirmed in Tampa on Monday night.
Chilling crowd. Frightening candidates. A sad night for America and for Florida.
We deserve an apology. They should be ashamed.
Fraud vs. Fraud: Stearns Tackles Medicare Fraud?
In an op-ed in Sunday’s Ocala Star Banner, long time Ocala-Marion Congressman Cliff Stearns (R-FL6) reveals a severe case of political misdirection as he launches his quest to attack Medicare fraud.
He uses a standard Republican tactic of ignoring real problems while inventing other problems. The newly conjured problem avoids implicating political benefactors while also jeopardizing and besmirching the capability of a good government program.
As chairman of the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations, Stearns is using his investigatory powers to chase the known problem of Medicare fraud. Curtailing such fraud was a component of the health care reform law, for example. Stearns makes no acknowledgement of this, preferring to state:
Under the president’s health care law, Medicare spending is supposed to be reduced by $500 billion over 10 years. Given that Medicare provides health coverage for 45 million Americans and the drastic funding cuts proposed for the program, I am interested in the financial condition of the program.
The Republican plan to curb Medicare spending as in the Ryan budget proposal is not mentioned, but I digress.
He continues by describing a hearing where he challenges administration officials about the extent of Medicare fraud to which they apparently give inadequately vague answers. Stearns remarkably seizes another source:
During my hearing, Special Agent Omar Perez, the head of the Medicare Fraud Strike Force in the Miami Region for the Office of the Inspector General, was able to find $3.8 billion in Medicare fraud. This is in just one city.
In extrapolating this across 50 states or 19,000 municipalities, we can get to $60 billion to $90 billion or more per year in Medicare fraud. According to the Inspector General, Medicare fraud is more lucrative than the drug trade with easy money, less violence and lighter punishments. And organized crime is taking notice and getting involved in defrauding Medicare.
That’s right; he takes figures from the Miami region and extrapolates the tidbit of speculation into a national number. Hardly a sliver of common sense tells you that Miami is not Peoria, Bangor or Yuma, and is actually a pretty unique region when it comes to Medicare, a program for seniors! Let’s just affirm it’s a real problem, okay?
In his op-ed, he meant to refer to his proposal of HR 173 (not HR 172) which would multiply the penalties for a variety of instances of Medicare fraud and abuse, a worthwhile effort assuming you catch the culprits. By the way, the bill got no co-sponsors and seems adrift in the committee system. Why aren’t Stearns colleagues more enthusiastic? In a moment….
Stearns then magically decides that Medicare should no longer use Social Security numbers, but a whole new set of ID numbers exclusively for Medicare. Doesn’t that sound like a great idea? How many new problems would that create? And where on earth did he come up with this idea?
And basically, that’s it from Cliff Stearns. New ID numbers to muck up everything. Why bother, Cliff? Really, why?
Glaringly omitted were the instances of once-respected, high-flying corporate giants fined heavily for their fraudulent billing practices. Like, Columbia/HCA, the giant hospital chain that was fined over $2 billion for its fraudulent billing and practices with Medicare, Medicaid and TRICare. Oh yeah; this is the company which also sent its CEO, now-FL Gov. Rick Scott, packing with a shiny golden parachute when the poop hit the fan so that he could take the 5th in depositions on the case.
Or like WellCare Health Plans which used fraudulent billing to scam Florida Medicaid for hundreds of millions of dollars. Yet WellCare was so well connected among Florida Republicans that the original penalty to be imposed by Florida Attorney General Bill McCollum was far less than the amount defrauded. The bold intimacy of state Medicaid regulators with WellCare was stunning. Their methods of defrauding the state were thorough. And this time, WellCare executives were indicted, unlike the Columbia/HCA episode. St. Pete Times columnist Howard Troxler also details the extent of WellCare’s political contributions to buy influence in all the right Republican places. And this was just Florida; WellCare had problems elsewhere, too.
Now we can see why Republicans aren’t jumping to co-sponsor HR 173. It isn’t nice to bite the hand that feeds you, even if they may be ripping off the government and the taxpayers that you are supposed to be serving. Imagine what those fines would be if multiplied!
For a more helpful look at Medicare fraud, Stearns might save the committee’s time and instead watch the 60 Minutes piece from September, 2009. It shows that Medicare has been ripe for fraud since so little has been invested in oversight and investigations, which also happens to be the name of Stearns’ congressional committee. Ahem.
Fortunately, the Obama administration invested stimulus finds, and the new health care reform act adds further funding, to beef up fraud investigations. It can surely help, far more than Stearns and the Republicans ever will.
If you’re going after fraud seriously, you can’t be a fraud about it. Therefore, with Cliff Stearns, what we have an obvious case of a fraud against fraud.