“The option to expand Medicaid to low-income adults remains available to the state, and as described later in this letter, could provide an estimated revenue increase of $2 billion annually to the Florida hospitals over and above funding through sources such as the LIP … The decision about whether or not to expand Medicaid is a state option, as we have noted previously.” - U.S. Centers for Medicare and Medicaid Services director Vikki Wachino in a letter to state officials.
Sometimes it feels like we're banging a drum when we, as if on rhythmic cue, speak in political tongues in hopes that the state of Florida will expand its Medicaid program to include the nearly one million people who are living in the coverage gap. Thanks, Supreme Court, for giving states the chance to opt out of the Affordable Care Act. Also, somewhere in that detritus haze is the discussion – OK, fight and lawsuit – over whether Gov. Rick Scott's flip-flopped refusal to expand the program that provides the state's neediest residents with health care is tied to the federal government's phasing-out of Low Income Pool funding for hospitals that take care of those who have no insurance.
But even if we are repeating ourselves ad infinitum, even if we are plainly advocating for compassion sometimes too often, the story keeps developing, and it's starting to make the GOP look like a short bus of petulant children.
$1.3 billion Amount Gov. Rick Scott initially included in Low Income Pool hospital funding in his January budget proposal
To wit, in this corner, we have Scott building a fake health-care commission out of the idiocy of his donors in order to take down public hospitals. According to the Palm Beach Post, that commission's chairman, a Scott check-writer and "builder" Carlos Beruff, admitted last week that the commission has no idea what it's doing, that "we've got more questions than answers," and, "we need a bigger magnifying glass." That's what happens when you have people who know nothing of hospital financials become the decision makers on health care finances. As a result of the pantomime, Beruff promises that his commission will not be a factor in the June special session of the legislature, which means, effectively, that Medicaid expansion won't either. Scott got what he wanted and what he wanted was an uncomfortable silence.
$600 million Amount the federal government estimates that Florida should receive in federal and local funds for Low Income Pool funding from federal and local sources in future budgets
But that's not the whole story; this confederacy of nine hired dunces couldn't possibly be the whole story, could it? This blind man's bluff? As we've previously reported, Scott's impetus to even form the fake commission was tied to his disdain for depending on federal money to fund hospitals right about the time that he sued the federal government to keep receiving federal LIP funds for hospitals. Also, Scott called on public hospitals to reveal their finances for scrutiny, to which the hospitals responded, rather appropriately, fuck off. It's all turning into a pathetic dustup, one with the state's ailing residents caught in the fog.
Last week, the U.S. Centers for Medicare and Medicaid Services crunched some numbers and stuck them in an envelope addressed to Florida Medicaid Director at the Agency for Health Care Administration Justin Senior.
"We have preliminarily concluded that that 2015-2016 funding should be at approximately $1 billion ... to maintain stability while the system transitions," CMS Director Vikki Wachino wrote, according to the Tampa Bay Times.
And if you need help decoding that message – you probably should, as this all gets really contentious and confusing – what's being proffered here is that the state basically needs to expand its Medicaid program because the feds are about to phase the LIP program out (that was one of the tenets of the Affordable Care Act, after all). In future budgets, CMS says, the state will need to whittle its previous experience with $2.2 billion in LIP funds down to something more reasonable, like $600 million. This tourniquet is for real.
In its May 21 letter, the Times reports, the feds, in no uncertain terms, are calling the state out for its insensitivity (remember, the feds were going to pay for all of Medicaid expansion under the ACA for a few years; they would pay the lion's share thereafter). Basically, this is what the ACA was supposed to do, but Republicans who hate President Obama and the health care he rode in on, refuse to allow it – even though, says the CMS, expansion could bring "significant benefits to low income Floridians and the Florida health care system."
Meanwhile, a blip on the news transom that runs through this office revealed that there are maneuvers from on high – OK, from presidential hopeful Jeb Bush – that there are ways to privatize Medicaid like he did with a pilot program in 2005 with extremely overrated success; also, maybe everybody should wear Apple watches to track their well being, because that sounds like a good idea. The world is going crazy.
Not everyone is so lost in this dizzying whirlwind, though. Oddly, Orlando Republican Senate President Andy Gardiner is standing his ground on the issue, even if there are bits of crust that resemble "market-based approaches" lining the corner of his mouth.
"It remains clear that a sustainable long-term solution is needed," Gardiner told senators, according to the Times. "As you are aware, the Senate has proposed a Florida solution."
And the House caught on fire. Just another week of dying in Florida, then.
$2.2 billion Amount the state of Florida received in Low Income Pool funding in last year’s budget
Who doesn't love a violence superstore, an accident waiting to happen, a Mecca of murder? We don't, but who are we to judge? Last week, the Orlando Sentinel reported that Shooters World – a sort of Fairvilla of weapons of carnage, or Walmart of heavy artillery – is moving ahead this summer with its 82,000-square-foot behemoth store out in the region of the Turnpike and John Young Parkway. Moreover, the place will be a tourist attraction, so it's kind of like Disney World for people who love guns maybe a little too much.
Think of all the fun you'll have, though, when surrounded by 3,000 firearms in a closed location. Think of the family sharing experiences you could have at a 54-lane shooting range, which is kind of like bowling, right?
At any rate, the plans have been in the works for about a year, with the city of Orlando approving the planned development last April. And, what the hell, there's already a Shooter's World in Tampa, and we all know that we could use more #floridaman here in the center of the state.
"It's a destination. Not just your typical gun store," Shooters World general manager Bruce Kitzis, told WESH-2 News last year. "We bring a family environment."