Florida Healthcare Reform

I read this column in Florida Context and it gives a very interesting reading of the conundrum Republicans have put themselves in with their unswerving opposition to affordable healthcare which is now being muted as election time approaches and millions of Americans have discovered the joys of affordable coverage from insurance companies no longer allowed to jack them around at will. So Florida which has rejected Medicaid expansion is now trying to recreate the expansion plan without attributing any credit to Obamacare...and our fearless moronic leaders are tangling themselves in knots trying to claim Medicare doesn't work and yet trying to provide coverage all the same. It's a lengthy tangled web:

Just as House lawmakers were putting together their annual “trains” – cramming multiple, tangentially related bills into hundreds of pages of amendments so they could pass them all at the eleventh hour – a funny thing happened. They upped and quit.

On April 27, House Speaker Steve Crisafulli prematurely banged his gavel, ending the session and leaving the Senate holding the bag on this year’s biggest and most contentious issue: Medicaid expansion under the Affordable Care Act.

A coalition of Senate Democrats sued the GOP-dominated House; the Florida Supreme Court says that the lower chamber behaved unconstitutionally, but that there is no practical solution.

Steve Crisafulli

In a nutshell, the House doesn’t want Medicaid expansion but the Senate does. The upper chamber has a nifty non-Medicaid name for it, too. The Florida Health Insurance Exchange (or FHIX) is, in name, an attempt to help GOP Senators get past the program’s unpalatable association with “Obamacare.”

FHIX focuses on people who wouldn’t qualify for the old, traditional Medicaid but who can’t afford private healthcare insurance. It’s being billed as a “free market” solution, and would finally give Florida its own Internet-based healthcare exchange. (In 2012, Florida opted out of creating an exchange for the ACA, following a Supreme Court decision that said it could, and Florida residents used Healthcare.gov instead.)

The current, Senate-endorsed FHIX plan was crafted with the help of business leaders across the state, all of whom are warning that hospitals that serve indigent patients will be closing their doors if the Legislature doesn’t get its act together soon. Former Jacksonville mayor and current University of North Florida President John Delaney is chief among those sounding the alarm.

The statewide consortium advocating for expansion of health benefits to the uninsured is “A Healthy Florida Works.” The details of the FHIX plan can be found in state Senate Majority Leader Bill Galvano’s letter to News-Press.com.

Basically, FHIX is a way for lawmakers to add a Florida twist to Medicaid expansion, much like creating the “Florida Standards” distanced the state from association with the negative connotations of “Common Core.”

FHIX requires working Floridians to pay nominal monthly premiums to get their “skin in the game” and get coverage, so that the state can draw down remaining LIP funds and other federal subsidies for our uninsured people. The controversial LIP fund is “Low Income Pool” money that goes to hospitals, health departments and community-based organizations that serve Florida’s uninsured, including our working poor.

A cursory look at the proposal reveals that the “free-market plan” resembles former Gov. Jeb Bush’s Med-waiver plan (see below) more than traditional, “straight” Medicaid. The key difference is that under the new, FHIX plan, LIP money would decrease as Florida moves closer to universal coverage.

LIP was the brainchild of our 16-year, de facto governor, Jeb Bush, who wasactual governor from 1999 to 2007. Bush got permission from the feds to outsource some Medicaid services to private companies through programs known as Med-waivers, and was permitted to relay any overage funds to the LIP cache. (The right-leaning Heritage Foundation has published a study that found favorable outcomes for Med-waiver participants, as compared to their traditional Medicaid cohorts nationally.)

Proponents of the waiver-and-LIP combination say that the programs save money. While it’s true that about 250,000 uninsured people qualify for Med-waiver programs, that still leaves more than 600,000 uninsured, according to a graph-meme that Republicans have published on Twitter. The website for “A Healthy Florida Works” reports its goal is to insure one million uninsured Floridians, but the number that would benefit is generally reported at 800,000.

The high number of uninsured Floridians begs the question: How would the Medicaid waiver and LIP combo “save money,” as Republicans contend? The ostensible answer is that the waiver programs pay out 5 percent less to private companies than Medicaid would.

But there are two main problems with the projected savings, one of which, identified by Politifact, is Florida might have saved even more money in the long run by setting up managed care outside the purview of profit-driven companies, which put investors and shareholders first, not patients. It’s unclear whether the FHIX proposal addresses the profit-motive in the insurance business.

The second problem with projecting “savings” in the old waiver-plus-LIP scheme is that we still have 800,000 uninsured Floridians. GOP logic goes something like this: “We once had three people in our family, and we worked hard to save money on our grocery bill, so why should we spend more money now that we’ve added six more kids?”

Washington made clear in 2012 that LIP was going to be phased out, because healthcare expansion would render it obsolete. Health advocates on the ground have been preparing for the switch by planning to flip LIP beneficiaries to “straight” Medicaid. Insure everyone, and we won’t need LIP, the logic goes.

But Crisafulli insists that “Medicaid does not work,” and that Washington shouldn’t be engaged in deficit spending, anyway.

The speaker doesn’t seem to mind “deficit spending,” though, when it comes to using federal dollars for LIP without expanding healthcare. And his family’s South Florida agriculture business didn’t seem to mind receiving six figures of “deficit spending” in the form of farm subsidies, according to columnistMichael Mayo of the South Florida Sun-Sentinel.

As for #MedicaidDoesNotWork – which is launching like a lead balloon on Twitter – the question is, #comparedtowhat?

Last year former Speaker Will Weatherford – Crisafulli’s predecessor in the House – cited a well-reported study from Oregon as justification for not expanding Medicaid. Oregon took Medicaid-expansion dollars, and used some of them to study outcomes for randomly selected Medicaid recipients. Random selection raised the reliability of its findings.

But conclusions based on the Oregon study are as diverse as the reporters who have covered it. In other words, the study is ripe for cherry-picking. That is, observers keep the results they agree with and discard the results they don’t like, in order to support whichever position they’re arguing.

The main finding that Weatherford skipped over in his interpretation of the Oregon study is one that most healthcare policy experts agree on: Medicaid is no more broken than our non-Medicaid, private health insurance system. Advocates point out that, in terms of health outcomes, the Oregon experiment found the two paths – traditional Medicaid and private insurance – to be equivalent.

As the Robert Wood Johnson Foundation reports, healthcare policy researchers have discovered the real culprit driving up healthcare costs is one-percent of people with insurance, who over-utilize emergency rooms. Programs in Camden, N.J, and Cleveland, Ohio, have aimed their laser focus on these “over-utilizers” and have lowered costs while measurably improving health outcomes.

Targeted attention to over-utilizers could certainly be applied to the privately insured and those covered by regular Medicaid, as well as people covered by the Senate’s proposed hybridized FHIX program. But this kind of reform happens on the front lines of care, and it belongs to doctors, nurses and hospital administrators, not politicians.

The far-right’s rationale for declining to expand healthcare coverage in Florida simply doesn’t hold water, and the business community, religious leaders and moderate Republicans all know it.

Meanwhile, uber-conservatives in the Florida House are making fools out of themselves on Twitter as they hold fast on their far-right, anti-Obamacare agenda. (Medicaid expansion is a key component of the ACA, but, as mentioned above, it requires states to opt in.)

House Republican and former heir-apparent to his father’s Senate seat, Matt Gaetz, decried the Senate’s lawsuit over the House’s adjournment in a tweet. The problem is, while poking fun of the lawsuit, Gaetz happened to mention two African-American Senators by name:

“This lawsuit reads like it was researched and drafted by Sen Joyner……and spell checked [sic] by Sen Bullard #sayfie”

The twitter-sphere responded vehemently with charges of racism directed at Gaetz. In an odd move, the House speaker apologized on his colleague’s behalf:

“I don’t condone the Tweet by @MattGaetz. He is an agitator, yes, but not a racist. Please accept my apology to those offended. #Sayfie”

But Crisafulli should be apologizing for a lot more than his colleague’s tweet.

He walked off the job, after all, before the state’s business was done, leaving at least 800,000 uninsured Floridians without access to health insurance.

Now, the taxpayers get to shell out even more, so the legislature can hold a yet-to-be scheduled special session in Tallahassee. Lawmakers still need to pass a budget. In fact, it’s the only thing they’re really required to do.

He should be fired for insubordination because he disobeyed state constitutional mandates regarding the length of Florida’s legislative session. He – and the rest of the Republican House members – should be fired for job abandonment, too, for not working for the entire time period for which we’re paying them to work.

Julie Delegal, a University of Florida alumna, is a contributor for Folio Weekly, Jacksonville’s alternative weekly, and writes for the family business, Delegal Law Offices. She lives in Jacksonville. Column courtesy of Context Florida.

Key West Bight

A  still night in a city that knows how to keep its secrets. I was abroad looking for a quiet place to drink a fizzy drink and empty my mind of work related stuff.

I strolled down the fuel dock, past the Harbormaster's office, closed tight at three o'clock in the morning and dangled my feet over the water. I like this spot on a calm night and I come back frequently when I feel like taking a walk on my lunch break.

I find the waterfront evocative too, partly because I know the history of what used to be working waterfront and partly because there are places that look like they don't belong in the 21st century. It makes me think of those delicious film noir that Hollywood used to churn out full of mystery and fog.

From Flesh and Fantasy  (1943) not my kind of movie, a bit over the top, but my kind of photography:

No one is around, the docks are empty and I find myself alone. Except for the odd drunk stumbling down the dock taking me by  surprise while I'm sucking on my coke. 

Look at that perfectly folded foresail. Reminds me why I want to go cruising on a nice tubby trawler with a big engine and a slow speed instead of a sailboat next time. If there is a next time. Sailing is romantic but I've had my fill of romance  and standing watch in the dark, in the wet, and all that stuff. 

I've seen those pictures of people slaughtering giant fish and turtles from a time when there was an abundance of fish in the ocean and they had time to grow into big creatures. Nowadays modern fish hunters have to content themselves with posing next to this big plastic representation of what used to be.

Turtle Kraals restaurant named for the turtle corrals (kraal is a South African word and how it landed in Key West I couldn't possibly say) where they stored the turtles prior to killing them and eating them. A nasty bloody business no one would support today in our kinder gentler less in-your-face world (cows, pigs and sheep excepted).

End of lunch break, always too short, with just enough time to rioll back to the police station, cool night air in my face.

For more on my Vespa adventures check out my guest post, Part One on Orin's BLOG where he gave me the opportunity to discuss the merits of in fact, "Scooting Old Skool." Orin operates the best and most widely read blog about scooters in the US and is always worth a read.

Street View, Key West

I sat on the Courtyard Deli bench and watched the people wandering in and around and across the sidewalk in front of the Green Parrot Bar.

 A sip of coffee, a page from my novel and a couple of photos.

Whitehead Street connects  Mallory Square to the Southernmost Point by way of the Hemingway House so its a main tourist thoroughfare. 

Nekkid?  The beach is a straight shot from here down Southard Street to Fort Zachary Taylor. 

This weird guy was telling all the women who walked by that he loved them and he included a few of the men too.  Clearly he was harmless and offended no one but it was the kind of Key West encounter that gives the city "character" or grossness depending on your point of view.

 He liked this protoypical blonde and made his opinion audible from across the street.

Yeah, this is the place you want to be looking for people to look at.

 I have to say that when I got up and walked past him to my Vespa he had not a word for me, not one word of love.

Was it my manly demeanor or my pink Crocs and pink iPhone? We'll never know.

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Alternative Irish

I have been  feeling bitter about the closure of my favorite place, Finnegan's Wake, and I have not been feeling any too enamored of the process of seeking out a replacement. But with the arrival in town of George who shared my approval of Finnegan's I figured it was time to do the work. 

 I first suggested The Cafe on Southard but upon mature reflection I figured I had to try something new, and I wasn't  going to try Backspace the rather dreary sandwich shop with a dreary literary theme which had replaced Finnegan's. Backspace has been getting some rather bad word of mouth  after some rather peculiar choices when it came to trying to bring along the devoted Finnegan's clientele and then changing plans half way. Their decision to unceremoniously change their minds about keeping the genius who designed and built Finnegan's menu killed their credibility with Finnegan's followers.  

McConnell's had music and lots of it but after the live signer quit the speakers were at a tolerable level playing folk-ish Irish music much liked by Irish Americans, leaving George and I able to talk and listen without strain.

The seating is not as snug or intimate as Finnegan's but I could sit and not face a television and that I liked a lot. We had wings which were really quite good, so even though we weren't up for food it promises well in that department and merits a return visit.

The atmosphere is pleasantly wooden and dark, though perhaps let's say not as absolutely dark as the camera shows! I could read the menu without artificial lighting at any rate.

There is an outdoor patio which could have looked inviting in the right sort of weather but we took our Smithwick's indoors with air conditioning. 

McConnel's link for  menu and drinks list etc...

Our waitress presented the check and George's eyes lit up. The quiet and reserved woman came back and George asked her where she was from, "San Francisco," she replied, adroitly turning the unwelcome questioner away from the source of her Slavic accent. I admired her swift reply as I use the same technique myself when strangers pry and want to know "where I'm from." 

George wasn't having any and addressed her in Czech which brought a sparkle to her eyes. He told me afterwards: "I saw her name was Sharka, which is Czech for Sarah," he said.

I imagine the conversation was the usual sort of thing, establishing identity and roots and connection and because I wasn't the linguist in this instance I enjoyed being on the sidelines for once. George has been in Prague for the best part of 25 years, making a career and a marriage in that famously beautiful city. And apparently he has mastered the language for they talked with  ease.

Yes, I think I like McConnell's despite a  couple of shortcomings perhaps.

 I suppose we could try the 801. On second thought perhaps not.

I wear pink Crocs and I ride a Vespa with joy and elan, but gay I'm not. Not yet.

After The Storm

A strange week of weather these past few days. Winds blowing from the wrong direction, west not east, north not south, bringing cooler air and heavy rain. 

Key West looked bedraggled if you could see past the bright splashes of color:

Puddles breed mosquitoes and being in the back country after heavy rain is an invitation to be eaten alive.

A briskly walking man brought a splash of color to a gray  morning.

The tree commission in Key West is a lightning rod of disaffection . Arguments rage in the newspaper over decisions made to cut down trees with both sides sounding a  warning of imminent disaster should they lose the debate over the next tree to be offered up for removal. This one, from Wong Song Alley, lost:

A  scooter with one mirror coming and one going, clearly a well-loved and well-tended machine:

Rain accumulated at Higgs Park:

I posted this picture on Facebook  wondering why this dog walker thought she was exempt from the stricture imposed by the sign:

The bocce courts were full of water too; they put me in mind of chicken swimming pools.

Free range chickens (and roosters) seem to be multiplying. I am not a great fan of these noisy messy birds but they are a tourist attraction.

The newspaper reported five inches of rain and major downtown flooding, as usual. No word of massive flooding on North Roosevelkt Bouelvard so I have high hopes the reconstruction did its job.

As an aside the paper also reports there is more alcohol consumed in Monroe County than in any of Florida's 67 counties. Big news, that, and I hope they spent a lot of money figuring that out.

Wet At Last

Heavy clouds, dark skies, sudden cool winds blasting down the street: it all adds up to summer.

In winter, rain comes rarely and lightly, usually with a  cold front but in summer its heavy and prolonged and I like it. I waited for the rain to pass, the sun came out and the combination made for a nice ride. 

By the time the streets had dried it was hot and muggy again. My kind of weather. California can keep it's drought, thanks.

A reminder: the Travel and Safety podcasts are up and easily accessible these days on Stitcher or iTunes at travelandsafety.com/ Thanks for listening!