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“A Steady Drumbeat”: Republican Governors Buck Party Tenets To Seek Expanded Medicaid

Republican governors are pressing forward to expand Medicaid even after being stymied by lawmakers in their own party.

As the Obama administration vows to help develop plans that will pass muster with conservatives, the governors of Utah and Wyoming said they still want the health care program for the poor broadened. Georgia Gov. Nathan Deal, who declined to act in 2013, may seek a federal waiver to make insurance available to more residents. Louisiana’s Republican legislature also opened a legal door.

Their views challenge party orthodoxy, even if some governors are crafting their own proposals and denying that what they’re doing is expanding Medicaid. Twenty states have refused the expansion under President Barack Obama’s 2009 health care overhaul because of cost and ideological opposition. The resistance is easing as states see a chance to recoup tax dollars and help hospitals get paid for charity care.

“This is about your citizens’ financial and health security, and it’s also about the economic health of your states,” Sylvia Mathews Burwell, U.S. secretary of health and human services, said Saturday at a National Governors Association meeting in West Virginia. “We want to help you design a system.”

This month, Alaska became the 30th state to expand, including 10 with Republican governors, according to the nonprofit Kaiser Family Foundation, a health-research group in Menlo Park, California. Gov. Bill Walker, a first-term independent, used his authority under state law to accept the expansion unless the legislature returns by September 1 and votes it down.

“I did it unilaterally because it was the right thing to do,” Walker said in an interview.

Governors in Tennessee, Utah, and Wyoming lack the ability to act alone, and their Republican-led legislatures declined to adopt expansion this year.

Even so, Utah’s Gary Herbert plans to meet with legislative leaders this week and said he hopes to call a special session in September to pass what he’s calling an alternative to Medicaid expansion.

Herbert’s program also would require a waiver from Medicaid officials for elements designed to appeal to Republicans, such as having applicants get job training.

“I’m optimistic,” Herbert said in an interview. “I think our approach is better than traditional government-assistance Medicaid.”

In Georgia, lawmakers last year blocked the governor from expanding Medicaid without their approval. A provision tucked into this year’s budget, though, allows the state to pursue a waiver.

Wyoming Gov. Matthew Mead called his expansion effort “a colossal failure.” Still, he hopes to bring it back in February’s budget session or in 2017.

“It’s going to take probably some time and continued work by all of us to eventually get to that point,” Mead said.

Tennessee Gov. Bill Haslam, a Republican, said he doesn’t know whether he’ll try next year after failing in February.

While Louisiana Gov. Bobby Jindal, a Republican presidential candidate, has been an adamant opponent, his state still could move, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

Jindal leaves office at year’s end, and Republicans running to replace him have all expressed support for expansion in some form, she said. The legislature has passed a provision requiring hospitals to pay the state’s share of expansion.

“I don’t think we are going to see a super-large number of states moving forward,” Alker said. “But it is a steady drumbeat.”

 

By: Mark Niquette and Margaret Newkirk, The National Memo, July 29, 2015

August 1, 2015 Posted by | Affordable Care Act, Medicaid Expansion, Republican Governors | , , , , , , , , | 1 Comment

“Particularly Shameless”: Rick Scott Lied On His Mother’s Grave — And Blew A Hole In The GOP’s Anti-ObamaCare Argument

When it comes to ObamaCare’s expansion of Medicaid, it may seem like a matter of simple logic for states to take the money that’s on offer. It would both help their most vulnerable citizens and pump lots of money into local economies.

Alas, logic and the contemporary Republican Party have little relation to each other, so most GOP-controlled statehouses have turned down the offer. But few have done so in a more clownish manner, or exposed the contradictions in the Republican position more clearly, than Florida Gov. Rick Scott.

Scott has flip-flopped on Medicaid, first opposing it, then supporting it, then opposing it again. This is bad, if not entirely unusual, political behavior. But Scott was particularly shameless, citing his recently deceased mother as his justification for suddenly embracing the expansion in 2013.

As he has now revealed, however, Scott was lying on his mother’s grave. He pretended to embrace the Medicaid expansion to secure a federal waiver for privatizing Florida’s Medicaid system, then quietly dropped his support once the waiver was granted. (The Obama administration’s decision to give the quid without first getting the quo, given who they were dealing with, was not its finest hour.)

So Scott used his deceased mother as a shield to lie about his motives in order to funnel federal taxpayer money to Florida businesses, then reneged on his part of the deal, leaving many poor Floridians to needlessly suffer and in some cases die. All par for the course for Scott, who before entering politics oversaw a massive amount of Medicare fraud as CEO of a large for-profit hospital operator.

At this point, one could say that, rank dishonesty and opportunism aside, at least Scott is standing on principle. He is turning down federal dollars to protect state sovereignty. Not a very attractive principle, but at least a principle, right?

Nope. Before the Affordable Care Act, the federal government made money available to states to create Low-Income Pools (LIP) that would reimburse hospitals that treated patients who couldn’t afford to pay for emergency services. Florida is receiving more than $1 billion a year in federal funds from LIP. The ACA, however, makes the LIP obsolete. It addresses problems of uncompensated hospitals by expanding Medicaid, greatly reducing the number of patients who cannot pay their bills.

The federal government has told Florida that it will not make the LIP funds available, pointing to the Medicaid funding which remains available. But Scott wants to have his cake and eat it, too. Not only is he demanding that the federal funding continue, he has actually filed a frivolous lawsuit arguing that the federal government is obligated to give Florida the LIP money. The Obama administration, having been burned by Scott already, is unmoved.

This lawsuit builds on the Supreme Court’s already shaky holding that allowed states to opt out of the expansion, pushing it to an extreme that would be too absurd even for the Roberts Court. It has virtually no chance of succeeding.

But the decision to file it is instructive. On the one hand, Scott is arguing that taking an extraordinarily good offer from the federal government to insure its poor citizens would be an intolerable intrusion on the sacred sovereignty of the state of Florida. On the other hand, Scott is arguing that Florida has a right to another source of federal tax dollars for health care.

There is, in other words, no actual principle involved here — not even a bad “states’ rights” one. It’s just pure partisan politics, with Florida’s poor people being punished as a result.

As Michael Hilzik of the LA Times observes, Scott’s disgraceful behavior reflects broader trends in Republican governance. The decision of Republican officials at the state level to reject the Medicaid expansion, while misleading their constituents about the dread ObamaCare, continues to have disastrous results for their citizens.

The ensuing mess in Florida — where a huge hole has been blown in the state budget because anti-ACA fanatics won’t take the Medicaid expansion — does at least provide a glimmer of hope for the longer term. Red-state legislators may not particularly care about the many poor people being needlessly denied access to medical care. But they will start to increasingly care about the medical professionals and hospitals who are also being screwed. Once Obama leaves office, it’s likely that more and more states will grudgingly take the federal money.

In the meantime, however, the consequences of misrule in these states will continue to be grim.

 

By: Scott Lemieux, The Week, May 18, 2015

May 19, 2015 Posted by | Low Income Pools, Medicaid Expansion, Obamacare, Rick Scott | , , , , , | 1 Comment

“Florida Gov Scott No Help In Time Of Crisis”: When The Going Gets Tough, Rick Scott Heads Straight For The Airport

Florida Gov. Rick Scott removed his Harry Potter invisibility cloak and flew to Washington the other day.

There he begged for billions of federal dollars from a person he is suing, Sylvia Burwell, the secretary of the Health and Human Services Department. Burwell patiently listened to the governor and, predictably, sent him back to Florida with nothing.

Last summer the feds informed Scott that the government was phasing out a fund that reimburses local hospitals for taking care of low-income patients, basically replacing it with an expanded version of Medicaid.

At first Scott was in favor of the Medicaid move, even though it was a tangent of Obamacare. Then the governor changed his mind. Later, as an afterthought, he sued Burwell and the HHS.

The state Senate supports Medicaid expansion; the House doesn’t. Tallahassee has been paralyzed by the dispute.

In a snit, the House packed up and adjourned the session early, leaving Florida with no budget. Leaders in the Senate were furious.

Remember, these are all Republicans, ripping at each other like addled meerkats.

And where was the newly re-elected Republican governor, leader of the party?

Gone, is where he was — jetting to crucial functions such as the grand opening of a Wawa gas and convenience store in Fort Myers and the debut of a humongous Ferris wheel in Orlando.

It’s impossible to imagine any of the fully functioning governors in Florida’s past — Lawton Chiles, Bob Graham, Jeb Bush, to name a few — vanishing from Tallahassee during a Code Red meltdown of the Legislature.

But Scott isn’t a functioning governor. He is the emptiest of empty suits — no talent for leadership, no muscle for compromise, no sense whatsoever of the big picture.

When the going gets tough, Scott heads straight for the airport. This is what happens when you elect a guy with his own private jet.

Last week’s trip to Washington was pure theater. Scott’s lawsuit over the low-income health funds is a loser, and he knows it. He was trying to do something to give the impression he was awake and experiencing cognitive activity.

In fact, he has been laser-focused on the future — not Florida’s future, but his own. He’s looking ahead to a possible bid for the U.S. Senate in 2018.

(We’ll pause here while you choke on your cornflakes.)

It’s astounding but true — while the legislative process disintegrated in bitter confusion, the governor was airing TV commercials cheerily touting his imaginary accomplishments.

Yes, they were short commercials. And, yes, little of what he claimed to have done for Florida had actually happened, lawmakers having already tossed his proposed budget into the metaphorical Dumpster.

There were no tax cuts, no hefty increase in spending for public schools, no big boost for Everglades funding. Yet Scott’s commercials made it sound like a done deal.

Relax, Florida. All is well!

Perhaps that’s how it looks from 38,000 feet, though not from the rotunda of the Capitol.

It’s weird for a politician to openly resume campaigning so soon after being re-elected, but weird is the norm for the Scott administration. Since the law prohibits a third term as governor, he can only be thinking about Bill Nelson’s Senate seat.

This would be a far-fetched scenario almost any place except Florida, where Scott has already proven that, if you’re rich enough, there’s no such thing as baggage.

Currently he remains one of the state’s most unpopular political figures. He won the November election mainly because his opposition was Charlie Crist.

Yet with money from his “Let’s Get To Work” political committee, the governor has begun the uphill task of inventing a positive legacy upon which to run three years from now.

In the TV commercials, he plays the role of a hard-charging, hands-on visionary, leading Floridians to prosperity one new job at a time. He smiles. He talks. He is, briefly, visible.

Tallahassee is one of the cities where Scott showed his commercials, yet it didn’t move the needle. He was on the plane when he should have been on the ground.

While the Legislature didn’t need any help disgracing itself, Scott’s disappearing act made things worse by validating the public’s view of all state government as insular and incompetent.

As the House and Senate prepare to reconvene next month, desperately trying to salvage some credibility, the governor seems content with his role on the sidelines, essentially a cheerleader for himself.

Coming soon to a Wawa near you.

 

By: Carl Hiaasen, Columnist for The Miami Herald; The National Memo, May 11, 2015

May 13, 2015 Posted by | Florida Legislature, Medicaid Expansion, Rick Scott | , , , , , | 4 Comments

“Rick Scott’s Hissy Fit”: Impatiently Snapping His Fingers At Sylvia Burwell Won’t Do Him Any Good

Rick Scott’s clearly a man who expects others to snap to it when he asks for something. But his demand that the Obama administration instantly give him assurances they’ll agree with his construction of an incredibly technical interplay between the Medicaid expansion option he’s now flip-flopped a second time to oppose, and an existing Low-Income Pool program who’s beneficiaries overlap with Medicaid’s, is now turning into a hissy fit, per this report from The Hill‘s Peter Sullivan:

Florida Gov. Rick Scott (R) on Wednesday demanded an answer from the Obama administration “right now” on the renewal of federal funds for hospitals in his state, amid a showdown over ObamaCare’s Medicaid expansion.

“I’ve let them know our timeline and we need an answer right now,” Scott told reporters outside the Department of Health and Human Services headquarters in Washington after meeting with Health and Human Services (HHS) Secretary Sylvia Mathews Burwell.

According to HHS, Burwell gave Scott the “preliminary view” that the state’s current proposal falls short of the administration’s requirements.

At issue are federal funds to reimburse hospitals in Florida for treating uninsured people, known as the Low Income Pool (LIP). Scott is suing the Obama administration, alleging that the administration is withholding the funds in an effort to force the state to expand Medicaid under ObamaCare.

The administration counters that Florida is free to expand Medicaid or not, and that the decision on LIP funding will be made “regardless” of whether the state expands Medicaid.

You don’t have to go all the way down into the weeds to understand this; the administration obviously does want to keep the pressure up on Scott to do the right thing, and Florida hospitals are probably giving their Governor holy hell for not only rejecting the cornucopia of dollars from a Medicaid expansion, but jeopardizing their existing federal funds while he’s at it. But in any event, HHS has a good excuse for delaying any final decision on Scott’s proposal for a larger LIP program than would normally be the case:

HHS pointed out that the proposal is still in the middle of a 30-day public comment period in Florida, a step before its final decision on the proposal.

“HHS is continuing to engage with Florida on the state’s LIP proposal, even as the period for public comment in Florida is underway,” the readout said. “HHS heard the Governor’s request for a timely response to help the state meet its budget timeline. HHS believes completion of the public comment period, on-going discussions with the state, and the state’s submission of its proposal to CMS are the next steps in the process.”

That doesn’t meet Scott’s politically driven timetable, of course, so he’s impatiently snapping his fingers at Sylvia Burwell.

Don’t think it will do him any good.

 

By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, May 7, 2015

May 11, 2015 Posted by | Medicaid Expansion, Rick Scott | , , , , , | Leave a comment

“Praise The Lord, Mom’s Alive”: Rick Scott’s Stunning Health Care ‘Ruse’ In Florida

In early 2013, Florida Gov. Rick Scott (R) surprised nearly everyone by announcing he’d changed his mind about Medicaid expansion through the Affordable Care Act. The Republican governor had long condemned the idea, but he apparently had a change of heart.

“I cannot, in good conscience, deny the uninsured access to care,” he said at the time. Scott added that Medicaid expansion is “a compassionate, common sense step forward.” The governor even referenced the death of his mother when explaining his rationale.

“A few months ago, my mother passed away, and I lost one of the only constants in my life,” Scott said. “Losing someone so close to you puts everything in new perspective … especially the big decisions…. As I wrestled with this decision, I thought about my Mom’s struggles raising five kids with very little money.”

That was February 2013. In April 2015, Scott reversed course again, announcing his renewed opposition to the policy he’d endorsed. And today, the local CBS affiliate in Miami reports that the governor offered an unexpected explanation for his posture two years ago.

Scott conceded this week that was all a ruse. He now says his support for Medicaid expansion was a calculated move designed to win support from the Obama administration for the state’s proposal to hand over control of Medicaid to private insurance companies. At the time, he denied that his support was tied to a deal with the federal government.

Now that he’s succeeded in privatizing Medicaid, Scott is again railing against Medicaid expansion and is suing the federal government for allegedly forcing it on him.

Oh my.

Of course, if you notice that CBS/Associated Press excerpt, you’ll notice that it’s missing something: a quote. The entire report appears to be a paraphrase of Scott’s comments, and the exact wording always matters.

Indeed, the governor’s office this afternoon pushed back against the AP’s reporting, saying the piece “editorialized” Scott’s comments.

So, which is it? On Twitter, Gary Fineout, an AP reporter in Florida, fleshed this out in a little more detail, explaining the argument Scott presented yesterday. As Fineout described it, the governor may have claimed at the time that his mother’s death inspired him to change his perspective, but in reality – according to Scott’s comments yesterday – the Florida Republican only supported Medicaid expansion as part of “a quid pro quo” to get a waiver from the Obama administration for Medicaid privatization.

Scott may have publicly claimed in 2013 that his position was about his “conscience” and deceased mother, but according to the governor’s new version of events, the rhetoric wasn’t actually sincere – his previous position was a calculated move to gain approval for his privatization plan.

In other words, the governor didn’t literally use the word “ruse” yesterday, so much as he effectively described a scheme in which he told the public something untrue in order to get what he wanted at the time.

I don’t expect much from Florida politics, but when a governor references his deceased mother to make a deliberately misleading argument, the Sunshine State is quite possibly breaking new ground in ugliness.

 

By: Steve Benen, The Maddow Blog, May 7, 2015

May 10, 2015 Posted by | Medicaid Expansion, Rick Scott, Uninsured | , , , , , | 4 Comments

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