Fla's Budget Deadline Explodes As Healthcare Standoff Continues

Apr 21, 2015

Shands Jacksonville says losing LIP funds could shut it down.
Credit University of Florida

Governor Rick Scott says if the legislature can’t get an answer on healthcare funding, he’ll call a special session to put a continuation budget in place. That would carry the state through the upcoming fiscal year, which begins the first of July. But in the meantime, some hospitals could be forced to shut down as the legislative standoff on healthcare funding continues.

The University of Florida’s Shands Hospital in Jacksonville, says if state lawmakers and the federal government cannot reach a deal on uncompensated care funding, it could lose up to 20 percent of it’s budget and will be forced to close.  Russell Armstead is the hospital’s CEO, and says half of his patients are uninsured or are on Medicaid.  

“We treat a disproportionate number of individuals who are un-or under-insured. We’re the 7th largest employer in Jacksonville, over 7,000 employees. 4,000 in the hospital, nearly 50 percent who are African American. 700 physicians, 350 in the training program and 350 who are teachers. As well as another couple thousand who are members of UF organizations.”

The Senate hosted what a workshop on the Low-Income Pool and its Medicaid expansion plan. The Hour-long conversation was more like a bid to refute talking points by the House—which is opposed to a Medicaid Expansion and has struck LIP funding out of its budget. Speaking to reporters afterward, Senate President Andy Gardiner said state officials have to take responsibility for all healthcare programs.

 “At the end of the day the state of Florida owns it. And it’s the state for Florida’s problem. So the finger pointing that it’s the federal government’s problem—our budget is littered with partnerships with the federal government that we’re ultimately liable for administering," he said.

Florida’s problems began last April—when the federal government said it would not renew the Low-Income Pool program in its current form. LIP is valued at $2 billion dollars—half given by the feds, the other half driven by local and state funds. It expires in June. And the federal government has been clear from the start—that it’s going away to make room for something else: an expansion of Medicaid under the Affordable Care Act. Here’s Health and Human Services Secretary Sylvia Burwell speaking to WFSU in January:

“The pool money was about helping low-income people have access. That’s what the pool money is about. I think we believe that an important way to extend that coverage for low-income individuals as what passed in the Affordable Care Act is this issue of Medicaid expansion," she said.

Just this week Florida submitted a formal request for an extension, using a plan mapped out by the Senate that redistributes the way money is given to hospitals. And that delay means an extended timeline of public hearings and formal response periods, as Republican Senator Don Gaetz points out:

"We have 30 days of public hearings…and then CMS itself has a 45 day period that extends beyond the  30 days. So even if everything goes well, the fact that nothing has happened in a year puts us into the next fiscal year with a budget that’s not solvent.”

A January study commissioned by the state’s own healthcare agency says even if the federal government were to renew the Low Income Pool, there is still a need. To that effect, the Senate has crafted a Medicaid Expansion plan. Florida economist, Amy Baker told lawmakers the state would save money, and Florida wouldn’t have to spend any additional money under the Senate’s Medicaid expansion plan, nicknamed “FHIX”.  

“You have generated enough money to pay the state’s cost of entering into this program. And actually, in your proposal, you’re generating a little bit of a surplus. So it’s a self-funding design. You’ve achieved that and you’ve gone slightly about that," Baker told lawmakers.

But that’s not, nor has it been enough to get the House on board. The House maintains the Senate's FHIX program, with its premiums, co-pays and work requirements--won't get federal approval. Tuesday the House Republican Caucus met in a closed-door meeting to discuss the healthcare issues pending before the state. Now, most meetings between public officials are supposed to be public—but House Speaker Steve Crisafulli says the caucus didn’t discuss pending legislation before his chamber, and therefore—the meeting was closed.

"We had a meeting with our caucus. There was no substantive policy before us. It met the letter of the law and the constitution we live under here in the state of Florida," Crisafulli said.

If the legislature does absolutely nothing  more than 800,000, largely working Floridians will remain uninsured. And if the LIP program is canceled and there’s nothing to replace it, some hospitals in critical areas of the state could start to fail-- and there will be fewer places to go to get help. Hatter.