A Test Case For Regulatory Health Reform: Florida Privatizes Medicaid

Via echidne, Florida the Guinea Pig:

Florida Gov. Rick Scott signed two historic Medicaid bills Thursday, placing the health care of nearly 3 million Florida residents into the hands of for-profit companies and hospital networks. Lawmakers said the program was overwhelming the state budget and needed to be privatized to rein in costs and improve patient care. Critics fear the bills build on a flawed five-county experiment where patients struggled to access specialists and doctors complained the treatments they prescribed were frequently denied.

[. . .] The bills removed a requirement for plans to spend certain percentages on patient care and Federal health officials encouraged state lawmakers to include that provision in the bill. Instead, the bills call for managed care plans to repay profits over 5 percent to the state.


[. . .] Federal health care officials still have to approve the plan. The Centers for Medicare and Medicaid Services sent a letter to Florida health officials in April saying the agency will work with the state to approve a waiver by June 30. The agency stressed Florida's plan must address concerns about patient care, transparency and accountability under the pilot program.

I imagine the Obama HHS will not approve this plan. But will a GOP President's HHS approve it? OF course they will. Therein lies the problem with the regulatory reform concept for health care. Federal public insurance programs are the only way to go.

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  • Display: Sort:
    I don't know what sort of shape (5.00 / 2) (#1)
    by Militarytracy on Sat Jun 04, 2011 at 10:16:06 AM EST
    Florida is in, but Alabama has a serious problem.  We have no doctors.  They can't paid here, nobody has insurance and they can't live on Medicaid or Medicare payments.  I can't imagine how privatizing Florida Medicaid is going to help anything.

    I'm glad to see that providers will be paid more, but how can this save Florida money?  It seems to me that this is destined to cost Florida even more money.

    It will help (none / 0) (#30)
    by Amiss on Sun Jun 05, 2011 at 02:28:28 AM EST
    line Rick Scott's pockets once again is who it will help.

    Isn't this basically why Scott was (5.00 / 1) (#2)
    by inclusiveheart on Sat Jun 04, 2011 at 10:24:30 AM EST
    put into the Governor's mansion in Florida?  To get all of those public funds for healthcare into the hands of his own private industry buddies?

    "was put" by whom? (none / 0) (#20)
    by gyrfalcon on Sat Jun 04, 2011 at 06:53:42 PM EST
    Florida voters have soured on him big-time according to recent pols.  Like voters in Wisconsin and Ohio, they lurvvv the rhetoric but shrink in horror from the implementation of it.

    He won didn't he? (5.00 / 1) (#28)
    by inclusiveheart on Sat Jun 04, 2011 at 07:23:10 PM EST
    I was basically saying that his industry probably gave him a lot of money and he's doing their bidding now.

    The failure of Florida voters was to understand that a man who comes from the private healthcare industry was probably going to give great favor to their desires over the needs of the people.


    Gotcha (none / 0) (#33)
    by gyrfalcon on Sun Jun 05, 2011 at 08:46:34 AM EST
    Quo vadis? (5.00 / 3) (#3)
    by lentinel on Sat Jun 04, 2011 at 10:33:57 AM EST
    Federal public insurance programs are the only way to go.

    If I'm not mistaken, this was also the only way to go when the health-care-insurance bill was being presented and debated.

    If I'm remembering correctly, it is the very first thing that Obama abandoned and took off the table.

    Ha-ha-ha (5.00 / 2) (#4)
    by TeresaInSnow2 on Sat Jun 04, 2011 at 10:44:36 AM EST
    needed to be privatized to rein in costs


    and improve patient care

    oh-hee-hee-hee, my stomach hurts from laughing.

    A laugh fest (5.00 / 1) (#6)
    by Stellaaa on Sat Jun 04, 2011 at 10:50:01 AM EST
    Seriously?  They say these things with a straight face?  

    Laughter is purportedly good for you health. (5.00 / 0) (#15)
    by oculus on Sat Jun 04, 2011 at 12:03:37 PM EST
    I see (5.00 / 2) (#17)
    by Stellaaa on Sat Jun 04, 2011 at 02:45:43 PM EST
    It's the new healthcare plan.  

    Good (5.00 / 1) (#21)
    by gyrfalcon on Sat Jun 04, 2011 at 06:54:50 PM EST
    to see you, Stellaa.  I miss you!

    Thanks... (none / 0) (#29)
    by Stellaaa on Sun Jun 05, 2011 at 01:07:22 AM EST
    Missed you all as well.  

    I will second the message (none / 0) (#32)
    by MO Blue on Sun Jun 05, 2011 at 08:28:49 AM EST
    that you were missed. Hope you will once again be commenting here on a regular basis.

    But you forgot something (none / 0) (#14)
    by NYShooter on Sat Jun 04, 2011 at 11:47:23 AM EST
    not only will it rein in costs

    it wil also improve health care

    its a two-fer


    "profits over 5 percent..." (5.00 / 3) (#5)
    by Dadler on Sat Jun 04, 2011 at 10:48:14 AM EST
    This seems to me to be an open invitation for the type of accounting that Hollywood studios use to deny that net profits ever exist.

    And I'm sure companies looking to make as much money as they can by spending as little as they can, of course, will be putting patient care above all else.

    Exactly... (5.00 / 1) (#12)
    by desertswine on Sat Jun 04, 2011 at 11:25:27 AM EST
    Profits will never exceed that slippery "5%" no matter how much the profit is.

    This is going (5.00 / 1) (#7)
    by Ga6thDem on Sat Jun 04, 2011 at 10:50:35 AM EST
    to show the inherent problems with GOP ideology: privatization neither saves money nor delivers better care.

    I hope you are right (none / 0) (#8)
    by Militarytracy on Sat Jun 04, 2011 at 10:56:41 AM EST
    Something needs to happen as soon as possible. I have no doubt we are going to kill a lot more people for profit in this struggle.  But I would like to kill as few as I can.

    GOP ideology? (none / 0) (#19)
    by Rojas on Sat Jun 04, 2011 at 06:40:46 PM EST
    Seems this kind of state experimentation is exactly what was to be expected from welfare reform.

    And didn't someone mention how welfare reform took the issue away from republicans. That was a real winning strategy. Proof is in the pudding.  


    Welfare (none / 0) (#26)
    by Ga6thDem on Sat Jun 04, 2011 at 07:11:51 PM EST
    was a failure. I have personal experience with that from a family member. Do you think that it worked?

    The 96 WRA modified Medicaid (none / 0) (#34)
    by Rojas on Sun Jun 05, 2011 at 10:16:04 AM EST
    eligibility requirements.

    There are several programs, intrinsically linked in a Federal/State partnership of social insurance, commonly referred to as welfare.

    As such that means there are in theory at least 50 different systems as each state is responsible for administration of the program under federal guidelines. The reality is that many states further allocate responsibility for administration of these programs to the county level. The net effect being there are hundreds if not thousands of variations of these programs nationwide.

    While Medicaid retained entitlement status after the WRA, more control was passed  to the states. Clinton bragged that they had passed more waivers then all other administrations combined. This was keeping with the reinventing government theme touted by the DLC.

    If one truly believes

    Therein lies the problem with the regulatory reform concept for health care. Federal public insurance programs are the only way to go.
    then an honest broker would not constrain their criticism to the GOP. The WRA was designed to encourage the kind of experimentation currently in the Florida plan.

    Oh, geez (none / 0) (#36)
    by Ga6thDem on Sun Jun 05, 2011 at 03:00:01 PM EST
    that's like saying that Bill Clinton was responsible for us going into Iraq.

    Welfare reform worked for my family member back in the 90's because she was not limited to $200.00 a month for buying shoes, clothes and anything outside of food for her three kids.

    She saw no difference in Medicaid because as it was and still is, a lot of doctors simply don't take it.

    And where is your criticism of Obama? I see none. Anytime someone criticizes Obama you bring up Bill Clinton like Obama isn't responsible for his own decisions.


    Non responsive (none / 0) (#39)
    by Rojas on Mon Jun 06, 2011 at 09:53:31 AM EST
    New York was granted it's medicaid to mananged care waiver in 97 IIRC.
    Beneficiaries can enroll in a Medicaid managed care plan voluntarily at any time. They can join by calling a community based facilitated enroller, a Medicaid managed care plan directly or by calling New York Medicaid Choice at 1-800-505-5678. NY Medicaid Choice is a private company which has been contracted by 13 local districts and New York City to help enroll people in managed care

    Who owns New York Medicaid Choice?
    Maximus Inc.

    Human services
    MAXIMUS operates a variety of human services programs, which fall into four primary service areas--employment, child support enforcement, child care, and child welfare.

    Employment services
    MAXIMUS began providing welfare-to-work services in 1988 with Los Angeles County's decision to award the first welfare-to-work privatization contract in the nation. Today[when?] MAXIMUS operates TANF programs in Los Angeles County; Alaska; San Diego; Orange County, California; Wisconsin; Maricopa County, Arizona; Nashville, Tennessee; and Cleveland, Ohio.

    And even (none / 0) (#37)
    by Ga6thDem on Sun Jun 05, 2011 at 03:02:33 PM EST
    you can't defend the old Welfare system. You keep trying to say reform was bad but I have yet to see you defend the Welfare system that was a failure.

    Anybody who's lived (none / 0) (#22)
    by gyrfalcon on Sat Jun 04, 2011 at 06:57:09 PM EST
    in a community where they fired all the DPW guys and privatized the trash pick-up and snow removal knows what a crock the whole concept is.

    I'm SOOOO glad to be back in a place where our own guys take very tender care of our roads because it's their place.


    The example of Christie Whitman (none / 0) (#27)
    by andgarden on Sat Jun 04, 2011 at 07:17:12 PM EST
    privatizing the NJ DMV is a good one.

    Obama's HHS will not approve? (5.00 / 3) (#9)
    by oculus on Sat Jun 04, 2011 at 11:00:37 AM EST
    Let's see.  

    To me, Scott's scheme (5.00 / 1) (#10)
    by KeysDan on Sat Jun 04, 2011 at 11:01:35 AM EST
    illustrates the problem of Medicaid and its extension under the Affordable Health Care Act--its "welfare" characterization by the uncaring that makes it politically vulnerable.  Of course, not to be outdone by Scott, the high flying Governor Christie's answer to Medicaid for New Jersey is to bring  eligibility for a family of three to under $100 per week--significantly below the poverty level and human decency.

    A lesson also to be learned for Medicare "reforms". Additional means testing of Medicare is a bad idea for similar reasons--taking it from a universal federal insurance program to the likely characterizations and vulnerabilities of a public dole--a somewhat slower but just as assuredly a Medicare killer as Ryan's coupon clipping program.

    Really??? (none / 0) (#23)
    by gyrfalcon on Sat Jun 04, 2011 at 07:01:15 PM EST
    100 bucks a week?  Is he insane?  Is everybody who agreed to this insane?  I'm truly seriously shocked.  That's far below even Alabama.

    Well, we can cheer up, (none / 0) (#35)
    by KeysDan on Sun Jun 05, 2011 at 12:53:45 PM EST
    Christie's plan would still cover the health costs of children. But, yes, the plan would deny coverage to adults in a family of four with an annual household income of little more than $6000 (down from the current $30,000) and adults in a family of three that makes $103 a week would earn too much to qualify-- $5,317 annually, down from $24,645.  The Obama Administration would need to approve the new eligibility requirements. Oh, and these new requirements, if approved, would only apply to new applicants. Christie's shared sacrifice.

    Don't you know the (5.00 / 0) (#13)
    by Ga6thDem on Sat Jun 04, 2011 at 11:30:47 AM EST
    joke about FLorida? It's not Florida it's Florid duh!

    Florida is a shambles (5.00 / 1) (#16)
    by Coral on Sat Jun 04, 2011 at 12:17:03 PM EST
    The economy is awful. Housing prices and mortgage crisis still in collapse. Jobs and wages horrible. And corruption rampant.

    And they have all these crazy (and corrupt) politicians running the place.

    The stupidest thing was nixing high-speed rail.

    The tea people (5.00 / 1) (#18)
    by Madeline on Sat Jun 04, 2011 at 05:20:42 PM EST
    were invited to the signing.  Those against were forced to leave. The tea people say the budget is a failure.  It does not go far enough and they are waiting for more cuts.

    He continues the War on Women.

    "He also vetoed millions more in health service projects set aside specifically for women and children. Programs that aim to lower infant mortality and increase women's health in the state have seen a major setback since Scott took office." (Palm Beach Post 6-3-11)

    However, his cuts to abortion surprised me. No insurance subsidies, expected that. And only for rape, incest and life of the mother.  I was sure he would let the mother die and blame the rape on the victim. Surprise surprise.

    Family Planning was cut; insurances can opt out of family planning; WIT is cut, Head Start is cut.
    screening for babies for genetic diseases - cut.
    Scott says they are "special interest waste".

    Do you live there? (none / 0) (#25)
    by gyrfalcon on Sat Jun 04, 2011 at 07:03:58 PM EST
    If so, why?  I'd run screaming into the night if maniacs like that took over my state.

    my business is here (5.00 / 1) (#38)
    by Madeline on Sun Jun 05, 2011 at 03:59:29 PM EST
    I also live in an area that is sort of the New YOrk 5th Ave of FL   Wealthy and cautiously spending.

    I do plan on moving after my lease is up as I have a relocatable business. I have some choices and will decide.

    Yes it is disgusting and immoral what the tea party people are demanding from Scott and he is their master. He really is.  He can't even reach consensus with this own party in the legislature.


    Jax is now (none / 0) (#31)
    by Amiss on Sun Jun 05, 2011 at 02:34:28 AM EST
    not even opening brand new schools because of his cuts to education. More empty buildings, that now the state has to pay upkeep on too.

    Truly (none / 0) (#24)
    by gyrfalcon on Sat Jun 04, 2011 at 07:02:27 PM EST
    I was absolutely baffled by that vote.  But it does seem that FL voters are seriously regretting it.