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A healthcare funding story only fit for Florida


Spend enough time on the Internet and you eventually come across a meme called Florida Man. The term typically describes an oddball criminal committing the sort of misdeed that, for whatever reason, only seems to happen in the Sunshine State.

As but one example, there's the Florida Man who ran through the Tallahassee Regional Airport trying to catch a plane. A perfectly normal scenario--except he left his car at the curb unattended, bypassed security and got tased in the buttocks, all while wearing only a pair of underwear.

Now, neither Florida Gov. Rick Scott (R) nor the state's legislators have made headlines for such shenanigans, but their recent political behavior unfortunately aligns all too well with their state's reputation for, shall we say, interesting behavior.

The state faces a healthcare funding conundrum. The Department of Health and Human Services (HHS) intends to withhold money for Florida's Low Income Pool (LIP) for the 2016 fiscal year, suggesting that Medicaid expansion is a better use of federal funding. HHS says it would instead help the state insure some 800,000 residents, and in the process have their care covered by Medicaid, rather than retroactively reimburse hospitals for the care they provide to those without insurance.

Scott disagrees--so much so that he has sued the Obama administration, saying that withholding LIP funds essentially coerces Florida and other states into expanding Medicaid, which the Affordable Care Act suggests but does not require. So far this month, the Florida governor has made two trips to the District of Columbia to plead his case and written a letter to HHS Secretary Sylvia Mathews Burwell with proposals for closing coverage gaps without expanding Medicaid.

Florida's legislature remains torn on the issue. The state Senate supports Medicaid expansion, but the House does not. (Scott himself supported Medicaid expansion while campaigning for reelection two years ago but has since changed his mind.)

So far, the story seems straightforward. Here's the Florida Man part: Facing political gridlock earlier this spring, House Republicans abruptly cut state budget talks short rather than try to come to an agreement. Like the kid on the sandlot who gets upset when his team loses, these legislators took their proverbial ball and went home, leaving everyone else standing in bewilderment.

That move forced the legislature to convene a special session in June in order to pass a budget by July 1. Without a budget, the Florida government may shut down, the Associated Press said. To advise that process, Scott formed a nine-person panel to examine hospital revenue and spending--but, in Florida Man fashion, he named only one person with healthcare experience, according to the Palm Beach Post.

Yes, outsiders can offer unique perspective to those who need help. On a micro level, we ask friends and family for advice every day, even though they may not be privy to every detail of a decision we need to make. On a macro level, organizations in desperate need of help typically turn to consultants, new leaders or even industry outsiders who refuse to accept the answer, "But we've always done it that way!"

However, Scott's panel takes that notion too far. Florida faces a shortage of 7,000 doctors in the next decade while leading the nation in ACA insurance plan enrollment; that bends the supply-demand curve the wrong way. Meanwhile, it's estimated that Florida misses out on $5 billion a year in federal aid by eschewing Medicaid expansion, compared to the $2 billion the state gets to fund the LIP. On top of all that, the Sunshine State is a hotbed of healthcare fraud.

Such serious issues demand the attention of several of the best and brightest healthcare minds in Florida, with one or two respected figures from outside the industry there to keep everyone honest. It shouldn't be the other way around.

Much more is at stake in Florida's feud over Medicaid expansion and the LIP than federal dollars or insurance for low-income Floridians. There are serious questions to be answered about how the United States plans to pay for a healthcare system that everyone agrees is too expensive and inefficient to sustain itself much longer.

For the next few weeks, the industry's eyes will be on Scott, his panel and the Florida legislature. All parties would be wise to stop the political grandstanding and start hashing out a mature compromise that's palatable to both Floridians and the Obama administration.

Otherwise, the annals of the Florida Man may get a whole lot bigger. - Brian (@Brian_Eastwood and @HealthPayer

Related Articles:
What Florida's feud with feds over Medicaid means for other states
Florida Gov. Rick Scott, federal government in Medicaid standstill
Florida may sue Obama administration over Medicaid expansion
Lack of Medicaid expansion will cost Florida hospitals billions

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