2014 Florida Legislature’s Health Care Legacy: Inaction, Irresponsibility

When the Florida Legislature adjourned its 2014 session earlier this month, the primary health care-related “accomplishment” it could claim was its decision to blatantly disregard Florida’s families, businesses and economy for purely political purposes.

(Download PDF of  The 2014 Legislature’s Health Care Legacy: Inaction,  Irresponsibility  here)

Sheer Force of Will Shuts Down Discussion and Blocks Expansion

The key outcome of the 2014 legislative session is well-known: the discussion of health care expansion ended before it began. Despite an unprecedented budget surplus, a minimal required state investment and a lack of any valid justification, the tenures of House Speaker Will Weatherford and Senate President Don Gaetz will end (barring a miracle) with massive benefits to Floridians left untapped.

Although health care expansion bills SB 710/HB 869 (“Healthy Florida”) were filed early in both the House and Senate, neither were heard in a single committee, which meant the “discussion” ended before it even started.  Although initially there had been hope that the Senate bill would be considered, that opportunity never materialized. For its part, the House kept its Select Committee on the Patient Protection and Affordable Care Act in place, but it met just once, and then only for informational purposes, in January.

Efforts to get expansion heard continued through the end of session, but leadership never budged in its determination not to allow their inaction to be placed in the spotlight. Some House Democrats voted against the budget because expansion was ignored, to no avail. Then a bipartisan amendment to include health care expansion for Florida residents as part of a bill proposing to subsidize medical tourism projects serving visitors was shot down on procedural grounds.  Most importantly,  efforts by uninsured Floridians living in the coverage gap to tell their stories in the Capitol fell on leaders’ deaf ears.

 

Waiting to End Waiting Period for Immigrant Kids Continues

Also blocked from advancing was HB 7/SB 282, which would have eliminated the five-year waiting period for KidCare eligibility for low-income immigrant children who are lawfully residing in the U.S.

Although this bill did advance through its initial committees in both chambers, it was blocked from coming to the floor for a vote. Among the factors working against the bill was a highly inflated official estimate of the cost and the fact that another good bill allowing undocumented immigrant college students to pay in-state tuition rates (which did pass) was competing for extremely limited willingness to take action benefitting immigrants.

 

Inaction Extended to Broader Range of Health Issues

Not only were legislative leaders willing to ignore a huge budget surplus, convincing arguments and real-life stories in failing to move coverage expansion forward, they failed to direct additional resources to fill health-related gaps in general. The only silver lining was the fact that the surplus pre-empted the threat of cuts to health programs and services we’ve seen almost every other year.

Several other major health-related initiatives, including much-discussed changes to the level of independence with which nurses can practice (which has implications for access) and telemedicine, were eventually combined into one combined mega-bill (HB 7113). However, the House and Senate could not agree on all of the issues before time ran out.  One of the other bills ultimately attached to the health care “train” (SB 1354/HB 1003) would have reined in some long-time health insurer abuses, such as requiring patients  to “fail first” on potentially ineffective medications,  requiring providers to complete arbitrarily complex “prior authorization” requests to refer their patients, and limiting access to provider network and prescription drug information.

 

ACA Insurance Protections Ignored  (Except the Few the Insurance Industry Happens to Like)

After last session’s embarrassing tantrum took prior efforts to obstruct the Affordable Care Act (ACA) to an extreme, stripping the Insurance Commissioner of his authority to regulate health insurance until 2016, health insurance issues were largely ignored in the 2014 session. As a result, dozens of provisions remain in the State Insurance Code that conflict with the ACA, although the weaker old state laws were made obsolete by the stronger ACA, assuming that insurers are actually complying with all of them.

However, the only real ACA-related insurance bill receiving any consideration in 2014 sought to eliminate one of the only provisions in state law that is actually stronger than the ACA requires.  SB 1364 would have increased the number of hours per week that a small business employee would need to work in order to qualify for health coverage from 25 to 30.  One of the primary “arguments” insurance agents made against the law is that many employers are apparently breaking it. For its part, however, Florida CHAIN argued that many of the workers who would no longer qualify for employer coverage would fall into the Medicaid coverage gap and become uninsured. The prospect of this bill being cited by advocates as further harm done as a result of the rejection of health care expansion was enough to doom it.

 

Scramble Lets Recipients Disembark from Medicaid Managed Care Jet Just Before Takeoff

Finally, the legislature did in fact address a few low-profile issues that are nevertheless of interest to consumers and advocates. In particular, even as Statewide Medicaid Managed Care is rapidly rolling out across Florida, the state is still trying to finalize the basic parameters. In particular, the legislature acknowledged that a provision in the 2011 law requiring Medically Needy (Share of Cost) patients with catastrophic medical expenses to pay up to 90% of their income on premiums can never get federal approval. As a result, the Medically Needy are no longer part of Medicaid managed care. In addition, provisions were made to allow medically fragile children receiving Prescribed Pediatric Extended Care (PPEC) services to also continue to receive care coordination through Children’s Medical Services and to allow residents of group homes to opt out of Medicaid managed care.