Friday, December 14, 2012

Florida and Obamacare: let your voice be heard

With the president’s reelection, the call to “Repeal Obamacare” seems to have subsided. So where does Florida stand with the Affordable Care Act (ACA)?

Today was the deadline for states to decide whether to set up their own health insurance exchange or let the federal government do it.  Like 19 other Republican-led states, Florida decided, for now, to let the Feds do it. (They can change their mind at a later date, with approval of the Legislature and the governor.)

Given where we are today, this is probably the best they can do for now. As recommended by Florida CHAIN (Community Health Action Information Network), a statewide consumer health advocacy organization:
As a result of Florida leaders' resistance to the ACA and inaction over the past two years, the state has not completed the planning or invested the resources needed to develop and launch a State-Based (or even a Partnership) Exchange by next October. Therefore, a Federally Facilitated Exchange should be established to serve Floridians, at least until Florida demonstrates that it can meet the requirements of the law and run their own Exchange with stakeholder and public input.
States also have to decide whether to expand Medicaid, which is a federal-state partnership, to a federally-mandated level in order to provide insurance for their uninsured.  This is because the Supreme Court declared the provision of the ACA that required states to provide that coverage unconstitutional.

Here’s the deal: If a state agrees to expand coverage by increasing the income limit for the program to 138% of the Federal Poverty Level (individuals up to $15,400 and a family of three up to $26,300 based on the 2012 FPL) starting January 2014, the federal government will pay 100% of the cost for the first three years, and 90% thereafter.

If Florida agrees, according to “Obamacare: Or How I Learned To Stop Worrying And Love The Affordable Care Act” in today’s Naples Florida Weekly:
The notion is that over time roughly half of the 4 million uninsured or underinsured people in Florida will join Medicaid, and half will use a health insurance exchange. 
In the program’s first three years alone, the federal government will spend at least $3.2 billion and as much as $4.78 billion while Florida taxpayers pay little or nothing, according to projections by the Florida Hospital Association.  
In a report issued last month, the association strongly recommended embracing the federal plan, “which is estimated to expand coverage to 32 million individuals at a cost of $940 billion over 10 years (2010 to 2019).”
Here are some additional facts from Medicaid Expansion and the Affordable Care Act in Florida, by Florida CHAIN (Community Health Action Information Network), a statewide consumer health advocacy organization:

  • The majority of newly Medicaid-eligible Florida adults are employed. They include workers in the areas such as retail, food preparation, tourism/hospitality and other service industries.
  • The health coverage provided to Florida workers under Medicaid expansion would be a fully subsidized employee benefit, worth an estimated $14.3 billion to their employers over 10 years.
  • Expansion will cost the state an estimated $2.1 billion over the next 10 years, increasing the state’s share of the Medicaid budget by only 2%, while drawing down $20.3 billion in federal funds.
  • Medicaid expansion will create an estimated 65,000 new Florida jobs in the first 6 years alone.

The Florida Legislature and governor have to decide whether or not to expand Medicaid in the coming months as they develop the 2014 budget, and already its causing lots of debate – as you would imagine.

The Senate has created a Select Committee on Patient Protection and Affordable Care Act (PPACA) and is inviting Floridians’ input on what Florida should do. They’ve even set up a webpage where you can submit your comments.  Here’s what I submitted today:
As a Florida taxpayer and voter, I urge you to fully adopt the Medicaid Expansion limits set by the PPACA so that Florida will receive its share of the Federal funding (100% of the cost of expansion in the first three years, and 90% thereafter) toward the insurance of our uninsured. It's the right thing to do.
It doesn’t have to be long or elegant. Just visit the webpage and tell them why you believe Florida should expand Medicaid coverage under the Affordable Care Act.

Let your voice be heard.

Saturday, December 1, 2012

The President's Plan

Last night at dinner with friends, conversation turned to the apparent lack of progress at the meeting between Tim Geithner, representing the President, and John Boehner on Thursday. One friend commented that he was disappointed in the President's failure to put forward a specific plan, a criticism that has been all over the media since the meeting.

I countered that the President had indeed put forward specifics, and that further, to do anything more would simply be negotiating with himself - a tact he was roundly and appropriately criticized for during the debt ceiling crisis. My friend challenged me to name the specifics and, while unable to do so last night, I followed up with him by email this morning. Here's what I sent:

From the 11/29/12 Press Briefing by Press Secretary Jay Carney;
Q    One last thing on this.  You say that the President has put forward specific spending cuts.  Boehner said again this morning that they haven’t seen any plan.  Where do they fall on this when they actually talk in person, what they did last night or what they did on Saturday?  Has the President said that he's put forward spending cuts and he doesn’t plan to put forth any more?

MR. CARNEY:  I'm glad you asked.  This is available not just here but to everyone in the world who has an Internet connection. And I know things are done the old-fashioned way sometimes on Capitol Hill, but I believe they have electricity and Internet connections and they can get this.  This is an 85-page plan that is very detailed -- sorry, maybe 65, going on 70 -- that's very detailed and it outlines -- it's the President's Plan for Economic Growth and Deficit Reduction that was submitted in September of 2011.  It is of a piece with his budget that he put forward in February 2012.   
 And in terms of where we are missing specifics is anything specific, politically feasible, or substantial from the Republican side on revenues.  …..
 And here it is: President's Plan for Economic Growth and Deficit Reduction.  In part, from the Introduction:
…. the President is putting forward a balanced approach that both asks for shared sacrifice from all Americans and draws from across the budget. This should include additional spending cuts in mandatory programs, modest adjustments in important entitlement programs such as Medicare and Medicaid, capping spending on Overseas Contingency Operations (OCO), and reforming our tax code so that we ask our biggest corporations and wealthiest Americans to pay their fair share. 
Specifically, the President is proposing $257 billion in cuts and reforms to a wide range of mandatory programs from Federal retirement to agricultural subsidies, reform of the Pension Benefit Guaranty Corporation, new program integrity initiatives, and getting rid of unneeded Federal real property to reduce the deficit. 
The specifics are in the 67-page document. Just because it’s nothing new, doesn’t mean it doesn't exist.

Why should the President have to put forth ANOTHER plan? The one he put out last year appropriately remains his initial offer, until the Republicans come forward with a specific counter-proposal on both taxes AND spending cuts.

The Republicans may think that continuing to say the President didn’t put forth a plan will make it so, but it doesn’t.