Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.
Here’s something to put on your radar.
Medicaid expansion, which has long been a no-go in Florida and as well as other states controlled by Republicans, is starting to get a renewed look in other states that have been holdouts.
Axios Atlanta reported Monday that some Georgia Republicans have “quietly changed” their minds about Medicaid expansion for a multitude of reasons, including the fact that the federal government has not cut back on the 90% of guaranteed funding for those eligible for Medicaid expansion.
Another noteworthy moment is that Medicaid expansion is under serious consideration in North Carolina, which, like Florida and Georgia, was one of the states that recently expanded to one year of Medicaid postpartum coverage. The expansion was allowed under the American Rescue Plan.
Democrats have long been arguing for the need to expand Medicaid and the two Democrats running for Governor, Agriculture Commissioner Nikki Fried and U.S. Rep. Charlie Crist are advocates for expanding coverage to the working poor. Without a Medicaid expansion, they are left without coverage because they do not earn enough income to enroll in the federal health insurance exchange and don’t qualify for subsidized coverage.
There was a (brief) moment in Florida when the GOP-controlled Florida Senate considered a form of expansion. But for several years now, the Florida Legislature has blocked the idea.
Right now, Florida is one of 12 states that opted against expanding Medicaid after the U.S. Supreme Court ruled in 2012 that the federal government could not withhold funding to those states that did not expand coverage. The ruling came in a lawsuit filed by NFIB and championed by the state attorney general’s office.
Most of the states that have opposed expansion have been in the South, including Texas and Tennessee. However, Wisconsin, Kansas, Wyoming and South Dakota also have not expanded Medicaid.
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— Big changes? —
It’s not often that Pharma takes a hit.
But that’s exactly what happened after the passage of the Inflation Reduction Act last week.
The measure is being described as the largest health care reform since passage of the Patient Protection and Affordable Care Act. While Medicare won’t be authorized to begin negotiating for drug costs until 2026 there are other provisions in the inflation Reduction Act regarding pharmaceutical costs that kick in sooner.
Beginning this year pharmaceutical manufacturers who hike drug costs above the rate of inflation will face financial penalties. In 2023, the bill limits co-payments for insulin to a maximum of $35 per month in Medicare Part D, the prescription drug benefit covered by Medicare. The Inflation Reduction Act also ends co-payments on Part D-covered vaccinations in 2023.
In 2024, premium increases for Medicare Part D are capped at 6% annually. In 2025, out-of-pocket drug costs for Medicare Part D will be capped at $2,000.
And in 2026, Medicare can start negotiating the top 10 most expensive drugs taken at home and on the market for at least nine years without competition. Those drugs which can be negotiated will increase by 15 in 2027 and (eventually) reach 20 additional drugs annually.
AARP Florida thanked U.S. Reps. Kathy Castor, Sheila Cherfilus-McCormick, Crist, Val Demings, Ted Deutch, Lois Frankel, Al Lawson, Stephanie Murphy, Darren Soto, Debbie Wasserman Schultz and Frederica Wilson for supporting the legislation.
In a statement, AARP Chief Executive Officer Jo Ann Jenkins reacted to the vote:
“Today is a momentous day for older Americans. By passing the Inflation Reduction Act, Congress has made good on decades of promises to lower the price of prescription drugs. Seniors should never have to choose between paying for needed medicine or other necessities like food or rent, and tens of millions of adults in Medicare drug plans will soon have peace of mind knowing their out-of-pocket expenses are limited every year.
“Many people said this couldn’t be done, but AARP isn’t afraid of a hard fight. We kept up the pressure, and now, for the first time, Medicare will be able to negotiate with drug companies for lower prices, saving seniors money on their medications. “I thank the House members whose votes today will bring real relief to millions of Americans, and I look forward to President Biden signing this bill into law.”
Democrats need to decide whether they take the victories in the Inflation Reduction Act or whether they try to push to lower the costs of prescription drugs for people enrolled in individual health policies or group policies. A move to cap at $35 the co-payment charged to commercially insured patients was unsuccessful.
The Inflation Reduction Act also continues through 2025 the enhanced subsidies that help with rising health insurance premiums for health care plans bought on the federal health insurance exchange. According to the Kaiser Family Foundation, subsidies are saving people $700 annually on their premiums. Had they not been extended, people’s premiums would have skyrocketed by 53%.
— More money, more projects —
Gov. Ron DeSantis signed a record-high $110 billion spending plan for the current fiscal year 2022-2023 but that hasn’t stopped lawmakers from wanting to spend a little bit more.
Included in the FY 2022-2023 budget is a $205 million pot of money in the new state budget to fund local projects, of which about $125 million will go to one-time payments for essential workers. That leaves the Legislature with about $80 million for what is referred to as “local support grants.”
Lawmakers sent 971 local funding requests that totaled nearly $844 million by the deadline. A Florida Politics search for local funding projects that included the words biology, biological sciences, cancer, diabetes, doctors, health, health care, hospitals, nurses produced 70 submissions worth more than $38.8 million.
Examples of health-care-related local projects for consideration include:
— $2.6 million request by Rep. Wyman Duggan for a pediatric behavioral health unit at Wolfson Children’s Hospital;
— $750,000 by Rep. Jay Trumbull for Jackson County for its hospital district renovation;
— $500,000 for Calhoun Liberty Hospital (also submitted by Trumbull) to connect water and sewer to the proposed new hospital site;
— $1,450,202 by Rep. Robert Andrade for a geriatric behavioral health care unit at Baptist Hospital;
— $1.2 million request by Rep. Joe Harding for renovations to SMA’s Marion County’s behavioral health campus; and
— $500,000 by Rep. Tom Fabricio for South Broward Hospital District to construct and equip a pediatric simulation room at Memorial Hospital in Miramar.
It’s not clear when the Joint Legislative Budget Commission will meet to discuss the local funding requests but the 2022-2023 budget requires that it approve requests no later than Sept. 15. The Executive Office of the Governor must submit a budget amendment no later than Sept. 30 to distribute the local support grants to the appropriate agencies to distribute.
— If, at first —
The big question, however, is whether the Joint Legislative Budget Commission will choose projects for funding that have already been vetoed.
For instance, DeSantis vetoed $500,000 for Show Your Real Stories from the budget that is now the subject of a $275,000 local project request submitted by Rep. Michele Rayner. The Governor also vetoed $500,000 for a chronic obstructive pulmonary disease readmission program and Rep. Clay Yarbrough has subsequently turned in a $500,000 local funding request for the same program.
DeSantis also vetoed funding for the Lady Storm Foundation, Smiling at Life, and the Thelma Gibson Health Initiative.
Yet, there were submissions for all three projects.
Florida’s Constitution states that it takes a two-thirds vote of the entire Legislature to reinstate an item vetoed by the Governor. A separate section of state law states that the Governor and state agencies are prohibited from authorizing expenditures for, or the implementation of any programs authorized by the vetoed appropriation.
The Florida House has taken the position that the LBC can set aside money for such projects because this is not being authorized by the executive or judicial branch but the legislative branch.
But so far, it’s been the House — not the Senate — that has been the driving force with this process. It’s not exactly clear as well how the governor’s office will respond if, in fact, the LBC were to sign off on projects that had been vetoed.
The LBC must act by Sept. 15, which is the deadline that the panel of legislators must also annually act on a three-year long-range financial outlook that is drawn up by state economists.
The legislative panel is made up of seven legislators from both the House and Senate and besides approving the annual outlook the committee is responsible for signing off on budget amendments that occur outside the Legislative Session.
The new “local support grants” authorized in the budget bring an entirely new responsibility to the Commission so it’s also unclear how this will be managed and whether the group plans to just roll out a list of approved projects.
— That was fast —
The DeSantis administration-backed rule that bans Medicaid from providing gender-affirming care was fast-tracked by Agency for Health Care Administration Secretary Simone Marstiller and is slated to take effect Sunday, Aug. 21.
Generally, a rule may be filed for adoption between 28 and 90 days after the state publishes notice of intent to adopt new rules or amend existing ones AHCA first announced its intent to amend Medicaid rules to ban gender-affirming care June 17 and submitted the rule to the Department of State for finalization Aug. 1.
Medicaid, which can spend months on crafting and passing new rules, was able to finalize in 45 days a rule that bans Medicaid from reimbursing health care providers for providing puberty blockers, hormones, and hormone antagonists, or performing sex reassignment surgeries, and other procedures that alter primary or secondary sexual characteristics.
The question is: All the Florida Board of Medicine also fast-track a rule on gender-affirming care?
The Board of Medicine earlier this month agreed to initiate its own standards for providing gender-affirming care. Board Chair and Winter Park physician David Diamond did not say whether he would expedite the rule, but he did promise at the board’s Aug. 4 meeting in Ft. Lauderdale to reach out to affected parties and to hold public meetings across the state.
The new Medicaid rule comes after Medicaid Director Tom Wallace released a report summarizing what it called a “robust review” of available medical evidence and deemed the health care experimental and investigational. The finding essentially precludes Medicaid from reimbursing for services because Medicaid doesn’t cover experimental care.
Wallace’s analysis followed a recommendation to deny gender-affirming care to children and limit gender-affirming care for adults that was issued by State Surgeon General Dr. Joseph Ladapo. That recommendation is at odds with the American Academy of Pediatrics and the American Medical Association which both support gender-affirming care.
While AHCA’s analysis has been criticized by scholars as well as those in the LGBTQ-plus community as politically motivated, the DeSantis administration notes that in 2016 the Obama Administration did not issue a national coverage determination, or NCD, for gender reassignment surgery for Medicare beneficiaries with gender dysphoria “because the clinical evidence is inconclusive for the Medicare population.”
The DeSantis administration also points to similar findings from Sweden, Finland (translated version), and the two reviews from the United Kingdom. The U.K.’s Cass Review resulted in the closing of the Tavistock gender clinic.
“Many of those refuting the Medicaid report are relying on studies and surveys deemed low or very low quality and insufficient to meet medical necessity criteria. Many of these ‘experts’ have also shown a remarkable blindness to what is happening in Northern Europe on this very topic,” AHCA representative Brock Juarez said in a statement. “I am still waiting for the critics to provide a logical and well-reasoned case based on quality evidence. However, rather than cite quality evidence, they have simply ignored the AHCA report’s main arguments while disseminating misinformation and making false claims.”
— RULES —
The Board of Pharmacy proposes amending Rule 64B16-26.1031 to update the coursework for the administration of vaccines and to provide language concerning coursework and training for pharmacy technicians in the administration of vaccines. More here.
The Board of Pharmacy proposes amending Rule 64B16-26.103 to update the rule regarding continuing education for registered pharmacy technicians that maintain immunization certification. More here
— ETC —
Melbourne Terrace RCC, LLC notified the state it plans to add nine community nursing home beds at a cost of $75,000 to its Brevard County facility that runs under the moniker Melbourne Terrace.
AHCA gave tentative approval to an expedited CON application submitted by Pruitt Health.
— LOBBYING —
Registrations and withdrawals — Week of Aug. 7-13.
Melody Selis Arnold withdrew from lobbying for the Florida Health Care Association.
Robert Beck registered to lobby for Team Select Home Care.
Anita Berry, Jeffrey Johnston, Amanda Stewart withdrew from lobbying for Impact Health Biometric Testing, Inc.
Ron Book and Kelly Mallette withdrew from representing the Florida Association of Rehabilitation Facilities, Inc. and the Small Business Pharmacies Aligned for Reform, Inc.
Ronald Brise registered to lobby for VERICARE, INC.
James Card registered to lobby for the Florida Chiropractic Physician Association.
Christopher J. Chaney registered to lobby for Elevance Health, and its Affiliates.
Christian Edward Cochran withdrew from lobbying for Veterans Affairs.
Steve Crisafulli registered to lobby for Inspire Health Alliance, LLC.
Shawn Foster registered to lobby for LifeStream Behavioral Center.
Nick Iarossi registered to lobby for Vaxxinity, Inc. and withdrew from representing COVAXX.
Sha’Ron James, Tim Stapleton and Lary Williams registered to lobby for VERICARE, INC.
James McFaddin III and James (Clark) Smith registered to lobby for Advantage Behavioral Health Services and withdrew from representing ChenMed, LLC, along with Frank Monte Stevens, III.
— ROSTER —
James J. Kelly Jr. has been named interim CEO of UF Health Shands Hospital following the resignation of Ed Jimenez, who had served in the position since 2014.
Health care policy expert and veteran political strategist Toby Philpot is joining Floridian Partners, effective Sept. 15.
— ICYMI —
In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.
— No third parties: Medical marijuana treatment centers have 60 days to ensure their website and website purchasing services comply with a new emergency rule issued by the governor.
— Uh oh: State economists have doubled the size of the projected deficit in the state group health insurance program for the state fiscal year 2023-2024. Members of the State Employees’ Health Insurance Estimating Conference tentatively agreed the state employee health insurance trust fund could have as high as a $170.3 million deficit by June 2024. That’s more than double the $61.8 million deficit economists had predicted in December 2021 when they last met.
— Reduced rates: Medicaid managed medical assistance plans are likely to see a 4.5% rate reduction beginning in October. Managed dental plans are set to see an 8.7% reduction. Managed long-term care plans will likely see an 8.4% hike in reimbursement rates, Wallace said.
— Go nurses: The University of Florida announced it will recruit about 20 new faculty members as it prepares to train and educate baccalaureate-prepared nurses, nurse practitioners and nurse scientists in the coming year to help abate a looming nursing shortage in the state.
— D.O. Heads the FMA: The Chief Medical Officer for the Broward Health system Dr. Joshua Lenchus is the new leader of the Florida Medical Association. The Ft. Lauderdale osteopathic physician was installed as the 146th President of the FMA during the board’s annual convention Aug. 6 in Orlando.
— FOR YOUR RADAR —
Aside from coverage by Florida Politics, these stories are worthy of your time.
—”U.S. drug price controls could kneecap DeSantis’ Canada prescription import plan” via Michael Moline of the Florida Phoenix — It’s been one year and nine months since DeSantis applied to the U.S. Department of Health and Human Services to import cheaper pharmaceuticals from Canada. That was after his patron Donald Trump lost his reelection but was still in the White House. The response thus far: mostly crickets.
—”For medically vulnerable families, inflation’s squeeze is inescapable” via Heidi de Marco of Kaiser Health News — For millions of families living with chronic diseases, inflation is proving a punishing scourge that could be harmful to their health. Unlike dining out less or buying fewer clothes, many patients don’t have a choice when it comes to paying for medicine, medical supplies and other ancillary costs.
—“Joint Commission tackles health equity with new accreditation standards” via Susan Kelly of Healthcare Dive — The Joint Commission, an independent accrediting body for hospitals, will introduce new standards Jan. 1 aimed at reducing health care disparities, calling the effort a quality and safety priority.
—“CDC takes back control of pandemic hospitalization data despite criticisms” via Riley Griffin of Bloomberg — The U.S. Centers for Disease Control and Prevention has won a months-long battle for control of COVID-19 hospital data, a rare victory during its pandemic response that’s seen some of its functions handed off to other players amid widespread criticism.
—“Scholars confirm what itsy bitsy babies around the world already know” via Susan Brink of NPR Health — Studies have long shown that Western parents speak a singsong, high-pitched language to babies. Now researchers are going to the Hazda people in the Amazon (among other places worldwide), to see if it’s a global thing.
— PENCIL IT IN —
4:30 p.m. The Florida Coordinating Council for the Deaf and Hard of Hearing meets.
Zoom link here. Meeting ID: 85330805922; passcode: 650385. Or call (888) 585-9008; participant code: 828532954.
4:30 p.m. The Florida Coordinating Council for the Deaf and Hard of Hearing meets. Join the Zoom meeting here. Meeting ID: 84547167843; passcode: 557877. Or call (888) 585-9008; participant code: 828532954.
9 a.m. The Florida Coordinating Council for the Deaf and Hard of Hearing meets. Join the Zoom meeting here. Meeting ID: 84547167843; passcode: 557877. Or call (888) 585-9008; participant code: 828532954
9 a.m. The Board of Nursing Home Administrators meets. Agenda here.
10 a.m. The Commission on Mental Health and Substance Abuse is holding a writing workshop for the Criminal Justice Subcommittee and will discuss ways to better improve the effectiveness of current practices, procedures, and programs, in providing such services; identify any barriers or deficiencies in the delivery of such services; and recommend changes to existing laws, rules and policies per SB 96. Meeting link here.
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