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News Tuesday, Oct 13 2015

Jeb Bush: "Repeal And Replace" — And Privatize Medicaid

Oct 13, 2015

Jeb Bush today committed himself to the tried-and-failed GOP promise to “repeal and replace” the Affordable Care Act. What would that look like? A reversal of the ACA’s expansion of quality, affordable health care access for millions of Americans. And an abandonment of those afflicted with pre-existing conditions who haven’t maintained continuous coverage, leaving them at the mercy of insurance companies.

Jeb throws around rhetoric about reversing the healthcare law to promote “choice,” “transparency,” and “affordability.” But there’s no substance to it. Jeb talks up his record in Florida, but there’s nothing to be proud of there, either. Bush has never had to go on Medicaid — but he did try to privatize it as governor. And Jeb’s callous dismissal of the program’s importance and efficacy this morning telegraphs that he’s back for more.

In 2005, Bush signed into law a troubled privatization pilot program that required Medicaid beneficiaries to get insurance through private providers. He used the same increased “choice” and “coverage” and “quality” rhetoric back then, too, but it didn’t work out that way. Florida saw:

  • A dramatic drop in some children’s access to dental care.
  • Increased barriers for patients’ access to their prescribed medications, with half of HMOs limiting drug benefits.
  • Nearly 25% of participating doctors depart the program by 2009.

Jeb also talked up his commitment to medical research this morning. But as governor, he vetoed hundreds of thousands of dollars of funding for medical research or health services — $500,000 for breast cancer research in 2004 alone. But then again, all this should come as no surprise coming from a guy who would prefer you to have no insurance at all rather than go on Medicaid.

Just get an Apple Watch, right?


2005: Bush Created Pilot Program To Privatize Medicaid


In 2005 Bush signed into law a pilot program that required Medicaid beneficiaries in two counties to start receiving benefits through private companies. The plan would require the state to pay the premiums of enrollees to private companies and then the private companies would provide managed health care to the beneficiaries. Bush claimed the changes would save money and increase consumer choice.


There were numerous problems under Bush’s plan.  In 2006, the number of poor kids getting dental care in the pilot area plummeted 40%, and by 2009, ¼ of participating doctors had left the program. A 2007 Georgetown University Study found that beneficiaries lacked easy access to medications, with half of participating HMO’s limiting drug benefits for Medicaid patients.


Bush Signed Law Requiring Medicaid Beneficiaries To Receive Benefits Through Private Companies


2005: Jeb Bush Signed Into Law Requiring Beneficiaries In Broward And Duval Counties To Get Their Health Benefits Through Private Companies Or Other Managed-Care Networks. According to Orlando Sentinel, “Some of South Florida’s poor, disabled and elderly will soon be in the national spotlight as part of an experiment at controlling the state and federal government’s skyrocketing health-care costs. Ambitious changes to the state’s Medicaid program that Gov. Jeb Bush signed into law Friday will require beneficiaries — starting with 200,000 people in Broward and Duval counties — to get their health benefits through private companies or other managed-care networks.” [Orlando Sentinel, 12/17/05]


2005: State-Approved “Provider Service Networks” Would Take Unprecedented Control Over What Health Care, And How Much Of It, Patients Receive. According to Orlando Sentinel, “State-approved ‘provider service networks’ will take unprecedented control over what health care, and how much of it, patients receive. The experiment is a model for other states plagued by increases in Medicaid costs, which at $16 billion a year in Florida consumes one-fourth of all state government spending. Nationally, Medicaid spending exceeds $300 billion a year.” [Orlando Sentinel, 12/17/05]


Plan Would Have State Pay Premiums To Private Companies Who Could Set Limits On Health Coverage.  According to the Associated Press, “Under the plan, which would need approval from Florida lawmakers and the federal government, the state would pay the premiums of Medicaid recipients for health care plans offered by private insurance companies and health maintenance organizations. Participating insurers or HMOs, rather than the government, would set limits on care and coverage. Providers would compete to serve Medicaid patients, saving money, Bush argues.” [Associated Press, 1/11/05]


Jeb Bush Called His Plan The “Single Biggest Change And Boldest Reform That Any State Has Ever Embarked Upon” In The 40-Year History Of Medicaid. According to Orlando Sentinel, “Bush called his plan, which lawmakers approved last week, the ‘single biggest change and boldest reform that any state has ever embarked upon’ in the 40-year history of Medicaid.” [Orlando Sentinel, 12/17/05]


Plan Led To Reduced Number Of Poor Kids Receiving Dental Care


2006: Number Of Poor Kids Getting Dental Care Plummeted 40 Percent In The First Year Of A Medicaid Pilot Project In Miami-Dade. According to the Miami Herald, “The number of poor kids getting dental care plummeted 40 percent in the first year of a Medicaid pilot project in Miami-Dade, according to a study released this month by the University of Florida. The program was intended to improve about 200,000 children’s access to dental care, reduce fraud and contain costs by moving them from standard fee-for-service to a health maintenance organization. The HMO is run by a Coral Gables firm, Atlantic Dental, and dentists are paid about $4.25 a month per child for all basic treatment.” [Miami Herald, 7/30/06]


  • Only 22 Percent Of Eligible Medicaid Kids Made A Trip To The Dentist And Fewer Dentists Took Part In The New Program.According to the Miami Herald, “But in its first year, only 22 percent of eligible Medicaid kids made a trip to the dentist, the report said, compared to 37 percent under the old fee-for-service program. The report also found fewer dentists took part in the new program, their dissatisfaction was high and the services they provided appeared to be worth less than what the state paid them.” [Miami Herald, 7/30/06]

By 2009 One Quarter Of Doctors Had Left Program


January 2009: A Quarter Of The Participating Doctors In The Medicaid Privatization Program Left The Program Over Payments And The Inability To Treat Patients As They Saw Fit. According to The Associated Press State & Local Wire, “A Medicaid privatization program former Gov. Jeb Bush touted as a national model for improving care while limiting state costs is foundering, with nearly a quarter of the participating doctors leaving over payments and the inability to treat patients as they see fit.” [The Associated Press State & Local Wire, 1/30/09]


May 2009: Bush’s Medicaid Reform Plan Included A $300 Million Penalty If Legislators Did Not Reorganize Medicaid Statewide Within Two Years. According to the Miami Herald, “State lawmakers learned this week that former Gov. Jeb Bush’s controversial Medicaid reform plan from 2005 includes a time bomb for hospitals: A $300 million penalty. That’s the amount Florida could lose in federal charity health care money if legislators don’t reorganize Medicaid statewide within two years.” [Miami Herald, 5/2/09]


July 2007: Study From Georgetown University Showed Problems With System.


Study Found That Beneficiaries Lacked Easy Access To Drugs. According to The Georgetown University Health Policy Institute, “Beneficiaries with disabilities who participated in the focus groups reported that access to drugs was perhaps the most serious problem they were having with their Medicaid reform pilot program plans. Some found their prescribed drugs were not covered, and others had to switch to alternative medications. Either scenario can have a negative impact on health outcomes.” [Georgetown University, July 2007]


Study Found That Half Of The HMO’s In THE Program Limited Drug Benefit.  According to The Georgetown University Health Policy Institute, “Seven out of 14 reform HMOs limit the number or dollar value of prescriptions that can be filled. Although these limits are high, those beneficiaries at risk of exceeding them normally have multiple health conditions that could worsen if they are denied the ability to get all their drugs.” [Georgetown University, July 2007]


“Virtually All” HMO’s Had Less Drug Choice That Medicaid In Rest Of State. According to The Georgetown University Health Policy Institute, “Virtually all reform HMO’s include fewer commonly prescribed drugs on their preferred drug lists than the existing Medicaid program does in the rest of the state. Preferred drug lists are used to encourage appropriate drug use and to reduce drug costs. The barriers created for obtaining drugs not on the list may be reasonable for those who can be safely switched to alternate medications, but for others – especially those with mental illness – the barriers can prevent access to the drugs that allow them to stay healthy.” [Georgetown University, July 2007]


October 2008: Study From Urban Institute Scholar Attacked Bush’s Medicaid Plan


Study Showed That One Third Of Benefit Recipients Were Not Aware They Were In Medicaid Reform And Three Quarters Of Those Enrollees Said They Had Not Received Notification From The State.  According to Health Affairs, “Yet about 30 percent of the enrollees across the overall Medicaid caseloads and the adult SSI caseloads in each of the counties were not aware that they were enrolled in Medicaid Reform (Exhibit 1⇓). Of those enrollees, 71–77 percent reported that they had not yet been told by the state that they needed to choose a plan under the waiver, which suggests that the enrollees either did not receive, did not read, or did not understand the letter from the state on the transition process for reform.”[ Health Affairs, October 2008]


Study Showed That Enrollees Were Not Made Aware Benefits Of Plans Or Resources Available. According to Health Affairs, “Roughly 30 percent of adult SSI enrollees and 20 percent of the overall caseload in both counties were not aware that they had a choice of health plans under the waiver. An even greater proportion did not understand that plans could vary benefits and benefit levels. This was particularly true among SSI enrollees, among whom more than 35 percent reported not knowing that such differences could exist. Also, more than half of the enrollees in all four groups were not aware of the availability of choice counseling to help with the plan selection process or of enhanced benefit accounts, and more than 60 percent were not aware of the opt-out option.”[Health Affairs, October 2008]


Tampa Tribune Used Study’s Results To Criticize Bush’s Program


Tampa Tribune Editorial: “Having Injected A New Level Of Bureaucracy And A Profit Motive Into The Health Care System, The State Cannot Show The Program Has Served Taxpayers Or Patients Very Well.”  According to an editorial in the Tampa Tribune,  “Having injected a new level of bureaucracy and a profit motive into the health care system, the state cannot show the program has served taxpayers or patients very well. Rather, the companies seem to have made money by saying no to doctors and limiting services to patients.”[Tampa Tribune, 10/27/08]


Tampa Tribune Editorial: Well care understated refunds due to state by $49 Million and federal authorities said there was evidence that they had tried to defraud state of $20 Million. “ According to the Tampa Tribune, “But companies like WellCare didn’t play fair. The company acknowledged last summer that it had understated the amount of refunds it owes state governments nationwide by $49 million. And earlier this month Federal authorities detailed what they call a scheme by the company to defraud Florida’s health agencies of more than $20 million.” [Tampa Tribune, 10/27/08]
Tampa Tribune Editorial: “In Essence, The Experiment At This Moment Seems To Be Failing. The Companies Appear Purely Profit Driven.” According to the Tampa Tribune, “In essence, the experiment at this moment seems to be failing. The companies appear purely profit driven. Then, in the midst of the economic slowdown that has cost Florida billions in tax revenues, the state cut Medicaid payments by five percent, guaranteeing lower revenues, a prospect the for-profit providers won’t abide..” [Tampa Tribune, 10/27/08]


Bush Vetoed Funding For Health Services And Research


2001: Jeb Bush Vetoed Funding For Family Planning Services Provided To Poor Women Through Planned Parenthood. According to the St. Petersburg Times, “Even the most powerful state lawmakers were hit by Gov. Jeb Bush’s vetoes on Friday. The Republican governor vetoed $ 290-million in the state budget that lawmakers passed this spring, including more than $ 25-million for projects in two counties – Manatee and Sarasota – represented by Senate President John McKay. […] The cuts also included $ 302,843 for family planning services provided to poor women through local Planned Parenthood affiliates, money that had been provided each year for more than a decade. The share earmarked for Planned Parenthood of Southwest and Central Florida, which includes the Tampa Bay area, was $ 125,800 for services for 1,258 women. The other regional affiliates affected by the cuts are based in Jacksonville and Naples. ‘Many of our patients have no health insurance nor are eligible for Medicaid. They absolutely depend on clinics like ours,’ said Barbara A. Zdravecky, president and CEO of Planned Parenthood of Southwest and Central Florida.” [St. Petersburg Times, 6/16/01]


2004: Jeb Bush Vetoed $500,000 For Breast Cancer Research At The University Of Miami. According to the Miami Herald, “Here are some of the largest cuts Gov. Jeb Bushmade Friday from the state budget: […] University of Miami, $500,000 breast cancer research” [Miami Herald, 5/29/04]


2005: Jeb Bush Vetoed $30,000 For A Cervical Cancer Task Force. According to the Ledger, “Rep. Anne Gannon, D-Delray Beach, sharply criticized Bush’s veto of $ 30,000 to fund a cervical cancer task force that was created by lawmakers last year but never funded. ‘The governor is greatly detached from the health issues that face women, and this veto clearly shows his disconnect,’ she said. But Bush said he was also a little more lenient on his vetocriteria for some areas, including communities that were hit hard by last year’s hurricanes and rural communities that have a limited ability to raise their own revenue.” [Ledger, 5/27/05]


2006: Jeb Bush Vetoed $43,000 For A Breast Health Initiative For Teens. According to the Florida Times-Union, “Here are some of Northeast Florida projects among Gov. Jeb Bush’s $448.7 million in vetoes announcedThursday: […] — Breast health initiative for teens, $43,000” [Florida Times-Union, 5/26/06]


2006: Jeb Bush Vetoed $75,000 For The Florida Cancer Control Research Advisory Council To Develop Cervical Cancer Priorities. In a veto message, Jeb Bush wrote, “Specific Appropriation 538 Pages 105 and 106 – A portion of proviso language […] FloridaCancer Control Research Advisory Council (C-CRAB) to Develop Cervical Cancer Priorities – Statewide…….. 75,000” [Jeb Bush 2006 Veto Message, 5/25/06]

Published: Oct 13, 2015

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