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Nancy Smith

LIP: Chalk One Up for the Scott Team

May 21, 2015 - 6:00pm
I Beg to Differ
I Beg to Differ

Still think Rick Scott doesn't know what he's doing?

Somewhere south of Winterfell, in Florida's ever-engrossing Game of Groans -- Scotties vs. Feds -- the Feds blinked first.

The Scott team won a big one this week.

Does anybody really believe that without the Scotties' lawsuit bluster, without the governor's health-care-commission showmanship and his trip to Washington and his ideological kinship with the House speaker, the Feds would be proposing $1 billion for LIP next year?


No way. Clearly, they intended to kill LIP here and now. Months ago, and several times since, theObama administration told the state the funding for hospitals to serve low-income people would end this year.

But the Feds had "a Florida problem." The governor's involvement was increasing, other balky states were drinking from Scott's glass of courage, and they had to make Florida go away.

AsWashington political consultant A. Ferris Guiletti told Beltway reporters last week, "While the media follow the White House's lead that Rick Scott is blowing it for Florida over LIP and Medicaid expansion, other red states, particularly those dominated by Republican leadership, aren't buying. They're making a kind of political folk hero of this man in Tallahassee. Behind the scenes on the administration side, there's a lot of hand-wringing and angst going on over Scott."

Bottom line, in Florida, instead of ending LIP as they had threatened, the Feds (CMS) proposed a 55 percent cut to the program next year, from $2.16 billion in combined state and federal funding this year to $1 billion, and then another cut, to $600 million, the following year.

Fifty-five percent is a major bite. But the Legislature can and will work with it, finding money elsewhere in a $1 billion surplus budget to reimburse hospitals -- at least for this year. The heavy lift is done.

Mark my words: There will be no vote in the Florida Legislature for Medicaid expansion in 2015.

Repeat, no Medicaid expansion this year.

During the last weeks of April, Speaker Steve Crisafulli, Appropriations Chair Richard Corcoran and the rest of the House team were already playing the game with only LIP as the prize. They had no intention then, have no intention now, of entertaining Medicaid expansion.

"The one thing that will not be compromised in the House is, we will not do Medicaid expansion," Corcoran continues to assure a mostly hostile press. "Thats the only line in the sand weve drawn."

The more moderate Senate, on the other hand, is still bent on crafting a watered-down version of Medicaid expansion. A broad coalition of liberal organizations, health care advocates and providers, and GOP-aligned business groups are rallying around the Senate effort.

But here's the rub. The clock is the Senate's enemy. The Florida Constitution requires a balanced budget, completed and signed by July 1. The budget is dependent on an LIP solution, no longer a Medicaid expansion solution.

Rick Scott played a blinder.

Oh, yes, and don't think for a minute Scott is leaving the table. He has at least one more hand and it's his deal. The real Game of Groans comes later for the Florida hospital industry, whose certificates of need (CON) were included in the special session call.

Certificates of need, remember, are like mother's milk to hospitals -- but to competitors,a clunky, free-market-unfriendly regulatory scheme meant to cap medical facilities and services. I'm thinking now might be a time when Scott trots out the story of how Texas eliminated them.

Here's a tip for June 1-20, hospital industry. Think full, raging retreat. And while you're at it, chip in on a ticket to send your leader and lobbyist Bruce Rueben on a long vacation, say, to a remote island in the South Pacific.

Florida can take another year to fully replace LIP. Certainly lawmakers will have to do something. But for now, Rick Scott's actions -- and the House leadership's dogged commitment -- are yet another example of how, five years after Obamacares passage, significant parts of the country refuse to go along with it.

Reach Nancy Smith at or at 228-282-2423. Twitter: @NancyLBSmith

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