Republican Charlie Crist would continue Gov. Jeb Bush's shift from government simply paying the health care bills of Medicaid recipients to placing them in managed-care insurance programs. Democrat Jim Davis, a Tampa congressman, is at least partly opposed, saying that shifting all Medicaid patients involuntarily into private plans tries to "balance the Medicaid budget on the backs of people who depend on the state's health insurance program to stay out of hospitals."
Crist, Davis differ on Medicaid overhaul
DAVID ROYSE
Associated Press
TALLAHASSEE, Fla. - Medicaid has been obscured by homeowners' insurance, taxes and prescription costs, but the future of the program that provides health care to the state's poor, disabled and many elderly may depend on who wins Tuesday's gubernatorial election.
Republican Charlie Crist would continue Gov. Jeb Bush's shift from government simply paying the health care bills of Medicaid recipients to placing them in managed-care insurance programs.
Democrat Jim Davis, a Tampa congressman, is at least partly opposed, saying that shifting all Medicaid patients involuntarily into private plans tries to "balance the Medicaid budget on the backs of people who depend on the state's health insurance program to stay out of hospitals."
Florida's Medicaid program will cost about $16 billion this year - about $1 out of every $5 the state spends. Only education costs more.
Traditionally, Medicaid recipients - mostly the disabled and women with children who are close to the poverty line - have gone to see a participating health care provider, who then seeks reimbursement from the government. The program's costs are split between the state and the federal government.
In 2004, Bush proposed that the state place recipients in private health plans. The plans would have the ability to limit some benefits, such as which medicines may be purchased, and add others, like care for patients with HIV/AIDS or extensive prenatal care.
The idea was to force Medicaid recipients and their doctors to take some responsibility for their own care, which should lead to better health and save the state money, too.
But some advocates have worried it could lead to the most vulnerable patients not being guaranteed the options they currently have.
The shift has already started through test programs in the Jacksonville and Fort Lauderdale areas.
Crist, the state's attorney general, hasn't been a huge cheerleader for the Medicaid overhaul, but supports it.
"I certainly think the pilot's worth a try," Crist said. "Any way that we can spread those dollars and therefore be able to offer health care to more of the poor in our state I think is worthy.
"I think we're all aware how much Medicaid takes up of our state budget currently, and if we don't do something to strive to get a handle on it we're not going to be able to continue to provide the kind of health care that the poor deserve," Crist said.
Those who are skeptical of the changes say they are concerned the issue has been relegated to the campaign's periphery.
Neither candidate talks much about it on the campaign trail, focusing their health care discussions instead on prescription drug costs, and the question of importing medicine from Canada.
Bob Wychulis, president of the Florida Association of Health Plans, said his sense is that while the two candidates may differ on the details, neither is against allowing a managed care approach for at least some Medicaid patients.
Almost 1 million Florida Medicaid patients - about half of the total - have already gone into voluntary managed care programs over the last decade, and few of those have returned to more traditional programs, Wychulis said.
"Member satisfaction rates have been high in all the managed-care plans," he said.
Advocates for the elderly are worried about the planned next phase of the Medicaid overhaul, which will shift more nursing home care into managed care plans as well.
Nearly 50,000 of the 75,000 Florida nursing home residents have that care paid for by Medicaid. Under the proposed "Florida Senior Care" plan, nursing home patients could be shifted into HMOs, which would manage their nursing home care.
One group that has concerns is the massive senior lobby, AARP, although like other nonprofits it can't endorse candidates.
AARP argues that managed care may be fine for some nursing home patients, but shouldn't be mandatory.
"Consumers want the opportunity to make their own decisions about long-term services and supports so they can maintain their dignity and maximize their independence," the group said in a recent issue paper.
AARP spokesman Dave Bruns said many managed-care plans wouldn't likely let seniors pick their own long-term care facility.
"Our biggest concern is freedom of choice," Bruns said.
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