Tallahassee is not Teheran

Tallahassee is not Teheran: We need a real Governor and not a spiritual (mis)leader Attached a link to John Dorschner's excellent front page article in today's Miami Herald titled “Gov. Rick Scott may shift stance on health reform law” reporting that Florida Governor Rick Scott may be open to discuss the (partial) implementation of the Patient Protection and Affordable Care Act (PPACA). The article correctly points out three important milestones which need to be achieved in order to move ahead with the healthcare law implementation: 1) The statutory deadline for submitting Florida’s blueprint for a new health insurance exchange is November 16. Unfortunately, the stubborn refusal of our political leaders in Tallahassee to even consider the creation of a healthcare exchange will force the federal government to step in to set up such an exchange. 2) According to the final PPACA rule Medicaid payments to primary care physicians will be increased to reach Medicare levels. The final rule requires state governments to take further action prior to 2013 to implement this provision. States, including Florida, will receive an estimated $11 billion in new funds over 2013 and 2014 to bolster their Medicaid primary care delivery systems. More than six in 10 (64 percent) family physicians accept new Medicaid patients, and these beneficiaries comprise 15 percent of the average family physician’s patient panel. Governor Scott has refused to accept additional Medicaid funding to increase the pay for primary care physicians. As a result of the increasingly inadequate Medicaid payments nearly two in 10 family physicians have stopped accepting new Medicaid patients. 3) On Jan. 1, 2014, a major expansion of people covered by Medicaid will go into effect. If Governor Scott decides not to expand Medicaid coverage, Florida will lose $27.9 billion in federal funds over 10 years. That breaks down to a $4.5 billion loss for Miami-Dade during that time, and a $2.3 billion loss for Broward. Under the law, Washington will pay all Medicaid expansion costs for the first three years, but then the states would have to pay up to 10 percent of the costs in following years which will amount to approximately $1.7 billion over 10 years in Florida. The expansion could provide coverage to an additional million-plus Floridians. Florida's political leadership has so far stubbornly refused to participate in or prepare for ANY of the above mentioned changes. Subsequently, billions of federal funds will be appropriated to those states who do participate. Our political leaders should be aware about the adverse consequences of their stubborn refusal to implement this federal law. Florida having the third-highest rate of uninsured residents in the country stands to benefit more than most states from the Medicaid expansion intended to increase preventive care and to reduce unnecessary emergency room visits. Health experts warn that not expanding Medicaid could cost Floridians, because many of the state's 3.8 million uninsured residents will continue to receive care they can't pay for in hospital ERs. Those costs ultimately are passed down in the form of higher insurance premiums for everyone else and will further strain the existing Medicaid budget. Often hospitals end up absorbing large amounts of uncompensated, or "charity" care, which experts say affects Floridians in several ways. To recoup those costs, hospitals either reduce services or charge higher rates to insurance companies, or both. Those costs are often passed down to businesses as a “hidden tax” adding to the insurance costs for their employees. Furthermore, health providers have long complained that Medicaid reimbursements are so low they don't cover the costs of care. And because of low reimbursements, fewer physicians in the state actually accept new Medicaid patients. The increase in Medicaid reimbursement by almost 7 % for primary care physicians will allow family doctors, pediatricians and internists to accept new Medicaid patients and to offer urgently needed preventive medical care. I am convinced that Governor Scott knows all of the above mentioned facts but he still refuses to act. In my opinion this represents an egregious case of political malpractice ! Why is this being overlooked? Maybe, Republican leaders consider Tallahassee as their spiritual Mecca and are sacrificing the health of our citizens on the altar of ideological correctness and purity. But Tallahassee is not Teheran and we definitely do not need a supreme leader to decide our personal fate. Governor Scott should recognize that he is not the Governor of the Republicans of Florida but the Governor of the State of Florida. If he is incapable or unwilling to fulfill his constitutional obligation to implement a federal law then he should step down! Its time to man up Governor or to hit the road! Bernd Wollschlaeger,MD,FAAFP,FASAM