Make Medicaid part of Florida’s health care fix
.......................................... Rick Christie ..................................... Tony Doris
THE PALM BEACH POST EDITORIAL BOARD mission is to articulate the issues of the day, advocate for policies for the betterment of the community and encourage a civil and robust exchange of ideas. The Board consists of Executive Editor Rick Christie, Editorial Page Editor Tony Doris and Editorial Writer Douglas C. Lyons.
Qualified kudos to Florida Senate President Kathleen Passidomo. At least she’s addressing problems facing the nation’s fastest growing state, unlike other elected officials who seem content with waging counterproductive culture war campaigns. As she laid out in her Nov. 9 Live Healthy memo, Florida will need more maternity wards, nurses, physicians and health services for the elderly.
“It is clear to me that we have work to do to make sure Florida’s healthcare workforce is growing — just like the rest of our state,” Passidomo correctly stated.
Florida has more than 21 million residents, with 800 new arrivals daily, and has long been home to one of the country’s oldest populations. That alone should be ample justification for state leaders to make access to health care a priority. We’d be remiss, however, if we didn’t suggest a change that would provide huge benefits — Medicaid expansion.
Yeah, yeah we know. Florida had its chances but remains one of only 10 states that hasn’t expanded Medicaid. Former Gov. Rick Scott and many Republicans in the Florida Legislature say expansion is too big a move with an already overspending federal government. So yes, the ship on Medicaid expansion in Florida might have sailed but Passidomo would be wise to reconsider, given the program’s many benefits to the other 40 states.
The infusion of federal funds on Florida’s healthcare infrastructure is a compelling reason to reconsider. Medicaid expansion requires the federal government pay 90% of the cost in covering newly insured individuals. The state pays 10%. The 2021 American Rescue Plan provides more incentives — another 5% match of federal funds for two years if the remaining holdout states adopt the expansion. Currently, the federal government only pays 60% of the program’s costs with Florida paying 40%. Expansion would help 1.5 million more Floridians gain access to healthcare and would give the state resources to provide it.
Medicaid expansion has helped hospitals, particularly rural ones, that used to dip into their resources to cover healthcare for the uninsured. They’ve seen reductions in uncompensated care costs of 45%, according to the Center on Budget and Policy Priorities. The reduction in non-expansion states isn’t as good — only 2%.
Other expansion benefits: More low-income adults visit their doctors; premature deaths among older adults are down. States have also seen reductions in the number of low-income adults struggling to pay their medical bills, a statistic that reflects a solid boost for state economies.
Passidomo prescription questionable
Passidomo has a clear grasp of the state’s healthcare problems: Florida’s rural areas need more healthcare providers. Emergency rooms in the state’s urban areas are often overutilized because of the difficulty in securing an appointment with a physician for routine checkups.
The data on physicians and nurses isn’t all that encouraging either. The supply of healthcare professionals isn’t keeping up with the state’s growth. According to Passidomo’s memo, estimates indicate a potential shortfall of nearly 18,000 physicians by 2035. State licensure data show the average age of the 58,062 full-time physicians actively practicing here is 53; one-third of them are over 60. It’s a similar story with nurses. By 2035, the state will have a shortfall of 37,400 registered nurses and 21,740 licensed practical nurses.
Passidomo believes technology and the free-market principles of the private sector are the remedies that will restore healthcare in Florida. She’s already marshalled the members of the Florida Senate to hold hearings and craft legislation with the idea of improving patient outcomes, increasing efficiency and expanding access to health and medical care.
“Access to healthcare is important at every phase of life,” Passidomo asserts in her Live Healthy memo. “Insurance, including Medicaid and Medicare, does not guarantee access. Even Floridians with great insurance face barriers to care.”
Point taken about the barriers, which is the gist of our concerns. But she misses the big point: Efficiency, technology and private sector principles have their limits if the money isn’t there. The Florida Senate might produce a robust bill but its efforts would go much farther if state leaders re-evaluated how Medicaid expansion would help Florida and then became the 41st state to adopt it.
Trump makes ‘vermin’ look good
“Vermin,” as spewed from the mouth of a multi-indicted loser ex-president, taken from the Hitler-Goebbels playbook. So who are the vermin; are they Italians, Greeks, Mexicans, Jews, Haitians, Guatemalans, Asians, Blacks, Arabs, Europeans? Or are they Catholics, Buddhists, Muslims, Hebrews, Protestants and their many sects, but surely not the evangelicals, who find favor in him. All the huddled masses looking for a better life. The only description I see for vermin is a red MAGA hat sprouting orange hair and sitting atop a head devoid of decency.
Ira Phillips, Lake Worth
US must reject Trump and Trumpism
Trump is as destructive to this union and the world order as was the German demagogue of the 1930s. The American voters cannot allow a repeat of that immoral abdication of civic responsibility be repeated in this century, in this country. Trump is panicked of being legally restrained on any of the pending 91 counts of alleged illegality, thus his unchecked verbal assaults on the courts. His mental incompetency and egomania makes him unqualified to reside untethered in any position of authority. It’s up to the courts and the voters.
Harriet Pashman, Jupiter
DeSantis short-shrifts taxpayers
Does Gov. DeSantis not understand the old saying “Don’t cut off your nose to spite your face?” The Post’s Nov. 13 headline read “Florida passed on $400M in solar power grants that could have helped trim bills.” The grants are intended to help lower energy costs for families,
Nov. 15 marked two years since President Joe Biden signed the bipartisan infrastructure law — the Infrastructure Investment and Jobs Act. Today we can say confidently that:
It was a landmark achievement. At $1.2 trillion, it is, by far, the biggest investment in U.S. infrastructure since President Dwight Eisenhower’s interstate highway system — one of the few programs where execution followed promptly, with ongoing projects across all 50 states, both red and blue. It has helped unemployment reach its lowest level in the past 30 years and benefitted low-income communities, with increased access to broadband and safe water. Better health and access to education means greater productivity and higher economic growth.
It is not nearly enough. Although $1.2 trillion is a major investment — and the president brought more funding to bear through the Inflation Reduction Act and the CHIPs and Science Act — the American Society of Civil Engineers estimated in 2021 that U.S. infrastructure spending was $2.59 trillion short over a 10-year period.
It almost certainly will never be repeated. Worsening political polarization makes it unlikely that the federal government will agree in the near term to anything close to the IIJA’s level of funding.
What’s more, the world has changed dramatically since 2021, and not for the better:
The pace of climate change has accelerated well beyond what was expected two years ago. While the Inflation Reduction Act is designed to help in the energy transition, we face massive weather events as we know well in South Florida, which means more investment in climate-resilient infrastructure than anticipated.
Onshoring of semiconductor manufacturing — a response to national security concerns and to the fragility of the global supply chain — has surged. This is a major focus of the CHIPs and Science Act. But national security concerns require significant investments in technology
hhhcreate jobs and help reduce greenhouse effects that accelerate global climate change by providing financial support and incentives to communities that were previously locked out of investments. What could be wrong with that?
The grants were part of Biden’s Inflation Reduction Act and that seems to be a problem for DeSantis. He pledged to unravel Biden’s green energy agenda if elected president. For DeSantis, turning down the $400 million is more of a political statement than good governing. When a private individual wants to give up money for principle that is not my problem. I do have a problem when it’s my elected official that is supposed to be representing my interests as a taxpayer. It’s my money he’s turning away.
Michael Kalisz, North Palm Beach
Voters will make the call in 2024
I can’t believe what I heard a few weeks ago: Trump stating that if loses Iowa, that the election would be rigged. I wonder what he will do if he loses to President Biden? I’m also getting sick of all the networks talking about all these crazy polls. We have seen over the last four years that polls mean absolutely nothing, and it’s shameful that they continue to act so surprised when they say Trump is leading Biden. Let’s give the American people credit when they go to the voting booth. We do the right thing.
Ed Pelka, Palm Beach Gardens
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These factors will require the administration to move into a new phase — Infrastructure 2.0. To make this happen, policy changes are needed, as well as a shift in outlook. It’s necessary to break the ingrained habit — which dates back to Franklin Roosevelt’s New Deal — that infrastructure investment is solely the government’s job. We must consider a number of mechanisms, among them:
Widening user fees. The federal gasoline tax has not been increased since 1993.
Creating a U.S. infrastructure bank to bring together both private and public funding and deploy it to public projects. At sufficient scale, with $100 billion in equity capital and a $1 trillion balance sheet, the bank could galvanize private markets, remove infrastructure funding from the vagaries of the political cycle, help investors locate promising projects and provide expertise to state and municipal governments.
Facilitating investment by U.S. public pension funds. The teachers, healthcare workers and first responders enrolled in these funds would be proud to invest in U.S. infrastructure, as long as the investment provides reasonable returns. States need to encourage public pension funds to invest in traditional infrastructure through public-private partnerships.
Encouraging foreign capital to invest in our infrastructure by removing impediments such as the Foreign Investment in Real Property Tax Act — which was intended for real estate investment but is a barrier to infrastructure funding.
None of these steps will be easy. But political and economic realities and the urgent need to maintain and enhance U.S. competitiveness argue for a determined effort to move in this direction.
Sadek Wahba is chairman of I Squared Capital, based in Miami. He is the author of the forthcoming book “Build: Investing in America’s Infrastructure” and is a member of the President’s National Infrastructure Advisory Council (NIAC). This opinion piece was distributed by The Invading Sea website (www.theinvadingsea.com). The site posts news and commentary on climate change and other environmental issues affecting Florida. (Kevin Wagner’s Civics Project column will return to this space next week.)
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