Our state’s sick healthcare system | Miami Herald

If a novel were written about Florida’s administration of its healthcare for the working poor, an appropriate title might be: “Don’t get sick, and God help you if you do.”

It could also be called “How to kill a hospital.”

Florida has tied the ultimate Gordian knot around its healthcare providers: refusing to accept the federal expansion of Medicaid, despite a 100-percent federal match for the first few years, meaning that the state’s estimated 3.8 million uninsured — that’s one in four Floridians under age 65 — have little hope of getting insured if they fall in the no-man’s land between the federal poverty line and a job with insurance.

And the hospitals that treat the indigent can thank the Legislature for ensuring that they will do so — presuming they can still afford to — at the risk of their solvency.

To add to the pressure on particularly large, urban hospitals, the Legislature passed a law that will essentially rob big-county hospital systems of part of their federal aid, and send the money north to the rural part of the state. Under that law, Miami-Dade hospitals will cede $218 million in Medicaid matching funds for its low-income treatment pools (including $140 million for just the Jackson Health System in Miami) and that money will be redistributed to the disproportionately powerful, smaller counties that can’t be bothered to fund their Medicaid programs with local tax dollars.

And now comes the unkindest cut of all: The state run by a former hospital executive whose company helped him get rich on the back of extravagant Medicare, Medicaid and Tricare fraud, has elected to limit Medicaid patients to six hospital visits a year, which is not only cruel, but also an illegal perversion of the program. The federal government has already begun levying the fines.

It’s a novel way to deal with the fact that the Legislature has held at arm’s length low-income Floridians like a cruel game of keep-away, the E.R. becomes the primary-care provider for an inordinate share of the working poor.

So rather than help those people get Medicaid via the federal expansion, or at least stopping the state’s serial obstruction of the navigators administering the federal exchange under the Affordable Care Act (the Legislature even stripped the insurance commissioner of the power to regulate insurance premiums) Florida’s uncompassionate conservatives decided to treat the potential hospital crisis as a demand-side problem.

As a result of this one-two-three punch, if you are poor in the Sunshine State, but you work a full-time job, or even two, but don’t get healthcare — and your employer, or employers — don’t pay you enough to afford to buy insurance on the federal exchange, you’re out of luck.

So if you’re a waitress, working a second job at the car wash or cleaning hotel rooms to make ends meet, but neither of your jobs, for which you stand on your feet all day and take the long bus ride home every night, pays you health insurance; and you don’t make quite enough money to qualify for the state-hobbled federal exchange; and because there’s no Medicaid expansion you can’t get insurance through Obamacare either — then the best advice to you is try really, really hard not to get sick.

Of course, if you get sick once, you can go to the emergency room. Under federal law, they have to treat you. In fact, you’re allowed to get really sick just five more times. God help you if your condition is chronic, because the seventh time, you’re just plain out of luck.

Because after six visits, your governor and your lawmakers say you simply aren’t entitled to more care. You’ve drained the well of their already thin gruel of compassion.

Maybe one of the Solantic clinics in Rick Scott’s “blind” trust will treat you, after they get done drug-testing the state employees in the waiting room next to you. And if you can’t afford their fee?

Well, I did say: Don’t get sick.