NCPA - National Center for Policy Analysis


February 18, 2008

Former Florida Gov. Jeb Bush led the most ambitious and significant reform to Medicaid in the country.  Since he completed his term one year ago, bureaucracy and special interests are strangling it, says James Frogue, director of the Medicaid Transformation Project at former Speaker of the House Newt Gingrich's Center for Health Transformation.

Bush's vision for a new Medicaid would have allowed all people on Medicaid to choose from competing private plans.

People who engaged in preventive screenings, necessary checkups and prescribed treatment regimens could earn credits to cover the cost of other health care services.  They would be healthier and richer.  The old Medicaid system had been a failure in both health outcomes and cost:

  • Only half of the children got well-child checkups, 16 percent received preventive dental screenings and a mere 4 percent of women got mammograms.
  • Old Medicaid also was on a path to gobble up over 50 percent of Florida's budget by 2015, up from 10 percent in 1995 and 25 percent in 2005.

People began enrolling in new Medicaid in the summer of 2006:

  • Each beneficiary would get a risk-adjusted monthly sum based on claims history and an initial health screening.
  • People with multiple chronic conditions would get more money than a healthy young person. Patients could then shop for plans with help from unbiased counselors.
  • Today, there are over 200,000 people enrolled in 16 private sector plans in Broward County, seven in Duval, and two each in Clay, Nassau, and Baker counties.

Unfortunately, officials in Florida's new administration have announced that they will not be recommending expansion of the pilot and have not indicated any plan to meet the statutory requirement to expand statewide by 2011, says Frogue.  The consequences may be that the great strides made during Bush's tenure will disappear, along with the promise of better health at lower cost.

Source: Editorial, "Florida Medicaid reform under siege," Florida Times-Union, February 6, 2008.

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