DeFlorida Blueprint: DeSantis challenges medical establishment in shaping GOP health policy

Breccan F. Thies

May 09, 07:00 AM May 09, 07:24 AM

DeFlorida Blueprint is a five-part series examining the legislative and policy record of Gov. Ron DeSantis (R-FL). As the Florida legislature wraps up its 2023 session, DeSantis is widely expected to declare he is running for the Republican presidential nomination, putting him on a collision course with former President Donald Trump. The first part of this series examined his record on education. The second part, below, will look at DeSantis's healthcare policy.

In his four years in office, Gov. Ron DeSantis (R-FL) has set a new conservative playbook for healthcare, from his defiant response to the coronavirus pandemic to his care network to combat opioid addiction.

Beyond the headlines of his war on woke, DeSantis has racked up a policy record that will serve as the foundation for his national political ambitions and expected 2024 White House bid.

DESANTIS SIGNS BILL TO ALLOW PURCHASE OF PRESCRIPTION DRUGS OUTSIDE U.S.

“DeSantis is leading the way in showing Republicans how to advance conservative policy goals and protect Americans from bad private actors across the issue spectrum but especially as it pertains to healthcare policy," American Principles Project President Terry Schilling told the Washington Examiner. "The status quo Republican policy of neutrality has always been a failure against Democrats' aggressive social agenda — they build institutions and change society with their policies and legal changes, and Republicans never even remove or reverse the Democrats' changes."

Coronavirus

On healthcare, DeSantis is probably most lauded by conservatives for his response to the coronavirus pandemic, wherein he sharply criticized mask and vaccination mandates, lockdowns, and school closures that were being pursued in states across the country.

The governor became an early critic of former National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, saying last year that "someone needs to grab that little elf and chuck him across the Potomac."

In a veiled jab at former President Donald Trump last month, DeSantis criticized "leaders" who "subcontract out their leadership to health bureaucrats like Dr. Fauci."

DeSantis was later than most governors in imposing lockdowns on April 1, 2020, and started loosening restrictions after only 28 days. By Sept. 25, 2020, he lifted the sanctions, declaring in his executive order that Florida had "suffered economic harm."

Paragon Health Institute President Brian Blase told the Washington Examiner, "DeSantis's policies to target protective measures for the most vulnerable, avoid mandates, and keep schools and businesses open led Florida to have one of the best overall COVID responses in the country."

The "biomedical security state"

In January 2023, DeSantis launched the "Prescribe Freedom" initiative, which passed the Florida legislature, aimed at permanently ending mask and vaccine requirements and allowing "protecting medical freedom of speech" of physicians.

The bill allows doctors to "disagree with the preferred narrative of the medical community."

“As a health sciences researcher and physician, I have personally witnessed accomplished scientists receive threats due to their unorthodox positions,” Florida Surgeon General Joseph Ladapo said in support of the bill. “However, many of these positions have proven to be correct, as we’ve all seen over the past few years."

Dating to the very beginning of the virus, there was an "attempt to suppress real scientific debate and discussion," Robert Moffit, a senior research fellow at the Heritage Foundation's Center for Health and Welfare Policy, told the Washington Examiner.

"Science requires open debate and open discussion. You can't have anything less than that," he continued. "If you establish a party line, you're shutting down scientific inquiry," and that "exercise of raw political power ... undermines public safety."

Not all physicians agree with the move and believe DeSantis's national presence and potential run for president will "bring more prominence to this ideology," according to Johns Hopkins Bloomberg School of Public Health associate professor Dr. Rupali Limaye.

"This idea of — we are going to reject, essentially, anything that is science-based because that’s part of our identity," Limaye continued. "The government can’t tell us what’s true, what’s not true. We make our own decisions. We make our own truth."

Public Health Integrity Committee

DeSantis is pushing back even further on the coronavirus response, starting the Public Health Integrity Committee, overseen by Ladapo, to assess federal public health recommendations to decide whether Florida will follow them.

The move comes with the state filing a petition for a grand jury to "investigate crimes and wrongdoing committed against Floridians related to the COVID-19 vaccine," as well as an inquiry into "sudden deaths of individuals that received the COVID-19 vaccine."

Treatment for gender dysphoria in children

Under DeSantis, Florida has taken on the American Medical Association and American Academy of Pediatrics, which push the "gender-affirming care" model of responding to children presenting with gender dysphoria.

In 2022, Ladapo issued guidance stating social transitions — like allowing children to use different names, pronouns, and restrooms — and genital mutilation surgeries "should not be a treatment option for children."

The guidance also says children should not be prescribed drugs such as puberty blockers and hormone therapies.

Citing several studies, including medical determinations from Sweden, France, Finland, and the United Kingdom, the guidance says, "Encouraging mastectomy, ovariectomy, uterine extirpation, penile disablement, tracheal shave, the prescription of hormones which are out of line with the genetic make-up of the child, or puberty blockers, are all clinical practices which run an unacceptably high risk of doing harm."

Florida's legislature recently passed several bills related to the treatment of gender dysphoric children, which DeSantis is expected to sign.

One bill bans the use of puberty blockers, hormone therapies, and surgeries on children, allowing courts to remove children from homes that allow such treatment. Doctors who provide treatment will also have their medical licenses suspended and can be subjected to felony charges.

Another bill bans the required use of "preferred pronouns" or alternate names for children in schools, as well as banning the teaching of gender identity and sexual orientation until the ninth grade.

Similarly, a bill requires gender-exclusive restrooms and that students must use restrooms that align with their sex.

Dr. Stanley Goldfarb, chairman of the medical advocacy group Do No Harm, told the Washington Examiner that Ladapo's guidance "is a well-thought-out and evidence-based approach to this difficult and controversial critical topic."

Abortion and child care

Like many other Republican-led states, Florida restricted abortion after the overturn of Roe v. Wade.

Currently, Florida bans abortion at 15 weeks gestation, but in April, DeSantis signed a heartbeat bill that would ban the procedure at around six weeks. That bill is waiting for a state Supreme Court decision to take effect.

Florida has also prioritized things like child care, foster care, and maternal health to make it easier for women to bring their babies to term.

According to the Florida Health Department, the Sunshine State has invested over $308 million in maternal and child care over the past four years, telling the Washington Examiner the state is on track to meet its 2030 benchmark of lowering infant mortality to five deaths per 1,000 live births. Other achievements include 94% of babies receiving all immunizations by 24 months.

DeSantis's "Framework for Freedom" budget includes a permanent sales tax exemption for baby and toddler necessities, $96 million in foster care and child care, and $143 million in aid to pregnant and postpartum women.

Addiction and opioids

To combat opioid addiction and overdose, as well as enhance recovery efforts, Florida launched the Coordinated Opioid Recovery network, a partnership of addiction care centers and infrastructure in 12 Florida counties.

The initiative aims to stop the "revolving door of addiction and overdose" by bolstering recovery from emergency response to rehabilitation.

After responding to an overdose, the system would bypass other hospitals and send patients to a specialty center "similar to a trauma center" and pursue treatment through recovery.

The program focuses on treating other medical and mental health problems alongside addiction, as well as involving social services for job training, housing, and food assistance.

According to the Department of Health, since its August 2022 launch, the program has provided 100,000 services to patients, transported 5,000 overdoses to specialized care, stabilized 2,000 overdoses, and placed 98% of opioid use patients on medicated assisted treatment.

"We are giving Floridians the tools they need to break the substance abuse cycle," DeSantis said. "Substance abuse can affect any family at any time, so from education to law enforcement to treatment, we are going to make sure that Floridians can take advantage of this new addiction recovery model."

Prescription drug prices

DeSantis has made several moves to reduce prescription drug prices and regulate the pharmaceutical industry.

Last week, DeSantis signed a bill to regulate pharmacy benefit managers, the organizations that acquire medications from drug companies and distribute them to pharmacies.

The measure requires more transparency from PBMs, which bill authors say have been "allowed to operate virtually unchecked," and increases consumers' pharmacy choices. It also requires pharmaceutical companies to disclose when drug prices increase and why that is the case.

In 2020, Florida became the first state to submit a proposal to the Department of Health and Human Services to begin importing prescription drugs from Canada.

The program would allow Florida to import drugs from Canada, which are less beholden to market changes because the Canadian government controls pricing.

HHS stopped the implementation of the program, citing quality and safety standards of foreign countries. Pharmaceutical companies in the United States have successfully lobbied against foreign importation of drugs.

"They have unlawfully withheld and unreasonably delayed this program, and we think this violates federal law," DeSantis said when filing a lawsuit against HHS.

Medicaid

Florida is one of 10 states that has not adopted a Medicaid expansion through the Affordable Care Act that would have increased eligibility for people earning up to 138% of the poverty line.

As a member of Congress, DeSantis voted for one of the more extensive options to repeal the Affordable Care Act, initially voting against a softer undoing.

The pandemic saw Florida's Medicaid recipients increase from 3.8 million in March 2020 to 5.5 million. Because the "continuous coverage" benefit expired March 31, 2023, Florida is determining whether recipients still qualify — a process that can take a year.

DeSantis has pursued several changes to Medicaid, such as an expansion of the program's postpartum eligibility from 60 days to 1 year post-delivery to reduce maternal mortality rates.

The Agency for Health Care Administration also issued a rule prohibiting Medicaid reimbursements to providers for puberty blockers, hormone therapies, and transgender surgical procedures.

“There is a lot of great work being done to advance public health in Florida," Ladapo told the Washington Examiner. "Our accomplishments demonstrate the dedicated and tireless efforts of the Florida Department of Health’s staff and partners throughout the state.”

California looks to spend some Medicaid money on housing

March 26, 02:13 PM March 26, 02:18 PM

SACRAMENTO, Calif. (WHD) — At the start of 2022, Thomas Marshall weighed 311 pounds. He had been hospitalized 10 times in five years, including six surgeries. He had an open wound on his left leg that refused to heal — made worse by living in a dirty, moldy house with five other people, two ball pythons, four Chihuahuas and a cage full of rats.

More than a year later, Marshall has lost nearly 100 pounds. His wound has healed. His blood pressure has returned to normal levels. His foot, which had nerve damage, has improved to the point he goes on regular walks to the park.

Lots of factors are at play in Marshall’s dramatic turnaround, but the one he credits the most is finally having stable housing, after the nonprofit Sacramento Covered helped him get a one-bedroom, 500 square-foot (46.4-square-meter) apartment in a downtown high rise. He has hardwood floors, white pine cabinets and a glass jar on the counter filled with Bit-O-Honeys.

“To me it’s the most important 500 square feet I’ve ever had,” he said. “Living here has just improved my well-being in every possible way.”

Marshall’s story is part of a radical rethinking of the relationship between housing and health care in the U.S. For decades, Medicaid, the joint state and federal health insurance program for people with disabilities or low incomes, would only pay for medical expenses. But last year the Biden administration gave Arizona and Oregon permission to use Medicaid money for housing — a nod to reams of research showing people in stable housing are healthier.

Now California wants to join those states, building on the success of programs like the one that got Marshall housing. Gov. Gavin Newsom has proposed spending more than $100 million per year in the state’s Medicaid program to pay for up to six months of housing for people who are or risk becoming homeless; are coming out of prison or foster care; or are at risk for hospitalization or emergency room visits.

It would be the biggest test yet of using Medicaid money for housing. California has the nation’s largest Medicaid program, with more than 13 million patients — or about a third of the state’s population. California also has nearly a third of the nation’s homeless population, according to federal data.

“It’s a huge step toward breaking down the silos that have gotten in the way of taking care of the whole person rather than limb by limb and illness by illness,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

It would also be an expensive step. California is expected to have a $22.5 billion budget deficit this year, and it could get bigger in years to come. Meanwhile the state’s Medicaid spending is projected to increase by $2.5 billion over the next three years, according to the nonpartisan Legislative Analyst’s Office.

“What we’re really doing is expanding the welfare state, which is going to become just a huge financial problem,” said Wayne Winegarden, senior fellow at the Pacific Research Institute, a group that advocates for free-market policies.

California experimented with using Medicaid money for some housing-related expenses in 2016 when it launched a pilot project in 26 counties. While Medicaid did not pay for rent, it paid for things like security deposits and furniture.

In Marshall’s case, he pays his own rent, using some of the $1,153 per month he gets from Social Security and Supplemental Security Income. But Medicaid paid for his security deposit, bed, sofa, table, chairs and nearly 3 1/2 gallons of Pine Sol. Marshall said keeping his apartment clean is one thing that helped his leg wound to finally heal.

Over five years the program has reduced expensive hospital stays and emergency room visits for people on Medicaid, saving taxpayers an average of $383 per patient per year, according to an analysis by researchers at UCLA.

Now California wants to go further by using Medicaid money to directly pay some people’s rent. Democratic Assemblymember Joaquin Arambula, who chairs the budget subcommittee that will vet Newsom’s proposal, said lawmakers are supportive. Arambula spent a decade as an emergency room doctor.

“I became very good at being able to get cockroaches out of people’s ears,” Arambula said. “The living conditions of many of our communities, especially in our rural communities, really can affect a person’s ability to get adequate sleep, to be prepared for the next day and to stay healthy.”

Advocates for homeless people say they welcome such programs but spending more money on rent isn’t enough, noting the state still has a massive shortage of affordable housing.

Kelly Bennett, founder and CEO of Sacramento Covered, said that during California’s first experiment with using Medicaid money for housing services, it would often take up to eight months for workers to place a patient in an apartment. In some cases, people have waited for years to find a place.

“Even when you have the deposit money and you have some rental subsidy, it’s still very, very challenging to find units — and to find units where the landlords will lease to our clients,” Bennett said.

Marshall said he grew up in Sacramento and got a degree in dietic technology and culinary arts. But a 30-year addiction to meth landed him on the streets from the late 1990s through about 2006. He camped at an old landfill, often eating leftovers from people’s picnics at a nearby park.

He applied for apartments at multiple subsidized housing buildings, but never made it off the wait list. It took him about a year to get his current apartment, where he pays $186 per month with the help of a subsidy.

“I feel like I’m electric. ... I have power and ability to do things that I could not do for a very long time,” Marshall, 64, said. “Whatever years I’ve got left now, I’m going to spend them up here in the glass tower.”

Healthcare policy wins for both sides included in must-pass funding bill

Abigail Adcox

December 20, 02:26 PM December 20, 02:26 PM

Leaders in Congress have agreed on legislation that would stave off Medicare pay cuts for doctors, decrease federal spending on Medicaid, and extend pandemic telehealth flexibilities in their year-end spending bill as they near a Friday deadline to avert a government shutdown.

Democratic and Republican appropriators unveiled a draft of the $1.7 trillion omnibus spending bill overnight, which included a number of priorities for healthcare interest groups, though it excluded portions of a pandemic preparedness bill that would have set up a 9/11-style bipartisan commission to examine the COVID-19 response.

CHILDREN'S FEVER AND PAIN RELIEVING MEDS ARE IN SHORT SUPPLY— HERE'S WHY

Medicaid coverage: Lawmakers have reached a deal that will allow states to begin removing ineligible people from Medicaid starting April 1, 2023, decreasing federal spending on the program.

The agreement will begin to unwind a pandemic-era policy that required states to offer continuous coverage for Medicaid enrollees until the end of the COVID-19 public health emergency, which is currently expected to last through at least the end of April, in exchange for additional federal funding.

The deal is a win for Republicans who have pushed for phasing out the policy, arguing that it allowed people who exceeded income qualifications to remain enrolled.

Federal savings from the agreement will go toward two policies long sought by Democrats. Children on Medicaid will receive continuous Medicaid eligibility for a year, likely reducing potential lapses in coverage due to not meeting the eligibility requirements.

The bill will also permanently allow states to continue providing 12 months of postpartum care for women covered through Medicaid or the Children’s Health Insurance Program. Thirty-three states already opted to offer 12 months of continuous coverage during the postpartum period earlier this year. Democrats fell short, though, of their goal of requiring it for all states.

Lawmakers also decided to extend funding for the Children’s Health Insurance Program until 2029.

Medicare pay cuts: The spending bill will ease a scheduled 4.5% cut to the Medicare physician fee in 2023 and instead incrementally increase cuts over the next two years. Physicians will face a 2% pay cut in 2023, which will increase to 3.5% in 2024.

American Medical Association President Dr. Jack Resneck said the group was disappointed that Congress did not avoid pay cuts altogether, suggesting that it could lead some practices to stop taking new Medicare patients.

Telehealth flexibilities: Medicare telehealth flexibilities enacted during the pandemic will also be extended for two years as part of the spending bill. The deal will enable Medicare to continue to reimburse for telehealth services, which have grown popular throughout the pandemic.

Prior to the pandemic, Medicare only paid for telehealth care in limited circumstances and only then allowed video visits, not audio-only calls between a patient and provider. The flexibilities were first granted under the public health declaration and built on an extension that Congress approved earlier this year.

Pandemic preparedness: Portions of a pandemic preparedness package led by Senate health committee leaders Patty Murray (D-WA) and Richard Burr (R-NC) also made it into the omnibus.

The deal included a proposal that will require a Senate confirmation for the director of the Centers for Disease Control Prevention, a position currently held by Rochelle Walensky. It did not, however, establish an independent panel, similar to the one set up after 9/11, to examine the COVID-19 response, as some lawmakers had hoped for. It comes as several GOP leaders signal that they intend to hold hearings on the origins of the COVID-19 virus when they take back the House in the new year.

The omnibus also included $858 billion in defense-related spending, roughly a 10% hike from last fiscal year, along with aid for the war in Ukraine and a federal ban on TikTok for government devices, among other measures.

The Senate is expected to vote on the omnibus legislation as early as Tuesday afternoon.

South Dakota rejects ballot measure aimed at thwarting condition Medicaid enlargement

Kate Scanlon

June 07, 10:50 PM June 07, 11:00 PM

South Dakota primary voters rejected a ballot measure requiring any upcoming ballot initiatives that maximize taxes, or invest additional than $10 million in five many years, to move with the assist of at least 60% of voters. The measure was aimed at thwarting a proposal to develop Medicaid eligibility that voters will think about in November.

FETTERMAN Suggests HE'LL BE Back ON PENNSYLVANIA SENATE Campaign Path 'REALLY SOON'

Supporters of Constitutional Amendment C, dubbed the “Taxpayer Defense Modification,” argued the larger threshold to go such provisions would safeguard public money far more than the latest 50%-in addition-one particular the greater part needed. Opponents mentioned it would minimize the electrical power of voters in the condition to pass steps by ballot initiatives in the point out.

A potent bulk, much more than two-thirds of voters, rejected the ballot evaluate demanding a two-thirds vast majority for some long term endeavours. The state’s legislature needs a two-thirds bulk for any new taxes in order for them to be enacted.

The inclusion of Modification C on the key ballot was sparked by a travel to contain an amendment on November’s ballot to broaden federal Medicaid eligibility in the condition. The state’s important healthcare teams opposed Modification C in response. The pointed out the state’s hospital methods are amongst its biggest companies.

Fiscally conservative groups, which includes Us citizens for Prosperity, backed the work.

Voters will look at the Medicaid enlargement evaluate, Modification D, in November.