Franklin County’s legislative delegation split down the middle when it came to supporting Gov. Rick Scott’s plan to go along with expanding Medicaid coverage to cover about 1 million more poor people in Florida.
At the annual legislative delegation meeting Feb. 26 in Apalachicola, State Sen. Bill Montford (D-Tallahassee) voiced cautious support, while State. Rep. Halsey Beshears (R-Monticello) was adamantly opposed.
Scott, a Republican who bitterly fought President Barack Obama's national healthcare plan as a candidate and in his first two years as governor, reversed course last month and voiced support for a three-year expansion of Medicaid, provided the federal government picked up the full cost for the first three years as promised.
“I think the governor is on the right track,” said Montford. “It is the law of the land. The concern I have is what happens three or four years from now when the fed government stops funding.
“You have to play with the cards that you’ve been dealt,” he said. “The best choice at this point is to move forward with expansion as it is and try to make sure we’re protected.”
Beshears spoke out in opposition to the Medicaid expansion. “The governor is elected to uphold the law,” he said. “Whether I agree with it or not doesn’t mean have to like it.
“The governor’s proposal was a proposal,” said Beshears. “I know the Speaker of the House (Will Weatherford) and Senate President (Don Gaetz) are studying this very hard. We’re faced with a very, very tough decision, I think in three years we’re going to be left holding the bag.”
Montford conceded the issue was a complicated one, particularly since Medicaid reimbursements are so low that many doctors find it does not pay them to see patients.
“Some tell me they would be better financially if they would give Medicaid patients a check and say go find another doctor,” said Montford. “General practitioners don’t make nearly what they used to make.”
The expansion has been fully backed by Florida's publicly owned hospitals. In the case of Weems Memorial Hospital, Medicaid patients make up about 6 percent of the patient base, but account for about 15 percent of collected revenue, according to Steve Lanier, the hospital’s chief finance officer.
“That’s been very consistent for the last few years but that doesn’t mean that everybody in the county who is eligible is on Medicaid,” he said. “Some won’t sign up for it.”
About half the hospital’s patients lack health insurance, and this patient load ultimately provides only about 5 percent of the hospital’s collected revenue, Lanier said.
Whether the hospital’s financial picture would improve by having more of these self-pay patients covered by Medicaid remains to be seen. A decision made March 11 by a select committee of the Florida Senate to reject the Medicaid expansion plan was widely seen as putting a difficult stumbling block in the plan’s way.
Beshears listened quietly throughout the legislative delegation hearing, with Montford offering most all the responses.
Clerk of Courts Marcia Johnson opened with an apology for having to leave early to attend her dad’s 84th birthday party. She offered a list of proposals, mainly regarding state funding for clerks’ functions.
County Commission Chair Cheryl Sanders offered a warm welcome. “This a real treat to see you all two times in one week,” she said. “That’s good, getting down to the roots of things.”
Sanders asked that the legislators be wary of unfunded mandates, and to work to preserve funding for the health departments, road projects and other infrastructure help.
“County pocketbooks are getting kind of slim. It’s going to get tighter, the economy’s not good,” she said. “You get them lobbyists up there but you know it’s special and dear to the peoples’ heart if you have a county commissioner. We all are closest to the people and you all are closest to us.”
Sanders, as well as Apalachicola Mayor Pro Tem Frank Cook and Carrabelle Commissioner Brenda LaPaz, all spoke in favor of preserving the work camps on either end of the county. There has been discussion, although no confirmation, of closing Bay City in Apalachicola, and no date has yet been announced on the opening for the Franklin Correctional Institution’s recently completed work camp in Carrabelle.
“We have a work camp that’s here that is to be closed as it’s talked right now,” said Cook. “We are concerned for two reasons - we depend heavily on the work force itself, to be able to do a lot of work that keeps our city in the condition that it’s in. That’s a very big part of us being able to do that.
“The second part of that is when camp was built and we built our sewer system, it was built to support the work camp,” he said. “If we lose the work camp we lose the income to support that sewer system.”
LaPaz appealed for support for opening FCI’s work camp, noting the value it has to the city’s recently expanded sewer system and to the number of jobs it would provide to the county.
Montford recalled the history of placing correctional institutions in the Panhandle, which welcomed them.
“North Florida stepped up and made the decision,” he said. “This was a good economic development issue, it turned out wonderfully well. There was some donated land to help build these facilities and the inmates would work in your community, a good deal for everybody.
“They’ve really worked real well, the money they bring is good,” Montford said. “When we start pulling back on those, we’re not living up to our side of the deal.”