A speech Don Gaetz gave gave at the Jacksonville University Public Policy Institute's Health Care Policy Conference on Obamacare
"After six years as a member of the Senate committee with jurisdiction over the health care budget and one year as President of the Senate with shared jurisdiction over the entire budget of Florida, I've learned that there is one rule with no exceptions.
That rule is health care will always cost more next year than it costs this year.
The number of hospital admissions may go up or down, the acuity of illnesses may vary from year to year or place to place, coverage may expand or shrink, fee for service may give way to managed care, but costs will always go up.
Florida's Medicaid program cost taxpayers $14 billion in 2004 and $23 billion this year. Up by two-thirds in 10 years.
Ten years ago Medicaid consumed 24 percent of the state budget, $14.4 billion. This year, Medicaid will take over $23 billion or more than 31 percent of a far larger budget.
Today there are 162 percent as many Floridians dependent on Medicaid as in 2004.
Medicaid is growing faster than revenues, faster than the economy on which it feeds, crowding out the state's critical needs, consuming its host. Medicaid is metastatic.
In every three chair barbershop, every or large retailer or mfg, this University, if you're a buyer of health care, public or private, you can count on this: it will never cost you less, it will always cost you more.
So the question is whether the negotiations are between Speaker Will Weatherford and President Don Gaetz or between management and unions or between husband and wife at the kitchen table.
The question is where will we take the money from? More for Medicaid in the state budget, then less for education.
More for health benefits at the company where you work, then less for pay increases.
More for health insurance premiums out of your family's income, then less for housing.
And the squeeze is tightening as increases in health care costs outpace the growth of state revenues, company profits and family income.
That is the context of the decision Florida faces as President Obama and even Governor Scott are urging the Legislature to expand Obamacare until one out of every four Floridians is dependent on Medicaid. Until every three of you are paying for your own increasing health care costs plus paying for a fourth person covered under Medicaid expansion or, more accurately, Obamacare expansion.
Here is the decision that faced Speaker Weatherford and I and our 119 House colleagues and 39 fellow senators last year and it will face us this year, as well:
The federal government is asking Florida to trust Washington to pay the costs in the beginning if Florida will commit itself to paying an increasing share of increasing costs forever to expand Obamacare in our state.
Governor Scott said yes.
The House of Representatives said no.
The Senate said no, we'd like to propose an alternative.
But before I share the Senate's alternative, let's consider the position of the Florida House of
Representatives. The Florida House said, in effect, "We don't trust Washington on this issue. We don't like being dependent on their promises and stuck with their obligations. We're not sure they'll do what they say.
And the critics roared, "Who are you to not take the federal deal. Look at what Florida is missing! How can you suggest that the federal government won't perform just like they've promised?"
Well, let's see. I'm not the first one to say this:
They said if you liked your insurance you could keep your insurance. That's not true. It was never true.
They said if you liked your doctor you could keep your doctor. That's not true. It was never true.
They said they would cover everyone who needed it and instead people who had coverage are losing it.
The Wall Street Journal reported Friday that, nation-wide, 50,000 people have successfully signed up for Obamacare through the federal exchanges and 5 million people are losing the health insurance they themselves chose.
If this continues, by January 1, under Obamacare, more people will have lost health coverage than gained it.
They said they would make insurance less expensive but it's more expensive. Premium shock. Deductible shock.
They said, don't worry, your health information will be secure, but now we know it's not.
They said it would not expand the federal deficit by one penny but now we know the costs will be breathtaking, the deficits backbreaking.
It's not just the website. As the Wall Street Journal said, this isn't something you can get the IT guy in to fix.
I always knew Speaker Weatherford was a smart guy. Now it looks like he has the gift of prophecy. Must be that Jacksonville University education.
So if the Speaker was right to not order health care mystery meat at the federal cafeteria,
What about the Senate? And where does Florida go from here?
The Senate wants to end Medicaid as we know it and instead use state and federal money to provide premium assistance to poor people to buy into private plans that meet their specific needs.
Twenty-six year old triathletes don't need long term care insurance. Fifty-six year old couples probably won't use maternity coverage. Single people shouldn't be forced to buy family plans.
The Senate plan offered help for those who truly need help to buy coverage that the market designs based on customer choice.
On behalf of the Senate I wrote to HHS Secretary Kathleen Sebelius and asked, "Could Florida begin by helping those who need help the most â€“ women with children, help the poorest first and see how that goes?"
No, she said. All or nothing.
If someone is a chronic smoker and wants his neighbors to pay for his health care, could we sign him up for a smoking cessation program to control the costs of the care he has offloaded onto us? No.
If a person is a drug addict or an alcoholic and wants the taxpayers to pay for his health care, could we expect her to seek treatment for her own sake and to avoid costly complications?
Many people in the "Obamacare expansion population" are able-bodied and employable.
At least if we're extracting money from the pockets of people who do go to work every day to pay for this program, could we please draw some distinction in the costs we incur between those who can't get up off the couch and those who won't get up off the couch? No and no.
I wish it were otherwise. It would be so much easier if I could say, "Mr. Speaker, you were wrong to be skeptical about Washington." But he was right. Or if I could say, "Thank you, Secretary Sebelius, for being willing to compromise and consider alternatives, for allowing Florida to innovate and improve on the President's plan." But she refused and she was wrong.
Instead I fear we are left, at least for now, with a vast, klunky, melancholy expansion of costs and controls."
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