AARP Florida’s top leader said Florida’s 2011 legislative session offered a mixed bag of outcomes for older Floridians: Some bad decisions, some pleasant surprises, and a late-emerging worrisome risk for the “frailest of the frail” in Florida.
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In the session’s final days, with no opportunity for public discussion, legislators voted to lower state standards for nursing care in Florida nursing homes. Lawmakers also cut nursing-home Medicaid reimbursement levels.
“AARP cannot supporting taking the ‘nursing’ out of nursing homes,” AARP Florida Interim State Director Jeff Johnson said. “This action could be the safety or even the lives of the frailest Floridians at risk. AARP will urge Florida’s families to report directly to their elected officials if these decisions harm the care of their loved ones, and we will inform our members if nursing homes do not provide the care that our elders have earned.”
However, Johnson noted that Florida consumers won a nearly $2-billion victory when lawmakers rejected a plan to let big electric-utility companies charge consumers in advance to build renewable-energy facilities.
“The session could have been worse,” Johnson added. “Both AARP and state lawmakers will need to hear from AARP members and other Floridians about how these laws actually work for Floridians.
Here is how AARP Florida sees some of the good, the bad and the too-soon-to-tell...
Renewable energy. AARP and other consumer advocates won a major victory when lawmakers did not adopt a bill to allow big electric-utilities companies to charge consumers in advance for the cost of constructing renewable-energy facilities, such as solar-energy, wind or other power-generating installations. The legislation (SB 2078, HB 7217) would have cost consumers $375 million a year or $1.875 billion over five years.
“AARP supports the development of renewable energy. But renewable energy should be as good for consumers as it is for the environment,” Johnson said. “We thank lawmakers, particularly Senate budget chairman J.D. Alexander, for raising serious questions about this legislation.”
Home- and community-based care. Despite Florida’s bleak budget, lawmakers recognized the intense demand for home- and community-based care by maintaining funding of most programs.
Nursing-home care. Lawmakers did not adopt legislation that would have “stacked the deck” against families suing nursing homes after a loved one died or was injured by poor care. Among other provisions, the legislation would have set a higher standard for families seeking to use state inspection reports to show poor care than for nursing homes seeking to use such reports to show adequate care.
Health-care transparency. Floridians could get a better idea of what health-care services actually cost under legislation that gives primary-care doctors incentives to post a price list of what an uninsured patient would pay. Urgent-care centers, where uninsured people often get care, are required to post prices. The concept is meant to help consumers get an idea of what services cost before they commit to care.
Title loans. AARP also was instrumental in stopping an auto title loan bill, which would have allowed loan companies to charge more than 200-percent interest.
Distracted driving. While lawmakers failed to adopt an outright ban on texting while driving, they did act to require driver safety courses to include warnings on the risks of using phones and other devices while driving. AARP’s online and in-person courses already include such information.
Nursing-home care. Lawmakers lowered state standards for how much nursing-home care residents should receive weekly. Florida’s standards, raised in 2006, had been third highest in the nation when enacted. The 2011 vote was buried in a provision of so-called “conforming legislation.” Lawmakers held no public hearings on lowering these standards, Johnson noted. Johnson said AARP will hold nursing homes accountable when the care of frail Floridians declines. Legislators also reduced Medicaid reimbursement for nursing-home care by 6.5 percent.
Phone rates. Lawmakers adopted legislation that allows telephone companies to raise rates for basic landline phone service at will, without having to ask permission from state utilities regulators.
Thousands of AARP e-activists called state lawmakers’ offices to keep the phone-company deregulation bill from being enacted. AARP fought the legislation (HB 1231) at every step. But lawmakers would not listen. “This is a very bad idea,” Johnson said. “We’re very concerned that our members, and all Florida consumers, are about to see big increases in phone rates.” Johnson noted that AARP will be asking Floridians to keep an eye on their phone bills, so older voters can hold legislators accountable if costs go up.
Revenue cap. Lawmakers put a proposed constitutional state fiscal cap on the state ballot modeled partly after a Colorado constitutional initiative. Voters in that state put their constitutional provision on hold for five years after critical state services and infrastructure began to crumble. The new Florida proposed revenue cap proposal could make difficult economic times in Florida tougher and longer.
Johnson described the proposed amendment (SJR 958, sometimes referred to as TABOR) as “a solution in search of a problem,” noting that the state ranks 46th out of 50 states in per-capita state tax burden, always runs a balanced budget and has the smallest state payroll in America in terms of per-capita income. “Who are we trying to compete with?” Johnson asked.
Too Soon to Tell
Medicaid. Lawmakers adopted legislation that gives private managed-care insurers, such as HMOs, control over the health care of millions of Floridians receiving care through the Medicaid program, including more than 40,000 frail elders living in nursing homes.
AARP had expressed grave concerns about the plan’s provisions forcing Medicaid patients to receive care through managed-care plans – or “mandatory Medicaid managed-care.”
But AARP successfully pushed for provisions that also would allow “provider service networks,” often run by local doctors and hospitals, local elder-care agencies and other local providers to operate plans for care under Medicaid. AARP advocates also fought for and won new provisions that encourage “patient centered care,” in which doctors, patients and other types of health and service providers work together to deliver and coordinate high-quality care.
“AARP believes that older Floridians will embrace better coordination of care, but they and their families are likely to resist traditional managed care,” Johnson said. “We remain concerned that this legislation will give private insurers control over the health and long-term care decisions of many Florida families but will not deliver the savings that some legislators and insurers claim.”
Johnson asked AARP members and other Floridians to directly report to legislators any difficulties they encounter in getting the care they need under the new Medicaid systems.