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[Syriel]

TL;DR - A whole bunch of FL doctors claim that the state moved sick kids off state insurance coverage and onto crappy private plans in order to pad the profits of insurance companies.

Long article. Well worth the read. Highlights are quoted, but MUCH more at the link.

If everything is as alleged, it's an example of Florida's Republican led government completely ignoring the advice of doctors in order to push profit.

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But just days before the procedures were to take place, the surgeons' office called to cancel them.

Like nearly half of all children in Florida, LJ is on Medicaid, which has several types of insurance plans. The state had switched LJ to a new plan, and his surgeons didn't take it.

LJ wasn't alone. In the spring and summer of 2015, the state switched more than 13,000 children out of a highly respected program called Children's Medical Services, or CMS, a part of Florida Medicaid. Children on this plan have serious health problems including birth defects, heart disease, diabetes and blindness.

The state moved the children to other Medicaid insurance plans that don't specialize in caring for very sick children.

First, the data analysis the state used to justify switching the children is "inaccurate" and "bizarre," according to the researcher who wrote the software used in that analysis.

Second, the screening tool the state used to select which children would be kicked off the program has been called "completely invalid" and "a perversion of science" by top experts in children with special health care needs.

Third, in fall 2015, a state administrative law judge ruled that the Department of Health should stop using the screening tool because it was unlawful. However, even after the judge issued his decision, the department didn't automatically re-enroll the children or even reach out to the families directly to let them know that re-enrollment was a possibility.

The nurse asked Stroud a series of questions, including whether LJ was limited in his ability to do things other children could do.

Despite his birth defect, LJ goes to school and plays with friends, so she answered no.

Stroud says that because of that answer, LJ lost his insurance with CMS, the program that has cared for children with special health care needs in Florida for 40 years, and was put on a different Medicaid insurance plan.

LJ was one of 13,074 Florida children kicked off CMS -- that's about one in five children in the program -- as a result of the telephone survey, according to a presentation, testimony and a letter from Florida's top health officials.

"I personally find it pretty astonishing that they can take a survey question like that and use it to justify the de-enrolling of these kids," said Dr. Jay Berry, an assistant professor of pediatrics at Harvard Medical School who studies policies for children with special health care needs.

What Florida did was "completely invalid," added Dr. John Neff, professor emeritus of pediatrics at the University of Washington, another expert on children with special health care needs.

"This was a truly duplicitous question," said Dr. Philip Colaizzo, a pediatrician in Jupiter, Florida, who said that many of his patients with special health care needs were taken off CMS. "It was a trick question."

"It's a perversion of science," said Dr. Jeffrey Goldhagen, professor of pediatrics at the University of Florida College of Medicine and medical director of the Bower Lyman Center for Medically Complex Children at Wolfson Children's Hospital.

That's scientifically invalid, Bethell said. Using the questions that way -- especially the question about limitations -- would lead to denying children with special health care needs the services they require.

"I'm speechless," she said.

To make matters worse, Bethell said, Florida repeatedly and publicly cited research done by her group at Hopkins -- the Children and Adolescent Health Measurement Initiative -- to support the children's removal from CMS.

"I feel really manipulated," she said.

She thinks of the children who were taken off CMS and fumes that the tool used to remove them was her own work.

Because of problems like these, switching the children's insurance "was a complete dereliction of Florida's responsibility to children," said Goldhagen, the professor of pediatrics at the University of Florida College of Medicine.

In November 2014, state officials set out to "go live" with the phone survey in six months, according to a timeline developed by the state and obtained by CNN under the Freedom of Information Act.

Before implementing the surveys, the officials gave themselves 21 days to "solicit feedback from the field" about the questions they would ask the parents.

One of the first things they did was to ask one of the state's most experienced pediatricians to leave a meeting.

"I protested. I asked her, is this meeting not in the sunshine?" he said, referring to Florida's Sunshine Law, which gives the public the right to access most government meetings.

"After she told me for the third time to leave, I decided not to create a scene," he said.

St. Petery got up and left.

There are no minutes for this meeting, according to Department of Health officials, but a year later, Tschetter presented similar data to the Florida Legislature.

But an expert who developed the software Florida used to make that data analysis said the state did its calculations incorrectly.

"It's totally inaccurate," said Todd Gilmer, co-developer of the Chronic Illness and Disability Payment System and chief of the division of health policy at the University of California, San Diego.

She said she and her colleagues brought up concerns that children might be taken off CMS inappropriately.

The Department of Health official wrote down what the doctors said on pieces of paper taped to the wall, Rumberger said. The official then told the doctors that these were issues to discuss at another time.

"She said, 'We're going to park these. We're putting these ideas in the parking lot for some time, and we're not talking about these things today,' " Rumberger remembered, adding that she was speaking on behalf of herself and not in her role as a CMS regional medical director.

"We were all amazed at what they did," she added.

"I'm going to be so fired for saying all these things," Rumberger said.

But she and other pediatricians say they're speaking up because they feel that the Department of Health hurt children because they didn't listen to their concerns.

They say it could be because pediatricians don't tend to have millions of dollars to donate to political campaigns.

But insurance companies do.

When the children were taken off CMS, they were switched to 11 insurance plans that are owned by private companies. The parent companies of nine of those 11 plans donated a total of more than $8 million to Florida Republican Party committees in the five years before the children were switched.

"I knew it had to be about money," said Wright, the pediatric endocrinologist in Tallahassee who said that dozens of her patients had their insurance switched. "This sounds very believable for Florida, and I'm from Florida."

"When this was all unfolding, I told my office manager, 'I feel like we're in a plot in a Carl Hiaasen novel,' " she added, referring to the Miami Herald columnist who writes about politics and corruption in Florida.

"The state will pay a pretty good rate for these children," said Agrawal, the pediatrician at Northwestern who studies health care systems for children with special medical needs.

"They could get paid thousands more per month for a child with serious medical needs," said Steve Schramm, founder and managing director of Optumas, a health care consulting group.

"The enhanced reimbursement may be 10 times what the insurance companies get for a well child," said Goldhagen, former director of Florida's Duval County Health Department.

Sick children are, of course, also costlier for insurance companies because they need more care. But insurance plans monitor that care to manage costs.

"Plans have gotten very sophisticated in their ability to manage very sick kids, so their willingness to take very sick kids is great," said Jeff Myers, president and CEO of Medicaid Health Plans of America, an industry group representing insurance companies.

Source:
http://www.cnn.com/2017/08/18/health/florida-sick-kids-insurance-eprise/index.html

 

[Binabik15]

Disgusting. US healthcare and insurance appears like a sick system.

 

[Steeped in a Sea of Games]

Republicans feel pretty comfortable doing shit like this these days knowing they have so many brainwashed voters who will bend over backwards to excuse whatever they do.

 

[Syriel]

The biggest issue is that it all seems to have been done in secret.

Ignore doctors, misrepresent research, and then when a judge rules against them, don't bother telling people that they pushed off.

 

[GoldenEye 007]

I mean this is a state that twice elected a governor who was implicated in Medicare fraud at his old company. A state full of old people.

The population does not seem to care in great enough numbers to change the governance of the state.

 

[Marvie_3]

I wish I could say this surprised me.

 

[Sami+]

I've heard our Department of Environmental Protection isn't even allowed to mention the term "climate change" in legal documentation. The engineers and consultants have to find ways around it.

 

[Kusagari]

A governor who committed the biggest medical fraud case in U.S. history is fucking over sick people?

SHOCKING. Fuck Voldemort.

 

[Ponn]

Friendly reminder again that Lord Voldemort was elected after being involved in a medicare fraud case and then transferred his stake in Solantic to his wife and then immediately tried to pass medicaid laws that would benefit his..er...i mean her company.

And he was re-elected.

 

[B-Dubs]

Rick Scott committed perhaps the biggest fraud against medicare in US history, we all knew something like this would happen the second he won.

Am I surprised? No.

Am I shocked and sickened? Yes.

This whole thing was preventable, but no one gave enough of a shit to vote out Voldemort.

 

[Glix]

I read this article and flew into a rage, a few days ago. The whole thing is utterly disgusting, but there were two things just beyond the pale.

1. CHILDREN WERE KICKED OFF FOR THEIR PARENTS SAYING "THEY CAN DO ALL THE SAME THINGS OTHER KIDS CAN DO". Things like Diabetes or HIV, those kids CAN do all the stuff other kids can do... BUT THEY STILL NEED SPECIAL MEDICAL CARE YOU FUCKS.

2. THIS DID NOT SAVE TAXPAYERS A SINGLE DOLLAR. NOT A DOLLAR. THEY CAN'T EVEN FALL BACK ON THEIR BULLSHIT SMALL GOVERNMENT STUFF. THIS WAS DONE, 100% TO GIVE MONEY TO THE COMPANIES THAT SUPPORTED THEM.

I felt so fucking sick after reading this article.

 

[Apt101]

It wouldn't surprise me if some democrats are involved, because US politicians are mostly ruthless, but I'm going to hazard a guess that this was a GOP thing.

 

[Dehnus]

TL;DR - A whole bunch of FL doctors claim that the state moved sick kids off state insurance coverage and onto crappy private plans in order to pad the profits of insurance companies.

Long article. Well worth the read. Highlights are quoted, but MUCH more at the link.

If everything is as alleged, it's an example of Florida's Republican led government completely ignoring the advice of doctors in order to push profit.

---------------

Source:
http://www.cnn.com/2017/08/18/health/florida-sick-kids-insurance-eprise/index.html

 

[Chumly]

I highly suggest people read the entire piece. It's pretty good and detailed about how fucked up this.

Bottom line was the state of Florida used unscientific questions to trick parents into answers and then kicked some of the neediest kids off "good" Medicaid insurance into garbage managed care plans run by private insurance companies which paid such shit rates that no doctors or hospitals would take the kids. The private insurance companies had an incentive to do this because they kept any leftover money the state paid them as profits.

 

[Glix]

I highly suggest people read the entire piece. It's pretty good and detailed about how fucked up this.

Bottom line was the state of Florida used unscientific questions to trick parents into answers and then kicked some of the neediest kids off "good" Medicaid insurance into garbage managed care plans run by private insurance companies which paid such shit rates that no doctors or hospitals would take the kids. The private insurance companies had an incentive to do this because they kept any leftover money the state paid them as profits.

In some cases though, it wasn't even a trick! There is no way a medical professional thinks that a parent of a kid with HIV or Diabetes is ever saying no to that question. Its lunacy. Disgusting.

 

[Andrin]

Can we now use this as a concrete example that Republicans are intentionally killing children?

I mean, since that issue is apparently so important to them when it comes to abortions, it has to be equally important here, right?

 

[Jonnax]

It's pure evil.

Republicans generally seem the most fundamentally religious. How do they reconcile supporting vile stuff like this conducted by the people they support?

ahaha, I guess the same way they brush off their racism.

 

[HazySaiyan]

Republicans are cartoonishly evil, fuck the GOP and anybody who enables them by voting for them.

 

[Princess Carl]

How can these people do this, do they feel nothing?

 

[GoldenEye 007]

How can these people do this, do they feel nothing?

They're not punished for it in FL and other places, so why not! Money and power is a hell of a drug.

Voters sure as shit are content to let it happen.

 

[Ri'Orius]

GOP official response: "See! This is exactly why we need to get the government out of healthcare!"

 

[Chumly]

In some cases though, it wasn't even a trick! There is no way a medical professional thinks that a parent of a kid with HIV or Diabetes is ever saying no to that question. Its lunacy. Disgusting.

Also we need to add that the state of Florida flat out lied and attributed all of this to scientific research. When the actual researchers were contacted they were horrified what Florida did and at no time did they ever have any input

 

[Karkador]

I hope Rick Scott is implicated in this shit and the third time is the charm

 

[LegendofJoe]

People should go to jail over this, but this is America so no one will face any consequences.

 

[IrishNinja]

A governor who committed the biggest medical fraud case in U.S. history is fucking over sick people?

SHOCKING. Fuck Voldemort.

I hope Rick Scott is implicated in this shit and the third time is the charm

for real, this has scott written all over it - at the very least, i'd hope it would dog his senate chances, but i can't say i have faith in northern florida

again if FL DNC wasn't a fucking shell of an actual organization, this'd be a big deal. but then so would scott's history, the shit with pam bondi and so much other fuckery we've let slide

 

[Linkura]

Just read the whole article. Motherfuckers.

 

[Dead Man]

Fucking hell. I don't really have anything else to say, just... fuck.

 

[Lyon N. Laap]

Absolutely disgusting. Nothing, not even children, is sacred to the Republican leadership when compared to the almighty dollar.

 

[Verelios]

How can these people do this, do they feel nothing?

I want to say it's predicated on a 'Fuck you, I got mine' mentality.

 

[kaname-san]

Shit like this happens and it never gets coverage. If CNN covered this the way they cover Russia, everybody would know about it.

 

[Dehnus]

Shit like this happens and it never gets coverage. If CNN covered this the way they cover Russia, everybody would know about it.

It's a state affair, and it does get covered in Florida. Yet Floridians keep voting for that (R).

 

[Anticol]

As long as they are not kids from the GOP representstives they won't matter.

 

[KarneeKarnay]

Question. Is this not illegal? First of all the "Sunshine Law" wasn't followed, secondly I sure as shit call that members of the Florida state government have a vested interest in Insurance companies.

There should be a massive law suit of colossal proportions?

 

[NoblesseOblige]

Kids can't vote. Or have money to give me.

 

[HeatBoost]

It's pure evil.

Republicans generally seem the most fundamentally religious. How do they reconcile supporting vile stuff like this conducted by the people they support?

ahaha, I guess the same way they brush off their racism.

Religious zealotry typically tends to be tied to a fundamental belief that everything you do is justified, combined with a persecution complex that makes everything you do even more justified because everyone's out to get you

There's a reason that you have "Islamic" terrorist groups in the middle east claiming that they they want to establish their own religious state. It's easier to sell that because it appeals to people who already think uncritically about religion. If they were being honest and just said "WE WANNA DO WHATEVER WE WANT, TO WHOEVER WE WANT, HOWEVER WE WANT, BECAUSE IT'S WHAT WE WANT" it'd be more obvious that they're a bunch of psychos. Which is the same reason the GOP adopted religion, really.

 

[Lonewulfeus]

Welcome to reason #7000 why capitalism and our government are both broken as fuck and need to be replaced

 

[PeakPointMatrix]

I can't believe the GOP would do something like this in the name of money.

 

[McLovin]

I can't believe the GOP would do something like this in the name of money.

I can

 

[120v]

"we're doing doing them a favor... you can't expect gov't to run anything right"