1. Florida Politics

In war over Medicaid expansion, Senate panel declines to confirm Gov. Rick Scott's pick for surgeon general

John Armstrong was first appointed in 2012.
Published Apr. 8, 2015

TALLAHASSEE — One day after Gov. Rick Scott came out against a Senate proposal to expand health care coverage to about 800,000 poor Floridians, a Senate panel declined to confirm Scott's pick for surgeon general.

The Senate Health Policy Committee postponed the vote on Surgeon General John Armstrong on Tuesday after he repeatedly declined to give his opinion on the Senate's proposed alternative to Medicaid expansion.

Senate Majority Leader Bill Galvano, R-Bradenton, later said Armstrong had failed to provide "an adequate answer" on the issue.

"I think members were frustrated, and so, hopefully with temporarily postponing this confirmation, it will give the surgeon general some time to reflect and give us an answer on what the Department of Health's position is on our health exchange," Galvano said.

Tensions have been building between the Senate and the governor's office since Senate President Andy Gardiner sent two senators to Washington last week to discuss the future of a $2.2 billion federal-state program known as the Low Income Pool. The program, which helps hospitals treat low-income patients, will expire in June unless the state and federal government can negotiate a successor program.

State Agency for Health Care Administration Secretary Elizabeth Dudek, a Scott appointee whose office had been leading talks with the U.S. Centers for Medicare and Medicaid Services, said she had no knowledge of the Senate trip until after it happened.

On Monday, Scott raised concerns about the Senate's Medicaid expansion plan, siding with the House on what has become the most contentious issue of the legislative session. Scott elaborated Tuesday in an interview with the Times/Herald, saying Floridians could not trust the federal government to make good on its commitment to provide subsidized coverage.

"They have a federal program that they are walking away from," he said, referencing the LIP program. "So how can we feel comfortable doing anything else with them until they live up to their side of the existing part?"

Scott said he was comfortable with "the program we have now" — a system that makes managed care mandatory for nearly all Medicaid recipients, and provides supplemental funding for hospitals that treat uninsured, under-insured and Medicaid patients.

His position drew criticism from U.S. Rep. David Jolly, R-Indian Shores.

During a joint meeting with the Pinellas County Commission on Tuesday, Jolly said Scott should work out a compromise with the Obama administration on Medicaid expansion, as other Republican governors have done.

"I think frankly the governor should be in Washington at the negotiating table," he said. "We don't as a state have to accept exactly what the administration has proposed."

Jolly acknowledged concerns about the sizable chunk that Medicaid already takes out of the state budget, and that states accepting federal dollars would be assuming more of the cost.

"Numbers are numbers. It doesn't have to be political," he said. "The budget reality of accepting the money is a real challenge, and so it's okay to go to the administration and say okay, let's negotiate on this and figure out where the solution is."

Jolly called Scott's comments "perplexing."

"That's a nice of way of putting it," said commission Chairman John Morroni, a Republican.

The Senate made its dissatisfaction known by putting Armstrong on the spot during Tuesday's confirmation hearing. As surgeon general, Armstrong would have little control over Medicaid issues. But former Senate President Don Gaetz, R-Niceville, asked his opinion on the Senate plan to expand health care coverage.

"We are mindful of the conversation regarding the Low Income Pool and Medicaid within the Legislature and with our governor, and we will continue to monitor that conversation," Armstrong replied.

Gaetz framed the question another way, asking if Armstrong believed expanded coverage would improve health care outcomes.

Again, Armstrong said he was "mindful of this conversation in the Legislature with the voices of the people."

Gaetz tried a third time.

"As a physician, you have no opinion as to whether additional health care coverage is good for outcomes?" he asked.

Armstrong's reply: "I am mindful of the thoughtful conversations that are occurring in the Legislature and carefully reflecting on how those conversations and results will ultimately impact the health of the people of Florida."

Senate Democratic leader Arthenia Joyner, D-Tampa, took a stab at it next, suggesting Armstrong might be under constraints from the governor's office to stick to his talking points.

"I am under no constraints before this committee," Armstrong said, launching into an explanation of other factors that contribute to health outcomes.

Joyner wasn't satisfied.

"I want to know how you feel about the Senate's plan," she pressed.

"I have not formulated opinion with regard to this bill," he said. "My focus is on the principal determinants of health."

Sensing that there wouldn't be enough votes to confirm Armstrong, Galvano moved to "temporarily postpone" the vote.

Senate Policy Committee Chairman Aaron Bean, R-Fernandina Beach, said the committee would discuss the confirmation at its next meeting.

Times/Herald staff writers Mary Ellen Klas and Tony Marrero contributed to this report. Contact Kathleen McGrory at Follow @kmcgrory.


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