GOP governors put millions of lives on the line

>>> available for three years fully, 90% for the following term. we believe, you know, that's just too much money on the table. it's $26 billion over ten years. $7 billion in the first three years for floridians to pass up.

>> that's mark robitaille, incoming president for the hospital association testifying before the florida state house . on the medicaid expansion where the government pays 100% of the expansion for the first three years. as a republican health policy , did rick scott do the right thing?

>> well, you know, one of the things we talk a lot about in health policy circles, coverage. we're expanding coverage. we're doing this for coverage. there's a lot less emphasis on the quality of coverage. and this is a problem. in florida , for example, for every dollar that a private physician paid for a patient, medicaid pays 44 cents. what this means, a lot of doctors don't take medicaid , because they lose a lot of money caring for medicaid patients. if you can't get seen by a doctor, your cancer doesn't get diagnosed late. your heart condition doesn't get diagnosed early. it's too late to treat.

>> but it's better on what the control group is, right? because they're much better than people that don't have health insurance ?

>> not necessarily. there are other studies that show otherwise. university of virginia conducted a study with 900,000 surgical patients that showed medical patients have a higher mortality than patients who have no care at all.

>> i sense of literature, medicaid actually has relatively good health outcomes. depends on the control group . there's been a lot of different stories.

>> there's certainly a lot of debate about it. nobody debates that medicaid is a lot worse than private insurance. there was an option, it depends on the state, to put more people on the exchanges where the quality of coverage would have been better than the medicaid where the quarter of coverage is worse. in terms of operators, it's not obvious that the patients are going to do better?

>> do you agree with that?

>> i don't. the study that you cite from virginia has mythological flaws in it, it looked backwards over time , what had happened in the past. i think a much better study and a study much more indicative of what's likely to happen with the expansion, the oregon health insurance . in 2008 , oregon created a lottery, anyone who met certain criteria 0 could come into it. and a group were able to get medicaid through that lottery. they followed the group that did get it to the group that didn't. and a year later, they studied what happened. the difference between the two groups were striking. the group that did get the medicate coverage reported both physical health and mental health .

>> that's subjective. that's not hard outcome.

>> they had much better outcome. 60% better mammogram screening than those who didn't have are insurance. they were more likely to be taking the right prescription drugs for their current conditions. less medical debt , fewer unpaid bills. so i think when we see in realtime, watching what medicaid does for people it making it a tremendously positive impact.

>> we're also going to have a good one going forward.

>> the oregon study has not measured actually yet.

>> florida is moving towards managed care . it will be privatized and hmr pistorius and insureds controlling the medicaid program in florida . florida is opting out of the exchange.

>> florida , the same thing, medicare managed care , they're still play paying at the below the combursment rates so the access to physicians and quality care will be better.

>> let me point out a few factual things lighter. medicaid reimbursement rates set for the state. medicaid has tremendous latitude for the states. they determine eligibility. there's a basic package required. the eligibility, optional benefits package and the reimbursement rate all determine ted state level. it squeezed providers so you have reimbursement rates lower than private insurance. unlike medicate where reimbursement rates get fixed in the federal government .

>> by the way, in florida , governor rick scott slashed the compensation that went to public hospitals because he wanted to favor private hospitals. and he has been running this experiment in medicaid managed care . people don't like having the hmo experience. at least to your point, when you compare people who have no insurance at all, those are people getting care in the emergency room , by and large. they're not going for mammograms or screenings. sure, doctors do a good job of treating people in the emergency room , but that doesn't mean that's where you get health.

>> given the political economy, that the hospital is grabbing the dollars which i think is a fair enough way to stay in florida . i'm fascinated what's happening in florida where you are. blue state , republican governor, seems to be leaning towards objecting against the medicare expansion. i want to talk about that right after this