HB: Look, you have to be very fiscally conservative in the experts you hire. And so, when I was the secretary of two different agencies every time that we looked to the outside experts you had to make good value judgments about what you paid expert witnesses obviously General McCollum made that judgment. I would make sure that we were appropriately conservative.
CL: On Immigration, you’ve come out in support of Arizona’s anti illegal–immigration measure. But let me ask you, we just had a regular session in the Legislature. A lot of issues on the state of Florida’s plate. A lot of big ones. Illegal immigration never came up, so aren’t people just jumping on this as sort of a hot topic because people are unhappy and this is a way …let me ask you this: You don’t think we need this exact law in Florida, do we?
HB: Right now our local law enforcement doesn’t have the tools to enforce the immigration policies. Under Governor Bush, there was a memorandum of understanding signed with the federal govt. to give our local law enforcement that power. Our folks need those powers, because if you stop somebody who is an illegal immigrant, then we haven’t given our law enforcement the tools to do anything about it. And so you have to figure out how you extend that authority to them. Now, we have a lot to learn from Arizona so we have to figure out how to extend that authority to them. I expect we will send our local law enforcement there to figure out similar policy responsibly.
CL: It’s interesting that you say that because there was a conference call I was listening in on today with police chiefs from across the country who were expressing their concerns about the Arizona law. They don’t like it, they say it will hurt them for people who are illegal immigrants to come forward and talk about crimes that they may be reluctant to call in. Isn’t that a concern as the state’s top cop?
HB: You want to make sure you have a solution that meets Florida’s needs. So before we go down this path we’ll get input from local law enforcement, from our State Attorneys and from local leaders, because we want to make sure we do it responsibly. Arizona’s words might not be our words but the message is clear we need to give local law enforcement tools, so we can stop the problem.
MP: The Health Regulation Committee in the Florida Senate last month rejected the man picked to replace you as AHCA Secretary, Tom Arnold, on a close 4-3 vote.
In the words of the Senators, 'Arnold was rejected because his agency failed to rein in fraud, failed to properly implement a medical-home program and didn't properly implement a so-called 'telephony' project designed to ensure that home-health agents prove by telephone that they were actually doing their jobs."
He had only been there a few months. You were there for a couple of years. What did you make of the Senate’s rejection of Arnold. ….is it fair to say that since you were there for over 2 years before Arnold took over, that you should shoulder some of those criticisms?
HB: Tom Arnold took over in November, and by the way, he was confirmed. I don't know how it went in the Senate hearing but the legislation took effect July 1st. Typically you do an implementation plan and my folks did that. So they were in the process of implementing a lot of those things, so I think if you look…
MP: Were those fair things for the senators to say?
HB: I don’t know. Honestly I’ve been running around the state so I haven’t been following some of the implementation progress. But, if you look at the annual report on Medicaid fraud which you can find on our agency web page, you can see a lot of great successes, and so we really did work in partnership with the Legislature and if you want more particulars on this stuff, I’d actually call the AHCA communications office , they’ll tell you why. I left in mid-October, so we had just started the implementation plans, once I left I wasn’t in charge now.
MP: Let’s talk about Medicaid experimentation. It was going to be expanded to 19 additional counties, but that failed to happen in the current session. This 4-year-old program has steered thousands of Medicaid recipients into managed-care plans controlled by private insurance companies or medical provider networks. The program is being tested in Baker, Clay, Duval and Nassau counties as well as Broward County in South Florida.
A University of Florida study showed the plans have accomplished some modest savings compared with traditional Medicaid. But critics, including the powerful Florida Medical Association, say the more-rigorous oversight under reform is leading to delays in receiving care and even blocking access for some people. And let me just quote to you One critic was Crestview Republican Senator Durell Peaden, he headed the Health & Human Services Appropriation Committee. He said, “It's not always savings, it's the effectiveness. It's taking care of people in rural areas and people with complicated diseases. That's how you judge success.” What’s your thoughts on how this experiment has gone?
HB: I think you’d be interested to see some of the data. We’ve found, you know, when we started down the Medicaid reform pilot what we saw was the Medicaid budget was growing out of control at a rate of like 16% annually. Already when we started this effort, about 55% of Medicaid beneficiaries were already enrolled in managed care of some sort. And so this was an effort to enhance Medicaid managed care. So we did things like enhanced benefit accounts where people could earn rewards for healthy behaviors, we also did things like risk adjusted rates where individuals who were sicker than others, the rate that the managed care companies were paid were higher. And so you could help get them the treatment they needed, so part of the goal was first to contain costs, because we believe there are other priorities like education, roads, and so you needed the flexibility to fund those things. But in addition, we believed it would improve outcomes and if you look at some of the outcome measures it really has. There are measures that we look at in the health care industry of health care outcomes. Whether it’s getting follow up visits for the mentally ill, making sure that women have their mammograms or regular exams, making sure men have their prostate exams and they’re called Hedis outcome measures.
What you found was, under traditional Medicaid/Medicare your performance measures were okay, we saw substantial gains in outcome measures under Medicaid reform. Many of the standard managed care measures were below national average for Medicaid managed care. With Medicaid reform you saw substantial improvements and many of them went above the national average. So there are a lot of folks …if you look at the data. I think it’ll prove out that outcomes improved.
MP: So you think it’d be good to expand this?
HB: There were lessons learned. In some of the different areas so we will have to take into account some lessons that we have learned during the time of the pilot implementation and I think the Legislature will go back and look at that again next year.
MP: Let me ask you a political question: Who are you supporting for the Senate this year?
HB: Marco Rubio.
MP: Were you before the Governor switched to become an independent?
HB: (Pauses) Look, I. I had not made a commitment prior to that. But I served in the House with Marco Rubio, he was my final speaker and so, I know he’ll be a great standard bearer.
MP: Now Governor Crist helped out your career in a way by naming you AHCA Secretary.
(HB: (quietly) yes.
CL: Do you think it’s appropriate – I saw this in Pasco County last week, they’re trying to throw Mike Fasano out of the Republican Party because he supports Governor Crist (for Senate).
To me, this is another reason why people who aren’t insiders hate politics. They see something like that, and think, that’s crazy, it could be Democrats it could be Republicans , you have to be pure. What do you think about that?
CL: He’s (Fasano) a State Committeeman, so the party has set up different standards for those who are standard bearers for the party so that’s been a decision made by the party.
CL: Oh, so you don’t want to tell us your own views about that?
HB: I’ve not held a state committeeman or woman position, I’ve never been an RNC chair, but I think when people accept those positions they do so with the understanding that part of the goal of leadership is to support Republican candidates. So I think the Republican Party has made that decision that that’s a standard that they’d like them to hold them to ..
CL: Last question, but it probably should have been the first one: why do you want to be Attorney General?
HB: Short answer is to put the bad guys behind bars, to put the good guys to work. But I’ll tell you that in March this race changed substantially. With the passage of health care reform, it has changed the whole nature of the debate and people are very worried about what Obamacare is going to do to our health care system. It’s going to cost taxpayers well over a billion dollars . It’s going to cost businesses millions of dollars it is going to wreck one of the best health care systems in the world, so the first fight this next Attorney General is going to take on is the fight against Obamacare because McCollum filed suit in Pensacola. I’m prepared to take that fight on, and it’s important and not just for our health care system but everything else that Washington is going to do to the states.
(And with that, we concluded the interview. But Benson said she had more to discuss regarding her tenure with the Agency for Health Care Administration. So we turned our recorder back on).
Holly Benson: One of the most alarming statistics we saw when I got to AHCA was that there were more health home agencies in Miami/Dade County than in the entire state of California. So for all of the legislative sessions that I was there, very high on our list were bills designed to target Medicaid fraud. The first year we put in safeguards to assure that fewer of them got licensed. And we immediately saw a downturn in the number of who were going into business there.
And the second year we worked with the Legislature in putting in place some other pilot programs like the telephony project - there was specific targeting in Miami/Dade the legislature was very supportive in getting additional human resources , staff resources to make a difference, and so you can see the trend line start to go down because we're targeting that program, but there's a whole lot of work to be done. And one of the things I hope to do as Attorney General is you know the agency and the Attorney General's office work together to prosecute Medicaid fraud. So the agency is on the frontline. But what I saw is that if the bad guys believe the law don't have teeth, if they think the lawyers won't come after them, then they'll continue to defraud the state. I know General McCollum's team does a great job, but they don't have the staff resources. They fast-track cases, and fast-tracking for them is a year before filing. And so I want to make sure there are immediate and swift consequences for those who would defraud the Medicaid program, because you can put all safeguards you want in the front, you still need to be able to go after the bad guys.
