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Jeb Bush on Health Care

Republican FL Governor; V.P. prospect


ObamaCare is flawed to its core

Former Florida Gov. Jeb Bush said that President Barack Obama's health care law "is flawed to its core" and will be a "big problem" for Democrats heading into the 2014 elections. "I don't think it will work," Bush said of the Affordable Care Act, known as ObamaCare.

Bush added, "If the objective is, don't worry about the budget, we'll just finance it the same way we're financing our deficits right now, build a bigger debt, you could see this thing surviving," he said. "But it will have failed what the promises were. It will have failed the American people. And I don't think it will bend the cost curve."

Bush has emerged over the years as a strong proponent of school choice, immigration reform and what he calls "consumer-directed health care." He noted that he underwent knee surgery a month ago and forced himself into the conversation on billing. "The whole experience is opaque," he said. "It's like smoke comes up, you don't know what's really happening, the third party pays."

Source: Bill Glauber of the Milwaukee Journal Sentinel, "Healthcare" , Nov 4, 2013

Let ObamaCare fail due to its own dysfunction

Q: This government shutdown started with House Republicans saying that they wanted to gut ObamaCare and they were willing to not fund the government until that happened. Your thoughts?

BUSH: Tactically it was a mistake to focus on something that couldn't be achieved. I would argue that allowing ObamaCare to be implemented, two things would happen. One, it would be so dysfunctional if it was implemented faithfully. Or it couldn't be implemented because the government is not capable of doing it. It looks like that, the latter rather than the former, may be happening.

Ted Cruz said, "Let's not agree to a funding resolution unless ObamaCare is defunded." Your message be to Ted Cruz?

BUSH: I think the best way to repeal ObamaCare is to have an alternative. We could do this in a much lower cost with improved quality based on free market principles. And show how ObamaCare, flawed to its core, doesn't work. It might actually be a politically better approach to see the massive dysfunction.

Source: ABC This Week 2013 series of 2016 presidential hopefuls , Oct 20, 2013

Move Medicaid from "defined benefit" to defined contribution

Bush proposed an overhaul of Medicaid that reflected another major philosophical shift in the state's program, moving it from a "defined benefit" to a "defined contribution" basis. The proposal had two significant features. The first was acceptance of a lump sum of money from the federal government to fund the state's program in exchange for flexibility to determine eligibility and benefits levels. The state took on the responsibility for meeting the health-care needs of its residents regardless of whether the costs to do so exceeded the amount negotiated between Tallahassee and Washington. If costs exceeded negotiated levels, Florida would be able to use the flexibility granted by the federal government to impose benefit restrictions and cap program enrollment in order to contain costs. This provision was designed to permit the state to more accurately predict and control its costs.

The second major change was to provide each person with a risk-adjusted allotment of funds.

Source: Aggressive Conservatism in Florida, by Robert Crew, p. 38 , Dec 11, 2009

Provide risk-adjusted premiums (insurance vouchers)

Announced in his State of the State Address, the governor's reform was to provide each person in the program with a risk-adjusted allotment of funds (a voucher which the state called a premium) with which to purchase health care. Using this voucher, enrollees were required to purchase a health-care plan from a participating managed-care organization. The benefit package offered had to be actuarially equivalent to the existing Medicaid benefit.

To entice companies to insure some of Florida's sickest and poorest citizens, the state proposed to cap Medicaid benefits, and set a ceiling on spending for each recipient. Managed-care companies and other health-care networks would design alternative health plans that Medicaid patients would use. Beyond that, different managed-care networks could attract patients by offering additional services. However, patients would have a choice only among managed-care plans and no longer have access to traditional fee-for-service health care.

Source: Aggressive Conservatism in Florida, by Robert Crew, p. 38 , Dec 11, 2009

Slashed every request for adult mental health

Bush's lowest spending priorities were for Florida agencies dealing with its most vulnerable citizens.

One embarrassing consequence of his lack of attention to social services agencies emerged in the days just before Bush left office when his secretary of the Department of Children and Families was fined and threatened with jail time for failure to provide enough beds to treat county jail inmates with severe mental illness. Records from the department showed that it had called repeatedly for funds for adult health and that Bush had slashed every request--in 1 year by 93% (Hunt, 2006; Rushing, 2006). To avoid court sanctions, the governor was forced to ask the Legislative Budget Commissions, an organization that authorizes appropriations when the legislature itself is not in session, for an additional $16.6 million for hundreds of new beds for these individuals.

Source: Aggressive Conservatism in Florida, by Robert Crew, p.107 , Dec 11, 2009

OpEd: Medicaid reforms won't cover chronic conditions

The Bush plan for reform of Medicaid fundamentally altered the underlying assumptions regarding the state's responsibility for helping disadvantaged citizens find medical care, and critics complained that Florida had abandoned its commitment as a social safety net for its most vulnerable citizens.

The governor proposed his plan as a way in which the state could more accurately predict and control its costs. Critics pointed out that no benefits were guaranteed , that access to care for all low-income families was questionable, and that there were no safeguards to make sure that private plans kept their promises. In particular, the AARP questioned whether or not service packages offered by the participants would be meaningful and cover the needs of persons with chronic conditions and special needs that the private market chose not to cover. It also wondered whether the premiums to be offered would be sufficient to purchase an adequate service package.

Source: Aggressive Conservatism in Florida, by Robert Crew, p.152-3 , Dec 11, 2009

ObamaCare is focused on access; should be focused on quality

Q: What do you think of ObamaCare?

A: Have you ever gone to HHS? Have you gone to CMS, the Centers for Medicare/Medicaid? It's scary. That's going to be the marketplace for health care if Democrats have their way. McCain had a fantastic health-care proposal that he had a hard time explaining, that said that basically you should empower people, individuals, to make choices, & they should be rewarded when they make choices that improve health-care outcomes. Under Obama, we're going to create a system that's not focused on quality; it's focused on access to care. You end up insuring fewer people the more government expands its insurance. People drop out of the private market. For every person the government takes on the rolls, there's an equal number of people leaving the private sector. We're like gerbils running in place. We're not expanding health-care access per se. There are all sorts of technologies that exist that allow us to improve health-care outcomes if we organize our system differently.

Source: Tucker Carlson interview of Jeb Bush in Esquire , Aug 1, 2009

Terri Schiavo: Did all possible to keep her hooked up

Most famously was Michael Schiavo, the husband of Terri, who fell into a vegetative state in 1990, and who became the center of 1st a family, then a state, and finally a national dispute over her right to die with dignity. Jeb did all he could to keep her hooked up to the feeding tube--in fact, he even tried to do what he legally could NOT do with an aborted attempt to override a judge's order and take her into custody. In the end, Jeb lost. So he got even with Michael Schiavo by trying to launch a criminal investigation into the collapse 15 years earlier--essentially using his office to accuse Michael Schiavo of murdering his wife. If you're not with the Bushes, you're against them.
Source: America's Next Bush, by S.V. Date, p. 60 , Feb 15, 2007

Compromised on limiting medical malpractice awards

Jeb stood in the Capitol rotunda, a pained smile on his face, explaining how he was glad that he and lawmakers were able to come to a reasonable compromise on his plan to limit pain and suffering jury awards to medical malpractice victims.

Jeb was saying this, but it was obvious that he wasn't enjoying it, probably because everyone knew it wasn't true. The "compromise" was hardly that--more like a near-total capitulation on Jeb's part. Behind him, state senators stood in the familiar semicircle of solidarity, but they were scarcely able to contain their glee.

Then, after hands were shaken and the senators had withdrawn to their private office, there were laughs and high fives all around. "This is probably the 1st time he's ever been spanked," crowed one. Said another: "I don't want to gloat. Well, yes I do."

Source: America's Next Bush, by S.V. Date, p.129 , Feb 15, 2007

KidCare and Medikids: expand to 1.6M kids and then even more

Florida's KidCare program needs our attention. KidCare was created to provide insurance to children who have no other access to coverage. Today the program serves 1.6 million children-- 755,000 more than in 1998, and there are still more children waiting.

In addition to Medicaid, KidCare includes other valuable programs--specifically Medikids, Healthy Kids, and CMS. These non-Medicaid programs provide the critical safety net many parents need to ensure their children are protected. They are not offered as cheaper alternatives for parents who currently buy coverage through their employers. Florida received additional federal funds in January, a bonus for fully using the federal dollars to serve Florida's children in need. The new money will allow us to serve even more children.

Source: 2004 State of the State speech to the Florida Legislature , Mar 2, 2004

Leave research funding to feds, not state

Senate Bill 330 appropriates General Revenue funds for capital improvements to the H. Lee Moffitt Cancer Center and Research Institute for FY2001-02. Because Senate Bill 330 contains an appropriation, I have evaluated its merits based on the standards and guidelines used for similar appropriations. Although the Center provides outstanding research and treatment of cancer, funding for medical research is primarily a federal, not a state, responsibility. The stateís top priority for capital expenditures for health care is improvements to county health units, and Senate Bill 330 does not further that goal.

My veto of Senate Bill 330 does not diminish our stateís commitment to addressing the important public health issue of fighting and preventing cancer. In conclusion, the appropriation does not fulfill some of the most important criteria by which other appropriations are being evaluated. For these reasons I am withholding my approval of Senate Bill 330, and do hereby veto the same.

Source: Veto notification on Senate Bill 330 , Jun 1, 2001

No physician-assisted suicide

Q: Should physician-assisted suicide for terminally ill patients be legal in Florida?

A: No.

Source: 1998 Florida Gubernatorial National Political Awareness Test , Nov 1, 1998

No federal pre-emption of employee health plan regulation.

Bush adopted the National Governors Association position paper:

The Issue

In 1999, 42.6 million Americans did not have health insurance. All states have been fervently working to reduce the number of uninsured Americans, to make health insurance more affordable and secure, and to provide quality health care at a reasonable cost to the uninsured. However, the federal government has also expressed an interest in this issue. Any action taken at the federal level could have serious implications for traditional state authority to regulate the health insurance industry and protect consumers.

NGAís Position

Although the Governors are extremely sensitive to the concerns of large multi-state employers, the fact remains that the complete federal preemption of state laws relating to employee health plans in the Employment Retirement Income Security Act (ERISA) is the greatest single barrier to many state reform and patient protection initiatives.

The Governors support efforts designed to enable small employers to join together to participate more effectively in the health insurance market. In fact, Governors have taken the lead in facilitating the development of such partnerships and alliances. However, these partnerships must be carefully structured and regulated by state agencies in order to protect consumers and small businesses from fraud and abuse and underinsurance. NGA opposes attempts to expand federal authority under ERISA. The Governors have identified the prevention of such federal legislation in the 107th Congress as a top legislative priority.

States have the primary responsibility for health insurance regulation. Across the nation, Governors are working to protect consumers and patients and to properly regulate the complicated health insurance industry.

Source: National Governors Association "Issues / Positions" 01-NGA13 on Oct 5, 2001

Protect state tobacco settlement funds from federal seizure.

Bush adopted a letter to Congressional leaders from 53 Governors:

As you know, preserving and protecting the state tobacco settlement funds is the nationís Governorsí highest priority. We strongly urge you to reach final agreement and pass the conference report on the emergency supplemental appropriations bill soon, and to retain the Senate provision that protects our settlement funds from federal seizure.

Many of our state legislatures are currently in session, and some have already completed work on their budgets. Therefore, it is critical that conferees reach agreement quickly on this issue. Governors are unified in their commitment to ensuring that the funds remain in the states and that there be no restrictions on statesí ability to tailor spending to meet the needs of their citizens.

We offer our strongest support for conferees to recede to the Senate version of the bill containing the Hutchison/Graham bipartisan tobacco recoupment protection legislation.

Source: National Governor's Association letter to Congress 99-NGA31 on Apr 14, 1999

Other candidates on Health Care: Jeb Bush on other issues:
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Page last updated: Mar 19, 2014