(Florida Today) - Florida may be waging a high-profile fight against the federal health reform law, but its governmental and health care institutions are on different pages when it comes to accepting funding connected to it.
On one hand, Gov. Rick Scott and the Republican-dominated Legislature have turned down or refused to apply for $142 million in grants attached to the law, known as the Patient Protection and Affordable Care Act, according to the governor's office.
The state also shunned as much as $400 million in federal funds that would have increased Medicaid payments to primary care physicians.
Scott's administration and lawmakers say their decision is based on the belief they ultimately will prevail in the U.S. Supreme Court, which is taking up the health reform law starting today.
On the other hand, nonprofits, universities and health organizations have been more than willing to take in tens of millions to upgrade services and expand health education. The National Conference of State Legislatures recently placed the total at $116 million, although that does not factor in some grants Florida later rejected.
The nonprofit Brevard Health Alliance hopes to get $30 million from the federal government for expansions.
A $2.6 million federal grant could help create a "health supercenter." Despite opposition to the Affordable Care Act by the governor and the Legislature, the Health Alliance sought federal funding to renovate a 30,000-square-foot commercial space at Sarno and Croton roads into a health complex.
"It's what needs to happen in our county," said Lisa Gurri, the chief executive officer of the alliance, said last fall. Nearly 18 percent of the employed people in Melbourne are uninsured, according to the alliance.
Nonprofits are eager for the funds, while the state often declines, said John Hilston, associate professor of economics at Brevard Community College.
"It's two different sets of incentives," Hilston said. "On the one hand, the nonprofits will tend to want to find money wherever they can find it. On the other hand, when the state takes money, it often comes with strings."
On a statewide level, Scott's refusal to accept $1 million to set up a health reform-required health insurance buying exchange has gotten much of the attention in the debate. If the law is upheld, the federal government could set up Florida's exchange if the state refuses to do so.
But, comparatively speaking, that grant is small change.
The Legislature, for example, rejected $37.5 million the federal government would have sent to Florida over five years to help Medicaid enrollees transition to community-based facilities. It also rejected $37.5 million that would have paid for social worker and nurse home visits for at-risk families.
In Brevard, the Affordable Care Act has provided preventive screenings, such as mammograms and diabetes screenings for thousands of Medicare recipients, said Laura Goodhue, executive director of Florida CHAIN in Jupiter. Also, some 111,500 Medicare recipients in the county now have access to preventive services without copays, Goodhue said.
The state has accepted funding that would pay for abstinence education ($10.4 million over four years) and background checks for long-term care workers ($3 million).
But state officials decided not to pursue three other grants worth $58.5 million that would have funded chronic disease prevention and health promotion efforts.
"I have always said that we should not be leaving federal funds on the table," said Sen. Thad Altman, R-Rockledge. "I think we should try to take advantage to the fullest extent possible."
Altman said the Legislature could use the Affordable Care Act to bring federal tax money back to the state.
"I think it has a positive economic impact," he said. "Health care dollars are some of the greatest multipliers of any dollars you can have. It mostly goes into paying physicians, nurses and (medical) technicians."
Some legislators oppose taking the federal funds on philosophical grounds; others oppose the expense of raising the matching funds.
Lane Wright, spokesman for Scott, said state officials based their grant decisions on the funding's attachment to the Affordable Care Act. Grants for programs in place were accepted.
Others, including those approved by former Gov. Charlie Crist, were returned if they were part of the health reform law, Wright said.
Scott declined an interview on the subject.
"We're doubtful it will still be the law by the time the larger pieces of it are required to be implemented," Wright said. "As such, it would be unwise for us to begin accepting funding and expending state resources for a law that may not be in existence by this time next year."
More broadly, federal officials are quick to point out the health savings for Florida seniors, adult dependents 26 or younger, and those with pre-existing medical conditions.
The Obama administration released figures this week saying the law has helped 133,000 Florida seniors save $78 million on prescription drugs, added nearly 160,000 young Floridians to their parents' healthinsurance coverage, and helped more than 3,700 adults with pre-existing medical conditions find insurance coverage.
Greg Mellowe of the patient advocacy group Florida CHAIN, said it makes no sense for Florida to turn down funding connected to an existing federal law.
Said Mellowe: "There's only one way to interpret the rejection of these available and desperately needed federal dollars because of the attached (Affordable Care Act) label: determination to score political points at the expense of vulnerable children, seniors and people with disabilities."
By the numbers
Health care-related grants turned down by Florida:
Rejected by the Legislature
$4.2 million ($35.7 million over five years): Funding to help Medicaid enrollees transition from health institutions to the community
$200,000: Funding to help patients transition from a health institution to a community-based facility
$875,000 over five years: Funding for comprehensive cancer control programs
$3.4 million ($31.5 million over five years): Funding for the Maternal, Infant and Early Childhood Home Visiting Program
$2.7 million ($11.1 million over five years): Funding for the Personal Responsibility Education Program
Grants being returned
$2 million for Medicare outreach to seniors
$500,000 for aging and disability counseling and assistance
$1 million: Funding to help the state set up an "exchange" through which Floridians could buy and compare prices of private insurance plans, beginning in 2014
$1 million: Funding to help the state of Florida conduct reviews of private insurance premiums
Grants not pursued
$4.2 million: Funding for health consumer assistance
$900,000 ($4.3 million over three years): Funding for coordinated chronic disease prevention and health promotion
$2.5 million($50 million over
five years): Funding to help communities prevent chronic diseases, such as heart disease, diabetes and cancer.
Source: The Florida Governor's Office