Governor Rick Scott. | Drew Angerer/Getty Images In Zika fight, Scott haunted by public health cuts, rejection of Medicaid expansion Critics says cuts impacted health infrastructure

TALLAHASSEE — Fighting the Zika virus has become a top priority for Gov. Rick Scott, but the state’s refusal to expand Medicaid coupled with his record of cutting money for county health departments, health clinics and programs for special-needs Floridians has started to complicate his message that the federal government is failing the state in addressing the potential crisis.

Scott and his office have steadfastly rejected criticism that any of the cuts have reduced Florida’s front-line capacity to manage the challenges of the fast-spreading virus, saying his budget cuts have only made the state more efficient.


“We have very good county health departments, and we have a great state health department, and I'm going to continue to allocate the state resources that are necessary,” Scott said Monday, according to The Sarasota Herald-Tribune. He points out he single-handedly reprogrammed $26 million in state money to fight Zika, while Congress failed to pass a funding package.

“The president and Congress have got to come together,” Scott said, according to the newspaper. “They've not been a good partner.”

Florida has the most Zika cases — 429 — of any state in the nation. And the Miami neighborhood of Wynwood was the first to experience 15 cases where the disease appears to have been locally transmitted, perhaps from mosquitoes, instead of being contracted overseas. A new case was documented Monday in Palm Beach County.

To Scott’s critics, the governor isn’t being realistic about the cumulative effect of the cuts to the state’s health infrastructure — a record that will come more into focus Tuesday as Democratic presidential candidate Hillary Clinton visits a Wynwood health clinic that lost public money following the state’s refusal to expand Medicaid under Obamacare.

“I think the record is clear that he has not supported public health funding,” said Karen Woodall, a longtime social services advocate and the executive director of the left-leaning Florida Center for Fiscal and Economic Policy.

Woodall, who has long faulted the governor for prioritizing tax cuts and private-business incentives over social-services spending, said it was good that the Scott administration has taken Zika seriously in recent months. But she said that the administration is reacting to a public health crisis and is not in front of it due to all the tea-party budget cuts under Scott.

“It’s not unusual for them to react in a positive way to individual circumstances,” she said. “But he’s totally missing the boat on the underlying systemic issues. He’s not connecting the dots.”

There’s bipartisan agreement that the state’s loss of federal money through a program called the Low Income Pool, or LIP, played a major role in reducing the money and services provided by health clinics, especially Federally Qualified Health Centers.

But who’s exactly to blame has a more-partisan fault line.

In the Florida budget year ending July 30, 2015, the 49 centers across Florida received about $42 million. But the Obama Administration began warning the state that the money would start to phase out as states were expected to expand Medicaid under Obamacare, which was supported by legislative Democrats and a number of Senate Republicans. Florida House Republicans refused as did Scott, who had once tepidly supported the expansion of the health program for the poor.

The federal government then made good on its promise and reduced the LIP money, and changed the rules on how the state could use it, making clear that the money could no longer be spent on anything other than to help hospitals that provide charity care. Florida legislators could no longer direct LIP dollars at federally qualified health centers, leading to a reduction of 60 percent for the health centers, which received only $16 million the following budget year.

Still, the House and Scott wouldn’t budge. They refused again, and this budget year the centers only received $9 million.

Overall, almost all eligible healthcare providers felt the deep reduction in LIP money, which totals $608 million in this year’s Florida budget. Two years ago, the state $2.1 billion budgeted for the program.

In the Miami neighborhood of Wynwood, where the 15 cases of locally transmitted Zika cases were documented last week, the Borinquen Medical Centers of Miami-Dade — which Clinton visits today — has seen its LIP money decline from $1.9 million three years ago to $420,000 in the current budget year. Officials from the centers wouldn’t comment.

State Sen. Don Gaetz, a Republican who supported Medicaid expansion, said he believes the funding cuts have made it difficult for the health clinic to respond to Zika, but he said the federal government is ultimately to blame.

“If Mrs. Clinton wants to point fingers, she should point them to her friends in the Obama administration,” he said.

Andrew R. Behrman, president and CEO of the umbrella group representing Borinquen and similar health clinics, didn’t want to lay any political blame for the current situation. But he said the rapid spread of the Zika virus is a wake-up call.

“Funding cuts,” he said via email, “have direct consequences. This is because the funds used help offset costs of the uninsured we see, and reduces our ability to expand and increase access for the state’s most vulnerable. … Cuts can also directly affect their ability to hire the personnel needed, especially for pregnant women.”

Of the 429 confirmed Zika cases in Florida, 55 involve pregnant women — a major concern because Zika is the first mosquito-borne virus that has been linked to infant microcephaly, a birth defect in which babies are born with abnormally small heads and incomplete brain development. Babies with the defect often have a range of problems including developmental delay, intellectual disability, problems with movement and balance, hearing loss and vision problems.

The potential for increasing the number of special-needs children and Floridians deeply troubles advocates like Deborah Linton, CEO of The Arc of Florida, who recalled how an outbreak of rubella in 1964-65 strained the state’s healthcare system. She said that if Zika abatement efforts aren’t successful there could be an influx of people with microcephaly. Many could wind up in costly Medicaid-supported programs that are perennially underfunded.

“They won’t take over the entire system,” she said. “But if there’s not a handle on this, you will will see a certain wave, a certain band in time.”

On average it costs upward of $30,000 annually to treat people at home through a Medicaid-supported program. But that’s only for those who are lucky enough to be enrolled in the program, she said; the Agency for Persons with Disabilities says the state’s waiting list has about 21,000 people on it.

And since and before Scott was governor, the state has not cleared the waiting list. Some people, she said, could “wait a decade, some people 15 years” for services.

But Melanie Etters, spokesperson for the Florida Agency for Persons with Disabilities, disagreed. She said that based on their needs some people don’t wait long for services and that the Legislature directed $36.4 million be directed to pare back the waiting list this year.

“The good news is this is the fourth year we have been able to take people off the list,” she said. “We are hopeful the Legislature will continue to fund the waiting list.”

Determined to stop the virus from spreading, Scott has requested 10,000 Zika-prevention kits from the Centers for Disease Control and Prevention, and asked the Obama Administration to clarify how it wants the state to ask for a federal-emergency disaster declaration. Scott has also urged people who believe they’re exposed to get tested.

County health departments, among the main places to get tested for Zika, have seen an overall reduction of $14.2 million in funding under Scott since 2011, his first year in office. The number of full-time jobs during the same period has been reduced by 20.4 percent. However, the governor’s spokeswoman, Jackie Schutz, said services have “absolutely not” been affected by the reductions.

“The majority of these positions were vacancies and there has been no impact to services,” she said via email. “No one has been denied services for Zika at county health departments due to any reduction in FTEs — our county health departments are ready to respond.”

Under Scott, Florida also reduced spending for the Children’s Medical Services program, which treats special-needs children — 9,000 of whom were purged, the Miami Herald reported in December. As enrollment in the program climbed, spending skyrocketed by about $100 million between 2010 and 2014. So the state reduced payroll, cut specialized clinics that treat children with cleft palates, and it curtailed funding for expensive food items that help children with metabolic disorders to prevent them from suffering permanent brain damage.

The department also reduced the number of children eligible for the program through the use of a controversial screening tool, the newspaper reported.

The health budget aside, Scott also cut mosquito-control money early in his first term, leading to the closure of a mosquito-research lab in the Panhandle. Scott pointed out he didn’t completely cut all mosquito control money and said that, since the 2012 budget year, he has “dramatically” increased mosquito control money.

But averaged over his six years’ in office, Scott’s mosquito-control spending represents slightly less than a 2 percent annual increase — had he not cut money for fighting the bugs by 40 percent his first year in office.

Scott’s mosquito-control and other budget cuts have started to come under increasing scrutiny from Democrats like U.S. Rep. Debbie Wasserman Schultz, the former national chair of her party, and U.S. Rep. Alan Grayson, who’s running for U.S. Senate.

Moderate Republicans, like Miami state Sen. Miguel Díaz de la Portilla, who has clashed with Scott on a number of occasions, said the governor deserves credit for using the bully pulpit and state purse strings to fight Zika and raise awareness.

But Díaz de la Portilla, one of the first Republicans to actively push for Medicaid expansion, said he wished the governor would again be an advocate for expanding health coverage.

“This is a clarion call to expand Medicaid,” Diaz de la Portilla said. “It not a time for any of us to point fingers.”