Sowder, Florida state health officer.(Wilson T. Sowder)(Obituary)(Brief article) - The Nation's Health

Wilson T. Sowder, MD, MPH, Florida's state health officer for nearly 30 years and former president of the Florida Public Health Association, died Feb.16 in Jacksonville, Fla., a few days before his 97th birthday.

As state health officer for Florida from 1945 to 1974, he directed the establishment of full-time health departments in each of the state's 67 counties. He also launched programs in air and water pollution control, radiation surveillance, mosquito control, chronic disease, mental health and was instrumental in establishing medical and dental scholarship programs.

An APHA member, Sowder received his medical degree from the University of Virginia School of Medicine in 1932.

In 1934 he entered the U.S. Public Health Service and served in U.S. Marine hospitals in Baltimore and Seattle.

In 1960, Sowder simultaneously served as chair of the APHA Executive Board and as president of the American Association of Public Health Physicians.

ROONEY VOTES TO REPEAL OBAMACARE RATIONING BOARD, REDUCE HEALTH CARE COSTS THROUGH LIABILITY REFORM. - States News Service

WASHINGTON, D.C. -- The following information was released by the office of Florida Rep. Tom Rooney:

U.S. Rep. Tom Rooney (FL-16) today voted in favor of H.R. 5, which would reduce health care costs through medical liability reform and repeal the health care rationing board, known as the Independent Payment Advisory Board (IPAB), created by Obamacare.

'When I talk to doctors in Florida, the number one thing they tell me we need to do to help patients and bring down costs is to cut down on junk lawsuits,' Rooney said. 'The current system may be great for trial lawyers, but it's terrible for patients and doctors. By passing medical liability reform, we can make health care more affordable for American families while saving billions of dollars in wasteful spending on junk lawsuits and defensive medicine.

'Our efforts to make health care more affordable by empowering patients and bringing down costs stand in sharp contrast to the rationing board created by Obamacare, which gave an unelected, unaccountable group of bureaucrats the power to deny American patients the care they need.

EDUCATION COMMISSIONER ROBINSON ISSUES STATEMENT REGARDING FLORIDA SCHOOL BOARDS ASSOCIATION'S ANTI-HIGH-STAKES-TESTING RESOLUTION - US Fed News Service, Including US State News

TALLAHASSEE, Fla., June 15 -- The Florida Department of Education issued the following statement:

'Public pronouncements by any governing institution remain one of the best ways to measure its tenacity of purpose. Embodied inside the words adults choose to convey an important message are their hopes and fears about the future. That is particularly true when schoolchildren are the topic of conversation.

'Yesterday's vote by the Florida School Boards Association (FSBA) in favor of an anti-high-stakes-testing resolution is a perfect example of adults expressing concern about the future. Unfortunately, the resolution is short on providing hope to schoolchildren who are Florida's future. Similar to the national resolution that calls into question the need for educational assessments, the FSBA's resolution claims the Florida Comprehensive Assessment Test (FCAT) is too expensive, narrows the curriculum and is a detriment to student success. Let us separate rhetoric from reality.

'Florida invests $16.5 billion in state and local funds to support public schools. Our assessment investment is $59 million. Ensuring that our parents, educators and taxpayers are aware of our students' educational achievement equates to less than one half of one percent of our investment in public education.

'Florida's Next Generation Sunshine State Standards are the foundation for what we expect our students to learn. Subjects covered by Florida standards include English language arts, math, science, social studies, physical and health education, world languages, and fine arts along with other content areas specific to colleges and careers. Contrary to the claim of the FSBA resolution, the FCAT neither drives the curriculum nor narrows the educational experience of Florida students. In fact, at the middle school level, student enrollment in courses such as dance, drama, and world languages has increased more than student enrollment in the subject areas assessed on the FCAT. At the high school level, enrollment in dance, world languages and the humanities has outpaced the growth in student enrollment.

'Florida statutes require students take the FCAT in grades 3-10. These assessments average two to three per student per school year and account for less than one percent of the instructional time provided during the year.

Grade 3 = FCAT 2.0 reading and math.

Grade 4 = FCAT 2.0 reading, math and writing.

Grade 5 = FCAT 2.0 reading, math and science.

Grade 6 = FCAT 2.0 reading and math.

Grade 7 = FCAT 2.0 reading and math.

Grade 8 = FCAT 2.0 reading, math, writing and science.

Grade 9 = FCAT 2.0 reading.

Grade 10 =FCAT 2.0 reading and writing.

EOCs = Algebra 1, geometry and biology.

'It is worth noting that local school boards require students to take many more assessments than those required by the state. For example, four of the first few districts to adopt the anti-high-stakes testing agreement require significant testing in addition to state requirements. This additional testing ranges from an average of four to nine additional tests each year per student.

Florida initiates health plan. (Special Double Issue)(Focus) - Chain Drug Review

TALLAHASSEE, Fla.--The statewide health care system that Florida will formally launch this July is being watched as a possible model for a national program.

'We would like to be able to chart the way for the federal government,' says Governor Lawton Chiles of the program, which he wrote and steered through the state legislature earlier this month.

Under the plan Chiles is to appoint 17 board members to each of 11 regional health care purchasing alliances by July 1. Once they are established, the alliances will begin receiving proposals on services and costs from health care providers within their jurisdictions.

The proposals, which will come from retail pharmacy operators, doctors, laboratories, hospitals, clinics, insurance companies, and other participants in the industry, will provide an inventory of health care services in each region. The information presented to the alliances will provide benchmarks for such services.

According to the proponents of the plan, it will ensure a steady flow of customers to low-cost providers, and lead to reduced overall expenditures due to the volume of business that they are expected to generate.

The state-chartered regional cooperatives could also help employers negotiate with providers to obtain the best care at the lowest prices for their employees. The demand for coverage could help insurance companies determine which plans should be offered in each region.

Recipients of Medicaid will be placed in a separate pool. The distinction was defended by a spokesman for the state's agency for health care administration, which helped develop the plan. 'We have a two-tier system now,' he says. 'People with more money can buy better coverage.'

The biggest beneficiaries of the plan could be the state's 2.5 million uninsured residents, many of whom make too much money to qualify for Medicaid but too little to afford insurance. 'These people are the working poor,' says the spokesman.

'Some of them work two or three part-time jobs, and still can't afford coverage. This should provide access to basic coverage at an affordable rate.'

Chiles doesn't expect immediate savings from the plan. 'But once it's in place,' he says, 'I think there will be people getting health care who never had a chance to get it before, and there will be small businesses that will be able to cover people that they were never able to cover before.'

Insurance reforms are being developed in conjunction with the alliance program.

'When this takes effect, the only things that insurance companies will be able to use to determine rates are age, gender, location, tobacco use and family composition--which can reflect susceptibility to diseases,' says the agency spokesman. 'However, people can't be refused coverage if they are in the alliance.'

Primary and preventive care will be stressed under the program. 'Family doctors are the big winners,' says the spokesman. 'If there are any losers, they'll be the high-tech specialists.'

Florida hopes that the program will stem cost-shifting, which the spokesman says drives up health care costs significantly. 'When someone can't pay now, the cost of the services is moved to someone else, who gets stuck with the bill,' says the agency spokesman. 'That's why you have $25 Tylenol in the emergency room.

'This program makes health care providers responsible for the care that they give. It also eliminates the potential for abuse. Cost-shifting opens the door to profiteering. Unscrupulous operators won't be able to keep up their scams if they have to go through the public scrutiny of presenting proposals to the alliances.'

Proponents say that the legislation will lead to efficiencies throughout Florida that reflect those realized at the Orlando Regional Medical Center, whose plan served as a model for portions of the state program. Doctors there review records of peers to determine which treatments are most effective for which conditions.

'They were able to bring down the length of the hospital stays and the cost per patient in just one year,' says the agency spokesman. 'As a result, they can treat more patients now in less time and for less money than they did a year ago. We want to extend that kind of efficiency throughout the state.'

For the purposes of health care reform, the legislation divides Florida into 11 regions to accommodate variations within the nation's fourth most populous state. 'What's a problem in Orlando might not be one in Miami,' the spokesman explains.

Having regional alliances also helps equalize the competitive position of small, local health care providers and nationwide operators, especially in quality of service. Businesses with less than $5 million in net worth are to be granted further protections to ensure their participation in the program.

Employers with fewer than 50 workers are the core of Florida's commercial base, and part of the reason for the state's surging medical costs. Small employers, many catering to tourists, account for about 95% of the state's businesses. Many rely on part-time workers, and don't provide them with medical plans.

Another factor that is pushing up health care costs in the state is the high population of immigrants and senior citizens, groups that tend to have limited incomes and more medical problems.

As a result of such factors, Florida's spending on health care soared to $38 billion last year from $9.8 billion in 1980. The state has no income tax to defray these costs, so it was forced to adopt a plan that is more comprehensive than those that are already being tried in Hawaii, Oregon, Vermont and Minnesota.

'Rising medical costs are eating up all of our growth revenues,' the agency spokesman says. 'We had to try something drastic.'

The alliances should become operational in January after they have sifted through the different proposals. How quickly the program will yield benefits could be determined in part by developments in Washington.

IRS Ends Audit of Florida Health Care ARS With No Status Change.(Washington) - The Bond Buyer

Byline: Patrick Temple-West

The Internal Revenue Service has completed an audit of $51.1 million of auction-rate securities the Orange County, Fla., Health Facilities Authority issued in 2005 for an Orlando health care provider without changing the tax-exempt status of the bonds.

The ARS were retired in May 2008 when the authority issued $48.4 million of fixed-rate, health facilities revenue bonds.

The issuer filed an event notice with the Municipal Securities Rulemaking Board's EMMA system Monday that said the IRS notified it that the audit was complete in a Sept. 6 letter.

The IRS tax-exempt bond office informed the issuer it was being audited in December 2010.

In the 2005 transaction, the authority loaned $34.1 million to the Orlando Regional Healthcare System for a current refunding of 1993 bonds.

Another $15.1 million was used to help finance the expansion of the Arnold Palmer Hospital for Women and Children. a 158-bed pediatric hospital facility located in Orlando.

In addition, $4 million was placed in a debt-service reserve fund and $2.1 million was spent on issuance costs, according to bond documents.

The 2005 deal was part of a series of transactions that date back to the 1980s and involve at least two past crossover refundings, a type of advance refunding in which the revenue stream originally pledged to secure the refunded bonds continues to be used to pay debt service on the refunded bonds until they mature or are called.

At that time the pledged revenues 'cross over' to pay debt service on the refunding bonds and escrowed securities are used to pay the refunded bonds.

During the period when both the refunded and the refunding bonds are outstanding, debt service on the refunding bonds is paid from interest earnings on the invested proceeds of the refunding bonds.

Florida attacks health care problems. (includes related articles) - State Legislatures

Florida lawmakers chose to 'make dust' rather than 'eat dust' by reforming health care in their state before the Congress acts.

Florida lawmakers hope they have found a public-private solution to the health care crisis.

Pushed by Governor Lawton Chiles, the Florida Legislature in April enacted a sweeping model for heath care reform based on the idea that businesses pooling their buying power can obtain quality health insurance at affordable prices.

The managed competition approach places Florida in the forefront of states trying to solve the problem that threatens to consummate state budgets and sink small businesses.

'This is a great model for managed competition,' Chiles said the day after the Legislature passed the 186-page bill. 'We have everything in this we thought we needed.'

The bill also:

* Sets up practice parameters, or guidelines to show doctors the most cost-effective proven treatments to get the best results for hundreds of medical conditions.

* Encourages hospitals in rural areas to cooperate in networks through which some would specialize in emergency care, others critical care and others convalescent care.

* Encourages public hospitals receiving state money for providing indigent care to expand primary care clinics.

While most states face growing budget pressures from the health care quandary, the problem is even greater in Florida. Of the state's 13.5 million residents, 2.5 million--18.5 percent--are uninsured. When medical problems become acute, the uninsured get attention in hospital emergency rooms where costs are the highest.

Floridians spent $31.4 billion on health care in 1990, and the number is expected to rise to $90 billion by the end of the decade if nothing is done. Doctor bills for Medicare patients in Florida are the highest in the country, according to a recent study in the New England Journal of Medicine.

Florida's health care reform was launched last year when the Legislature began plans to develop health care for everyone by 1995. In his State of the State address on the Legislature's opening day, Chiles challenged lawmakers to act swiftly on his health care reform plan.

'We can't wait for a national plan that will delay our ability to provide access to people who need it,' he said. 'We can show the way. We can make dust or eat dust.'

Lawmakers chewed plenty on Chiles' plan before they finally swallowed it.

The most fiercely fought piece involved the community health purchasing alliances (CHPA), state-chartered buying pools of small businesses.

Republican legislator wanted the CHPAs to include only small businesses and to provide information about price and effectiveness of doctors, hospitals and other health care providers. Chiles wanted strong CHPAs that would have the power to negotiate directly with health care providers and insurance companies. He also wanted to jumpstart the alliances by including Florida's 312,000 state employees and dependents and its 1.5 million Medicaid patients.

The fight over strong or weak CHPAs, known as 'chippas,' became distilled into shorthand as 'Chippa-munk' vs. 'Chippa-Kong.'

In the final compromise, Chiles won most of his demands.

The purchasing alliances (11 of them across the state) will include businesses of up to 50 employees, plus state workers and Medicaid recipients. But, under pressure from Blue Cross and Blue Shield of Florida, the third-party administrator of the $450 million state employee health plan, the Legislature inserted language ensuring state employees' health benefits will be the same or better under a CHPA arrangement.

Businesses that join a CHPA will choose from a menu of plans assembled by health care providers linked with insurance companies.

In a concession to the Florida Medical Association, Chiles and the Legislature agreed that the menu must include both traditional indemnity type insurance and network arrangements such as health maintenance organizations.

Each CHPA will have a board representing government, business and consumer interests. The board will provide members with information on the plans, rating them by quality and price.

Insurance reforms represent another major breakthrough.

The bill requires insurance companies in the small group market to take all comers and bars insurers from writing coverage for only the healthy.

Under modified community ratings, insurers may vary rates based only on age, gender, family composition, location and tobacco use. No more cherry-picking--and insurance company practice of covering a small business with healthy employees and then drastically raising premiums or refusing to renew the policy when one or more workers incur expensive medical costs.

Chiles, a Democrat, had both Republican and Democratic support for his goal or reducing health care costs immediately and making sure all Floridians had health care coverage by Jan. 1, 1995.

Health Care Reform Not Limited to Sunshine State

Florida isn't alone in seeking health care reform. Maryland and Washington also enacted health care plans this session, and Vermont reformed its system in 1992. Oregon and Massachusetts adopted health care reform in the late '80s. Hawaii and Minnesota have plans that date back to the '70s.

Here's what these states have done:

* Maryland approved cost control on doctors' fees and changed state insurance laws to make coverage cheaper for small businesses.

* Washington adopted a comprehensive program that provides basic coverage for 500,000 uninsured residents, establishes guidelines for managed competition among doctors and hospitals and sets ceilings on health insurance premiums.

* Vermont expanded access for all children, instituted community ratings for individual insurance policies, established incentives to contain costs and created a health care authority.

* oregon received federal waivers this spring to institute its 1989 plan to deny Medicaid coverage for some medical services in order to make benefits for basic procedures available to 120,000 more poor people.

* Massachusetts postponed implementation of its Health Security Act adopted several years ago. The new target date is 1995. The act requires companies with six or more workers to offer health insurance or pay a tax that will be held in pool for uninsured workers.

* Hawaii, with one of the oldest state programs, requires that small businesses provide insurance coverage for employees. it also insures citizens not covered by Medicaid or by prepaid health care through a state health insurance program.

* Minnesota endorsed managed care in 1972 when it required that employers of 50 or more offer health maintenance organizations as an option to individual insurance. More recent legislation provides a source of insurance coverage for low-income families, requires insurers to offer plans with minimum benefits and cost-sharing to small employers and creates a commission to help reduce health care inflation.

Eighteen other states are considering health care reform programs this session.

Oregon Gets its Waiver, But Now the Money Isn't There

Innumerable days and nights of drafting, redrafting and fine-tuning an innovative health care plan ... four years of controversy ... one failure on the federal level ... and, finally, success of a sort.

It's been a long, bumpy road for the oregon health care plan devised in 1989. Waivers from a federal Medicaid law that requires provision of 'all medically necessary services for recipients under age 21' were finally granted this spring. But now there is serious concern that the state may not be able to afford the program that would add an estimated 120,000 more poor people to its rolls. Oregon is suffering an estimated $1.7 billion budget shortfall this year.

Restrictions applied by the Clinton administration and increased cost have raised serious questions as to whether or not the state can executive its plan to deny Medicaid coverage for some medical services in order to make benefits for basic procedures available to all poor people.

Senate President Bill Bradbury and House Speaker Larry Campbell say the plan cannot be funded with existing state revenues.

Oregon's effort to devise a better state Medicaid program was first stymied when it was denied exception from federal law last year by the Bush administration on the basis that the plan conflicted with the new Americans with Disabilities Act (ADA).

The original proposal used 'contribution to a patient's quality of life' as one of the criteria to rank medical services. That provision, said the feds, discriminated against people with disabilities who were viewed as not having a high quality of life.

The quality of life guideline was deleted from the current plan, but advocates for the disabled are still not happy. State officials say critics will probably file a lawsuit to block implementation of the program. Opposing Oregon's model are the AIDS Action Council, American Civil Liberties Union, the American Foundation for the Blind and other organizations.

Oregon's controversial plan ranks 688 medical procedures and services according to cost and benefit to patients. Services ranked 1 through 568 will be paid for under the program. (In general, the state will not pay to treat conditions that will clear up on their own nor for ineffective practices.)

Rankings include treatment of severe head injuries, No. 1; treatment of insulin-dependent diabetes, no. 2; and obstetrical care, no. 27. Services below the no. 568 funding cutoff include treatments for the common cold or chronic back pain.

Similar to what is being considered by the Clinton administration for a national health program, the Oregon project encourages Medicaid recipients to use health maintenance organizations or other managed care. It also requires employers to provide health insurance for workers, a provision that will take effect in July 1995. The plan emphasizes preventive treatment and early intervention for women and children.

In granting the waivers from federal Medicaid law, Donna Shalala, secretary of the U.S. Department of Health and Human Services, said the Oregon plan was consistent with the president's philosophy of giving states 'flexibility to design new approaches to local problems.'

NEW EXECUTIVE DIRECTOR OF FLORIDA BOARD OF NURSING VISITS MIAMI DADE COLLEGE - US Fed News Service, Including US State News

Miami-Dade Community College issued the following news release:

Enrique 'Rick' Carlos Garc�a came home on Monday, Oct. 9. Home to the place where his dreams first found wings to take flight.

Home for Garc�a is Miami Dade College's (MDC) Medical Center Campus. And Garc�a has grown eagle-sized wings since he received an Associate in Science degree in nursing from MDC back in December of 1993. Today he is the newly-appointed executive director of the Florida Board of Nursing.

During his visit to MDC Garc�a counseled soon-to-be nurses on the nuances of applying for the licensure by examination test, the final stage future nurses make before becoming licensed.

'It's all about giving back and not forgetting your roots and where you started,' said Garc�a, who also taught a pediatrics and obstetrics course at MDC in 1995.

The nursing students Garc�a addressed took notice. Mostly, they noticed that Garc�a was once like them, aspiring to launch a career centered on caring for others.

'We should be very proud that he was one of us,' explained Izabella Waldo, who is scheduled to graduate in December.

Garc�a, who has also earned a Bachelor of Science degree in nursing from the University of Miami and a Master of Science in integrated health systems from Georgetown University in Washington D.C., said the nursing students should enjoy these moments.

'Find your passion and love what you do,' Garc�a said. 'Be passionate with your career.'