Miami-Dade County’s healthcare system has great strengths but also gaping holes. We are very fortunate to have an outstanding safety net system with Jackson Health in the lead, many free or low-cost clinics and excellent private hospitals and other healthcare facilities, and a strong area healthcare planning body (Health Council of South Florida). And our citizens have been willing to pay for much of this care through a half penny sales tax as well as a recent bond referendum. The Miami-Dade County Commission’s policy in healthcare is mostly reflected through its support of Jackson, but more can be done to assure better access, coordination and efficiencies.
Some of the healthcare metrics for Miami-Dade show us areas for improvement. According to data released recently by the Centers for Disease Control and Prevention (CDC), the Miami metropolitan area ranks No.1 in the nation in AIDS case rates. We are also top in mental health needs and rate of uninsured. According to the US Census, 42% of adults in Miami-Dade County are uninsured. Lack of insurance contributes to low access to care and results in residents having to incur costly hospital visits for otherwise preventable conditions that should be treated on an outpatient basis. A July 2013 report from the Center for American Progress found that Miami-Dade County ranks No. 1 in the nation for counties with the most uninsured residents eligible to gain from the Affordable Care Act. The recently released 2014 Robert Wood Johnson Foundation County Health Rankings report gave Miami-Dade a clinical care ranking of 56 out of 67 Florida counties due to high rates of uninsured residents and preventable hospital stays.
I propose several ways in which the government of Miami-Dade County could be of assistance in assuring that all of its residents, particularly those with low incomes, can get the healthcare they need.
The application process for healthcare insurance can be overwhelming, particularly to those residents whose first language is not English. County facilities are currently being used for this process on a limited basis. Now that the first wave of applications for the Affordable Healthcare Act (ACA) ended on March 31, it is a good time for us to take stock of what worked, what could be improved, and how to integrate ACA with other application assistance. County staff could be trained in the application processes and assist residents to apply for healthcare on an individual basis, also providing trilingual seminars on the application process. These need to be offered in locations that are both convenient for low-income residents and easily accessible by public transportation. Hospitals and urgent care facilities can be requested to collaborate in these efforts.
Unfortunately, the State of Florida is one of the states that has chosen to not extend Medicaid coverage to the additional groups covered by ACA. Low income residents who make too little to benefit from the subsidies available under the ACA, cannot take advantage of the new rules and remain uninsured. The County Commission has approved a measure to advocate for Medicaid expansion at the state level, but strong lobbying of our state representatives and senators is needed to get this measure passed during the next legislative session.
All residents regardless of insurance status lack ready access to emergency care. Only 35 percent of American adults’ primary care physician practices have arrangements for patients to see physicians or nurses after hours as compared to around 95 percent in some European countries. The County Commission could encourage the opening or expanding of additional 24-hour urgent care facilities through tax or other incentives.
Medicare and Medicaid fraud are also rampant in Miami-Dade County. Citing Miami’s embarrassing status as a national Medicare fraud “hot spot,’’ federal health officials last year imposed a six-month ban on new home health agencies in Miami-Dade and Monroe counties enrolling in Medicare and Medicaid. Although Medicare and Medicaid fraud come under federal jurisdiction, county government can play a role in prevention and monitoring such abuses.
It has been my honor to serve in many roles that have contributed to improvements in our healthcare system and prepare me to play leadership roles in future healthcare initiatives. I was co-founder of Florida CHAIN (Community Health Action Information Network), fiscal sponsor of We Care of South Dade, chair of the Health Council of South Florida Planning Advisory Council, member of Mayor Penelas’ Blue Ribbon Healthcare Committee and the University of Miami Community Advisory Board for the Clinical and Translational Science Institute. Catalyst Miami, which I founded and led for 18 years, also founded the Immigrant and Uninsured Task Force, Healthcare for All, and Union of the Uninsured. I produced healthcare resource materials for the Greater Miami Chamber of Commerce as well as Healthcare Essentials, for Catalyst Miami’s network of clients and providers. I have lectured widely on healthcare access at the local, state and national levels.