Republican gubernatorial candidate Ron DeSantis and Democratic nominee Andrew Gillum have clashed over health care as they battle in the Nov. 6 election.
But when it comes to the nuts and bolts of providing access to coverage, it may be their running mates who have a deeper knowledge of the industry and the ripple effects that potential changes could have across the state.
DeSantis, who has sharply criticized the federal Affordable Care Act and government-provided health care, tapped as his running mate state Rep. Jeanette Nunez, a Miami Republican whose income comes in part from a public hospital that relies heavily on Medicaid.
Gillum, meanwhile, chose as his running mate Winter Park businessman Chris King, who spelled out a detailed health-care proposal while running unsuccessfully in the Democratic primary for governor. King has shied away from discussing the concept known as “Medicare for all,” which Gillum embraced in the primary.
Health care has become a major issue in the race for governor and in numerous other races. A key part of that issue is the role government programs, such as Medicaid and Medicare, should play in the health-care system.
While DeSantis criticizes the Affordable Care Act and government programs, his running mate has deep ties to the public Jackson Memorial Hospital, one of South Florida’s most important health-care providers.
A financial-disclosure form filed with the state shows that Nunez drew a $148,000 salary last year from OnPoint Strategies, a consulting firm she launched in 2013 after she left a job with Kendall Regional Medical Center.
The firm’s biggest client, according to the form, is Jackson Memorial. Public hospitals have been among the biggest proponents in recent years of efforts to expand eligibility for Medicaid, a key element of the Affordable Care Act, better known as Obamacare.
Nunez, who opposed Medicaid expansion in the House, said in an email to The News Service of Florida, that, if elected, her experience in health care, will “only benefit Florida families.”
“Jackson is a well-known and respected institution that saves lives, invests in cutting edge technology and is a valued community partner,’’ she said in the email. “I am proud of my work and I know that the experience I have from working in health care and seeing the real impacts it has on Floridians.”
While Nunez has a long track record on health-care issues, the DeSantis campaign has come under fire for not releasing a detailed health-care plan ahead of the election. But Gillum, who as Tallahassee mayor has a limited record of dealing with health-care issues, also hasn’t released a detailed plan explaining his priorities.
Gillum is quick to support Obamacare, and with it, a Medicaid expansion for many low-income adults who are currently blocked from getting coverage in Florida. Medicaid is a government program that pays health-care costs for poor and disabled people.
Outgoing Republican Gov. Rick Scott and the GOP-controlled Florida House have blocked attempts to expand Medicaid, while 32 other states have approved such expansions under Obamacare.
Gillum also supports a popular provision of former President Barack Obama’s signature law that provides protections for people with pre-existing conditions.
But during the Democratic primary campaign, Gillum also came out in support of “Medicare for all,” which is an alternative to Obamacare espoused by Sen. Bernie Sanders, the Vermont progressive who unsuccessfully sought the Democratic presidential nomination in 2016. Even though “Medicare for all” would have to be approved by Congress and not at the state level, Gillum’s stance helped earn him Sanders’ endorsement.
While “Medicare for all” and Obamacare have a similar goal of ensuring more people have access to health coverage, the approaches are different. Obamacare works to make private insurance affordable and largely picks up the tab for states to expand Medicaid eligibility.
In contrast, “Medicare for all” would allow all Americans to enroll in the Medicare program, which currently is limited to people who are 65 or older or have disabilities. But it would also fold funding for existing health care programs --- including Medicare, Medicaid and the military’s TRICARE --- into one new program.
“Medicare for all” would replace private insurers with a public insurance system, and employers and individuals wouldn’t choose plans. They essentially would be enrolled in a program.
King, who was one of five candidates in the Democratic gubernatorial primary, did not come out in support of the Medicare-for-all proposal during the primary campaign. He released a detailed health-care proposal showing how he would work to improve Obamacare by increasing the number of insurance companies selling health policies on the federal health-insurance exchange.
King’s plan would have required the insurance companies that want to sell Medicare plans in the state or participate in Medicaid to also write on the exchange.
After becoming Gillum’s running mate, King has stumped across the state promising that he and Gillum would work to do everything they can to protect Medicare, which he described as an “extraordinary program that serves so many of Florida’s seniors.” But that is not the same thing as the Medicare-for-all concept.
Gillum also is now appearing to sidestep questions about the Medicare proposal.
In their first debate Sunday, DeSantis repeatedly hit Gillum over his past support for “Medicare for all,” even asking him pointedly if he would sign legislation that would put the system in place in Florida.
Gillum did not address his support for the proposal and, instead criticized DeSantis, a former congressman, for votes to repeal the Affordable Care Act.
"His votes have deluded him into his own definition of what health care is," Gillum said.
DeSantis and Nunez are on the record saying details of their health care plans will be released. But with two weeks left before the election, that hasn’t occurred.
DeSantis’ answer to a reporter’s question this week, though, shows insight into how Nunez may be helping shape his positions. Scott and House leaders, including Nunez, tried unsuccessfully to eliminate an arcane health-care licensure program called certificate of need.
They offered it as an alternative to Medicaid expansion, arguing that the licensure requirement is an unnecessary regulation that enables some providers to monopolize the health-care delivery system.
While their efforts fell short, DeSantis has appeared to take up the cause.
“Health care is really the only area that where if you go to a building on one side of the street, a procedure may cost $5,000 but if you go two blocks the other way the same thing can cost $17,000. It makes no sense,” DeSantis said.