In a 5-4 vote, a Senate panel on Tuesday approved the confirmation of Surgeon General John Armstrong as secretary of the Florida Department of Health.
Members of the Senate Health Policy Committee spent an hour peppering Armstrong with questions, nearly all dealing with Floridians' access to health care, before signing off on his nomination.
Questions centered on cuts to county health departments, the state's high rate of new HIV infections and a drop in enrollment in the Children's Medical Services program, which serves youngsters with "chronic and serious" conditions.
In the end, the three Democrats on the panel voted against confirming Armstrong and were joined by Sen. Anitere Flores (R-Miami).
Sen. Don Gaetz (R-Niceville), noted that county health departments now see 200,000 fewer patients and provide 800,000 fewer individual services than they did when Armstrong became surgeon general in 2012.
"Is that because there is, in Florida, less need for preventive care, less need for primary care, less need for health education, less need for the services of our county health departments?" Gaetz asked. "Is that why we've seen this extraordinary and precipitous decline in the number of patients served and in the number of services provided?"
Armstrong replied that "changing dynamics" over the past three to five years have "transformed the nature of the relationship" between the county health departments and their communities.
"We're seeing these currents as a result of changes from the Affordable Care Act," he said. "We're also seeing these currents as a result of success with the state's Medicaid managed-care program."
Armstrong added that he had asked local health administrators to advise him of service gaps and that it was the county health departments' responsibility to "step up to the plate" where people were not being served.
Gaetz said counties such as Dixie, Escambia, Hardee, Okeechobee, Suwannee "and many more (have seen) a 35- to 45- to 55 percent decrease in the amount of services that county health departments are providing, yet these are the counties that have high poverty, have high incidence of uninsured individuals --- notwithstanding the Affordable Care Act, notwithstanding Medicaid managed care. What's happening to those people who used to come to the county health department?"
Armstrong said the change was due, in part, to the state's 51 federally qualified health centers, which are types of facilities that provide primary care in rural and urban areas.
"In 43 of those areas, we see individuals who previously came to the county health department now using the federally qualified health center," he said. "And because of the changing dynamics in the health care environment, the gradient really does favor utilization of federally qualified health centers."
He also said he was "very concerned" by the numbers Gaetz cited.
Gaetz also questioned Armstrong about funding for clinics that serve low-income people. State funding for the state's 125 free and charitable clinics began with $4.5 million in 2014, which the clinics say allowed them to provide about $160 million worth of services. But last year, when lawmakers approved $9.5 million for the free clinics, Gov. Rick Scott vetoed the money.
"(The $9.5 million is) in the budget again this year," Gaetz said. "As our state's chief health officer, are you prepared to advise the governor that it's a good idea to support free clinics that leverage local charitable resources in order to take up some of the slack that the county health departments are leaving?"
"I am prepared to advise the governor that free and charitable clinics provide important services of value in our communities and need to be supported," Armstrong said.
Flores questioned Armstrong about how long it would take to provide data about the role of federal qualified health centers in the counties Gaetz mentioned, "because I think that would help us clarify as to what correlation there is."
"Within 24 hours," Armstrong replied.
Sen. Rene Garcia (R-Hialeah), said after the hearing that that while he'd voted to confirm Armstrong, he wanted more data about how local health care is being provided, especially in rural counties.
"If you're there to provide a service, you have to provide that service, and if you're the only entry point, then you cannot cut back on those services," Garcia said. "I think that's where Senator Gaetz was going. And for that reason, I think it's important that my vote was to ensure that more members get to vet him thoroughly at the next committee stop, and maybe get to the floor, and we'll have a through vetting of General Armstrong."
Armstrong needs to receive Senate confirmation this year to stay in his job. The Senate could have confirmed him last year but did not. In addition to grappling with major issues at the department, Armstrong also has been treated in recent months for cancer.
The question of Armstrong's confirmation goes next to the Senate Ethics and Elections Committee.
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