In it, but not of it. TPM DC

Florida Takes Obamacare Obstruction To Whole New Level

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AP Photo / J Pat Carter

"Navigators will not conduct activities on the grounds of the health departments," the state directive read. It also said that county health departments could accept information from Navigators and provide it to citizens, if citizens asked for it. "If citizens request informations about the Navigators' operations, health department staff may provide those materials as well as direct citizens to the appropriate location or contact number for additional assistance," the directive said.

Within a few days, navigators were pushing back. The Pinellas County Board of Commissioners, which received its own $600,000 navigator grant from the U.S. Department of Health and Human Services and is the only county in the state to receive navigator funding, had planned to hire 15 navigators through the health department and have them work out of the department's offices.

County Commissioner Kenneth Welch, a Democrat, told TPM that the actions of the state health department, which is under the authority of Gov. Rick Scott, a vehement Obamacare opponent, were "purely political."

"It makes no sense whatsoever. It's ridiculous," said Welch, whose county is the sixth-largest in Florida. "They're reaching for any way to obstruct anything that's related to the Affordable Care Act."

In Florida, local county health departments are extensions of the state health department. The state operates them and their workers are employed by the state. But in Pinellas County, the county government owns the building that the health department's facilities are housed in. Welch charged that the state couldn't tell the county what to do on its own property.

Pinellas County Health Department Director Claude Dharamraj sent an email Thursday morning to her superiors at the state health department asking for clarification, saying: "I believe I am not in the position to dictate to [the county] what kind of staff they put in their office."

By Thursday afternoon, the state had relented. The navigators, who will be hired by the county instead of the health department as originally planned, would be allowed to work from the same building as the health department, state officials told Dharamraj by phone.

But what about the rest of the state?

Nathan Dunn, a spokesman for the state health department, told TPM that the state has always prohibited outside organizations from operating on department grounds for privacy reasons and the guidance was intended to ensure that enforcement was consistent across the state. He declined to provide other specific circumstances where the issue had been raised, however.

TPM could not immediately identify how many other counties had a situation like Pinellas County -- state-run health departments operating out of county-owned buildings -- but Dunn said the circumstances were "not unique to one county." If so, other counties could still be able to allow navigators in their facilities if the grounds are county-owned.

Obamacare advocates told TPM that the state's guidance would likely impede navigators' efforts to reach Florida's uninsured population, estimated to be 3.8 million people.

"Naturally, people that want to do outreach to let people know about new coverage opportunities would go to health departments," said Laura Goodhue, executive director of Florida CHAIN, which is a navigator partner with the University of South Florida, "because that's where people who need health coverage often go."

The Obama administration condemned the state's guidance as outright obstructionism.

"This is another blatant and shameful attempt to intimidate groups who will be working to inform Americans about their new health insurance options and help them enroll in coverage," Fabien Levy, a spokesperson for the federal Department of Health and Human Services, said in a statement to TPM. "We are confident that navigators will still be able to help Floridians enroll in quality, affordable health coverage when open enrollment begins on October 1."

About The Author

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Dylan Scott is a reporter for Talking Points Memo. He previously reported for Governing magazine in Washington, D.C., and the Las Vegas Sun. His work has been recognized with a 2013 American Society of Business Publication Editors award for Best Feature Series and a 2010 Associated Press Society of Ohio award for Best Investigative Reporting. He can be reached at dylan@talkingpointsmemo.com.