Florida Gov. Rick Scott (R) signed “a landmark Medicaid overhaul” yesterday that will put “hundreds of thousands of low-income and elderly Floridians into managed-care plans.” The proposal “gives managed care companies more control over the program that’s paid for with federal and state money,” a shift the state GOP claims will “hold down spiraling costs in the $20 billion program.” However, as TP Health editor Igor Volsky pointed out, a five-county pilot program in Florida already revealed that such a plan produces “widespread complaints and little evidence of savings.” Under managed care, states “have to ensure that private payers aren’t looking out for short term profits by denying treatments or reducing reimbursement rates” and — given what occurred during the pilot program — the results “are already less than promising.”

But Scott may have another reason to push a dubious bill into law. As Mother Jones reported, one of the private managed-care companies that stand to gain from the new law is Solantic, “a chain of urgent-care clinics aimed at providing emergency services to walk-in customers. Solantic was founded in 2001 — by none other than Rick Scott:

The Florida governor founded Solantic in 2001, only a few years after he resigned as the CEO of hospital giant Columbia/HCA amid a massive Medicare fraud scandal. In January, according to the Palm Beach Post, he transferred his $62 million stake in Solantic to his wife, Ann Scott, a homemaker involved in various charitable organizations.[...]

“This is a conflict of interest that raises a serious ethical issue,” says Marc Rodwin, a medical ethics professor at Suffolk University Law School in Boston. “The public should be thinking and worrying about this.”

Scott’s office dismissed the conflict of interest concern as “incorrect and baseless.” However, Scott’s history of fraud with entitlement programs (in that case Medicare) should certainly raise a red flag here. And it is not as if Scott is completely clean when it comes to the mix between professional office and personal interest.

Incidentally, Scott also just signed a bill that will require anyone applying for welfare benefits to pay for a drug test to qualify for benefits. They will only recoup that fee if they pass. One company that provides such drug tests? Solantic.

As states begin to establish their own health insurance exchanges, progressive policy wonks are hoping that more governors and state legislators will follow the models established by California and Massachusetts, in which the exchanges are empowered to “selectively contract with carriers, set tougher participation criteria than the federal standards and/or negotiate price discounts in order to effectively serve consumers.” Former Massachusetts exchange head Jon Kingsdale believes that this provision is do or die — not having it “would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery,” he says. “The Exchanges would be nothing more than an automated Yellow Pages.”

But a new report from National Academy of Social Insurance and Georgetown University argues that not all states can implement an active purchasing requirement in the same way. For instance, “exchanges that sit in highly concentrated insurance markets are limited in how selective they can be.” States in which the exchange represents a small part of the commercial market will also have little leverage, as will states with a sicker risk pool. These states won’t be able to actively purchase in the same was as California and Massachusetts, but they can still improve the value of coverage for enrollees, the report finds. For instance:

While an exchange in a concentrated market may have limited leverage to negotiate price discounts, they could work to recruit new market entrants or encourage smaller carriers that may be able to expand market share through an exchange. They can also focus on promoting better consumer decisionmaking and encouraging competition based on value. The exchange could also collaborate with other large purchasers to align purchasing strategies.

It’s an interesting read and one state lawmakers should be looking to and referencing to push back against the insurance industry’s attempts to water down the effectiveness of exchange-based consumer protections.

On Tuesday, ThinkProgress Health reported on Tim Pawlenty’s past flirtation with enacting universal coverage by mandating insurance, expanding Medicaid, and reforming the health care system. During a November 11, 2006 health care forum, Pawlenty — fresh off a close election victory for his second term — said his administration has been “studying very diligently the Massachusetts model about how that would apply to Minnesota” and pledged to “move in stages” toward “universal coverage.” “Everyone should be in a health plan of some sort…but I think as a goal we should start with covering all kids,” he said.

Yesterday, the other potential presidential candidate from Minnesota — Rep. Michele Bachmann (R) — criticized Pawlenty for his 2006 remarks:

“I think it will concern the voters,” she told conservative talk show host Laura Ingraham. [...] Bachmann said that it’s important to have candidates who have been consistent on issues like healthcare reform, saying she has been consistent in opposing President Obama’s healthcare law.

“We need to have people who have enough foresight and common sense to know these programs aren’t going to work. I’m that kind of person,” she said.

Pawlenty is certainly not the only GOP primary candidate who is taking heat for supporting the mandate. Mitt Romney, Newt Gingrich, and Jon Huntsman have all advocated that individuals take personal responsibility for their health care costs and are now paying a price with conservative leaders. Yesterday, for instance, both Rudy Giuliani and Sarah Palin criticized Romney for enacting universal health care reform in Massachusetts.

The growing conservative frustration with all of the GOP frontrunners suggests that Pawlenty’s adage is true — “Everyone has some clunkers in their record.” Whether or not conservative voters will stand for them, remains to be seen.

Every state but South Dakota follows the requirements of the federal Hyde Amendment, which prohibit the federal government from spending federal dollars on abortion services except in cases of rape, incest, or if the life of the mother is in danger. But now, lawmakers in Iowa have resurrected a proposal that “would prohibit low-income Iowans from having a taxpayer-paid abortion in cases of rape or incest” and are tucking the measure “inside what is expected to be a nearly $6 billion budget bill.” If the budget passes with the amendment intact, Medicaid would only pay for abortions when a mother’s life is in danger and the state could risk losing billions in federal Medicaid grants:

The proposal launched in March by House Republicans would remove rape and incest from the list. The Senate, which is narrowly controlled by Democrats, stripped the provision from a budget bill….Civil rights groups have been highly critical of the proposal to prohibit Medicaid money from being used to abort fetuses conceived by rape or incest.

“What are we saying here?” asked Randall Wilson, legal director of the American Civil Liberties Union of Iowa said in March. “We’re saying that if a rich woman is raped, she can get an abortion because she can afford one, but a poor woman will have to bear the child. There’s no social justice in that.”

These moves come just days after a new study found that the national abortion rate has actually decreased by 8 percent between 2000 and 2008, but rose “nearly 18 percent among the country’s poorest women” — the very women who are most impacted by the state’s attack on abortion.

The number of abortion that resulted from rape or incest is also small. Since 2005, state statistics report just “three Medicaid-paid abortions for cases of rape in Iowa. There were no requests for abortions resulting from rape or incest last calendar year.”

The 695-word biography on Mitt Romney’s campaign website highlights the former governor’s business experience, his success in “salvag[ing] the 2002 Winter Olympic Games from certain disaster,” and stabilizing the state economy. But it doesn’t devote a single word to his greatest accomplishment as governor: enacting comprehensive universal health care reform in Massachusetts.

The glaring omission seems to undermine Romney’s latest effort to honestly address the issue and explain his continued support for the law. As Romney himself pointed out, more than 98 percent of Massachusetts residents now have health care coverage, including 99.8 percent of children — the highest in the nation — and the state is now spending less on uncompensated care.

But Romney — who announced just yesterday that he is officially running for president — has also downplayed his role in enacting what he once referred to as the “ultimate conservative plan,” eschewing health care reform in his CPAC address and changing the second edition of his memoirs to downplay his belief that Massachusetts’ success could be exported to the nation.

This new, somewhat ambivalent tone toward reform contrasts sharply with how Romney characterized the law five years ago, when he presented the measure as a bipartisan accomplishment that could, at least in part, serve as a model for the nation.