Florida Governor Rick Scott (R) is one of the most vocal opponents of the Affordable Care Act, rejecting millions of dollars in federal grants and failing to implement key infrastructure that could help lower the state’s ballooning uninsurance rate and control costs.

Now, a new report from the Florida Health Care Insurance Advisory Board finds that the state’s health care picture is only getting bleaker: enrollment in health insurance has dropped for the fifth straight year in a row, from 4.5 million in 2006 to 3.7 million in 2010:

The drop last year stemmed primarily from losses in the in-state small-group market, which saw enrollment decline by almost 19 percent. The individual market saw a 3 percent increase in 2010. But the report, which is updated annually, said the uptick in individual coverage is linked to the drop in the small-group market. “Because of the natural link between small business coverage and individual coverage, enrollment gains in the individual market can be reflective of a somewhat weakening small group market as smaller employers drop coverage,” the report said.

The 2010 Census found that Florida is home to the third-highest percentage of residents without health insurance and 3 of the top 10 highest-spending metropolitan areas in the country. Meanwhile, Scott — a former health care executive whose for-profit health care hospital chain was charged with excessive government fraud — refuses to even recognize the legality of the federal health care reform law. As he told the Palm Beach Post in November, “It’s not the law of the land,” Scott said. “I don’t believe it will ever be the law of the land.”

Our guest blogger is Lindsay Rosenthal, a Special Assistant for Domestic Policy at the Center for American Progress.

With lawmakers determined to curb spending, legislation to prevent Medicare providers from taking a 27 percent cut in 2012 has been swept up in congressional battles over the payroll tax, bringing a new urgency to the debate surrounding how best to reform the Sustainable Growth Rate formula (SGR). Since 2002, when the cost of health care skyrocketed beyond the nation’s economic growth rate, Congress has sheltered doctors from the excessive payment cuts required by the SGR, continuously voting to prevent full cuts to Medicare reimbursement payments and kicking the can down the road through so-called “doc fixes.”

Sarah Kliff of the Washington Post raises the question of whether we should “fix doc fix” at all. As she argues, we already pay doctors, particularly specialists, much more than other countries pay their physicians, without achieving better health outcomes. But surveys conducted by the American Medical Association (AMA) also show that cutting doctors’ payments could cause some to flee the system and exacerbate the Medicare doctor shortage (which is quite pronounced in some geographic areas).

Ultimately, fixing the doc fix is a problem we need to tackle, if only to free ourselves from the perennial headache that the legislation has caused. But the fix should be part of a larger package of reforms in which doctors accept changes in the way that health care is paid for and delivered. Effective payment and delivery system reforms would build on the measures already put in place by the Affordable Care Act and improve the quality of care for patients, while lowering the health care growth rate over the long term. For example, bundling payments would ensure that doctors are reimbursed for the quality of services they deliver, rather than the volume and quantity of (often unnecessary and unproven) tests and services they provide.

In a system where one-third of Medicare spending is excessive and unnecessary and over 56 percent of annual spending on health care goes to labor costs, examining how we pay providers for their services should be part of any conversation that takes place around reforming the SGR.

Despite the plasted pictures of fetuses that are so ubiquitous at anti-abortion protests and literature, nearly 90 percent of all Americans abortions occur in the first tri-mester of pregnancy. The 10 percent who undergo the procedure at 13 weeks gestation or later tend to be “women with lower educational levels, black women and women who have experienced multiple disruptive events in the last year, such as unemployment or separating from a partner,” a new comprehensive survey from the Guttmacher Institute finds. Second-trimester abortions are more expensive, pose greater health risks, and are offered by fewer providers.

The data also demonstrates that conservatives and anti-abortion activists seeking to limit access to the procedure through burdensome regulations of abortion facilities or other restrictions are targeting society’s most vulnerable women and are “all but guaranteed to make these women’s lives more difficult“:

– 14 percent of women undergoing second-trimester abortion were under 30; 9 percent were 30 or older.

– 13 percent of women were African American; 9 percent were non-Hispanic whites.

– 13 percent had not graduated from high school; 6 percent had college degrees.

– 15 percent experienced three or more disruptive events; 9 percent experienced no disruptive events.

The study suggests that less educated women “may have had less knowledge about reproduction and taken longer to recognize they were pregnant” or may have had a harder time tracking down abortion providers during the first trimester or faced difficulties paying for the procedure. Similarly, women who underwent disruptive life events likely faced delays “in recognizing the pregnancy as well as delays in accessing services.” [HT: Irin Carmon]