Q&A: Rep. Duran discusses health equity, Medicaid expansion

Representative Nicholas Duran is a member of the Florida House of Representatives and the Health Care Appropriations Subcommittee. He also serves as the executive director at Florida Association of Free and Charitable Clinics, along with other previous positions he has held in health care advocacy. In this Q&A, Rep. Duran discusses a few bills he has introduced for the upcoming legislative session and potential Medicaid expansion in the state.

Mansur Shaheen: How did you get involved in state level politics and what is your background in working in health care?

Representative Nicholas Duran: This is my third term in the Florida house. I’ve been in the nonprofit sector for the last 10 years, particularly with respect to children’s health care and early childhood and investment issues. I left practicing law back in 2010 to join an organization that was working to ensure that children’s issues were a top priority for the legislature.

So that was kind of my beginning of working on policy, particularly I got to work within the healthcare realm and healthcare policy. Around the same time the Affordable Care Act (ACA) was passed I had the opportunity to really dive deeply into the ACA, how it impacted communities, impacted individuals, families, healthcare systems and worked on that.

I really learned quite a bit about how the Medicaid gap really impacted our state, as Florida has not expanded Medicaid. There’s a lot of Floridians who we would encounter that could not be helped. They could not fit into the marketplace because they didn’t get tax subsidies and they couldn’t afford it, they’re priced out, and they were also making a little bit too much money so that they couldn’t be eligible for our very high threshold eligibility levels in the Medicaid program. And it really kind of stuck with me and my staff across the state that we couldn’t just help them. They couldn’t allow them to get enrolled in the marketplace.  

I joined as the executive director of the Florida Association of Free and Charitable clinics back in 2015. And I’ve been working with them since. A lot of my work is with the healthcare safety net, health care services and social service programs in the state of Florida. I was elected back in 2016, and a lot of my focus is very healthcare driven.

MS: Why did you file HB 989, which publishes more detailed demographic data for who has received the COVID-19 vaccine in each county? What can this bill do for Florida if it passes?

ND: That’s something that came together through my conversations with our county leaders, our mayor and the chief medical officer and his team. They are driving a lot of the efforts of testing and vaccination.

They get reports back from the State Department of Health that there is not mandated specificity or that they can use so they have asked [for more specific demographic] data [at a county level].

We’re working in a time crunch and we want to move rapidly, but they also want to move in a data-informed way. I think that when you have resources you want to extend your resources as efficiently and as effectively as you possibly can. And that’s the case here, with respect to both the vaccination and testing efforts, that type of data will allow them to be more surgical. With a fleet of testing and vaccination locations they can identify if there are the kinds of trends or anything that’s important to them. It will help them have a more informed approach to where they place resources.

 

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MS: How does this bill fit into the larger health equity push within the state?

ND: We know with COVID that some communities of color have been impacted tremendously more than any others. The data-based sort of approach to this allows us to make sure that we’re getting those vaccines and we’re putting this testing in those communities that could be benefited from it the most.

That workshop that we did a couple of weeks ago that took a look at [racial disparities in] maternal-morbidities and looking at how our communities of color, and African Americans in particular, have helped us create what I think is better health equity-type policies. And I think we’re going down that path.

I never thought we would ever do that in this particular juncture and it speaks a lot to how [Speaker Rep. Chris Sprowls] is approaching things. It is also going to be more helpful in taking on health equity inequities that have been historic and ongoing.

MS: The COVID-19 liability shield has been a hot button issue in Florida, what is your stance on it?

ND: I think COVID has been monumental in how it impacted us in our society, our businesses, our communities and our healthcare providers. I serve on the board of public health, health system and the largest hospitals in the state of Florida. And I also work with reinsurance clinics across the state. I know and I remember profoundly how every day [when the pandemic began] we were trying to figure out how to first get Personal Protective Equipment [PPE] and ensuring that our clinics continue to deliver services without endangering folks.

We definitely relied on the CDC for information. It was a very difficult time to figure things out and to ensure safety. So, I just remember profoundly from that and this bill just harkens back to this memory of how difficult it was. So I think the bill in many respects is important for us to consider. We have to consider it carefully, though.

I love the idea that this is not something that’s going to be in statute perpetuity and that there’s a sunset provision in it. I think it is sort of carefully balanced in a way that allows us to ensure that there are moments that happen, but also taking into account the reality that the COVID-19 has created  tremendous difficulties that we face as individuals, a community, as systems and as providers.

MS: What do you want to see out of the coming legislative session?

ND: I think it is important for us to consider here that our social service programs are so critical right now. They are critical to allow folks at the lower economic level, as they have been the ones who’ve been tremendously impacted the most [by COVID-19].

In times like these, we can’t be considering cuts to social service programs or Medicaid cuts. I think it’s going to be critical for us to ensure that those programs are funded and supported so that we can provide that kind of platform that allows families to dig themselves out of economic disasters that they have encountered. This is when you sort of see the true value and efficiencies of those programs.

I’m working hard to ensure that the legislature sees that the numbers that are there, that we do have the finances, we do have money in place that allows us to ensure that the Medicaid program is fully funded, that our good care programs are fully funded and that we’re not allowing families to find themselves uninsured and ineligible.

Also, there is a bill that I have been working on with my colleague throughout the summer last year that focuses on postpartum coverage, HB 645. We introduced this bill a couple weeks back.

Right now in the state of Florida we give new mothers postpartum Medicaid coverage up to 60 days. It is smart for us to make the state of Florida provide that extended coverage for up to 12 months, and that’s what the bill would do.

We have data that shows when a parent has health care, it is more likely the child will go to the doctor.  It is critical for both children and for that parent that [they see a doctor when needed]. I think this kind of bill is a monumental one and I think it has good momentum and energy right now.

MS: Florida is one of a few states that has not expanded Medicaid under the Affordable Care Act, what is preventing Florida from doing so?

ND: This is just an ongoing ideological divide. Republicans have controlled the legislature and the governor’s mansion. I think what I’ve read from conversations I had [with Republicans] is that they just really don’t see how and why the state should provide a childless, adult, male with stuff. In their head, they say ‘why should we give somebody like that, who can go to work, who is fully capable of being able to go to work, healthcare for free.’

I think we have to be more serious about looking at these things. The funding is there. You see it at a national level we are in the minority in terms of states who have not done this yet, and a lot of red states have already [expanded Medicaid] and it financially made sense.

I also think the other thing is that there’s always kind of the boogeyman in the room that the [federal government] is going to pull back on their commitment. But that has never been the case, particularly with Medicaid programs.

 

This interview has been edited for clarity and length