DeFlorida Blueprint: DeSantis challenges medical establishment in shaping GOP health policy
Breccan F. Thies
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DeFlorida Blueprint is a five-part series examining the legislative and policy record of Gov. Ron DeSantis (R-FL). As the Florida legislature wraps up its 2023 session, DeSantis is widely expected to declare he is running for the Republican presidential nomination, putting him on a collision course with former President Donald Trump. The first part of this series examined his record on education. The second part, below, will look at DeSantis’s healthcare policy.
In his four years in office, Gov. Ron DeSantis (R-FL) has set a new conservative playbook for healthcare, from his defiant response to the coronavirus pandemic to his care network to combat opioid addiction.
Beyond the headlines of his war on woke, DeSantis has racked up a policy record that will serve as the foundation for his national political ambitions and expected 2024 White House bid.
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“DeSantis is leading the way in showing Republicans how to advance conservative policy goals and protect Americans from bad private actors across the issue spectrum but especially as it pertains to healthcare policy,” American Principles Project President Terry Schilling told the Washington Examiner. “The status quo Republican policy of neutrality has always been a failure against Democrats’ aggressive social agenda — they build institutions and change society with their policies and legal changes, and Republicans never even remove or reverse the Democrats’ changes.”
Coronavirus
On healthcare, DeSantis is probably most lauded by conservatives for his response to the coronavirus pandemic, wherein he sharply criticized mask and vaccination mandates, lockdowns, and school closures that were being pursued in states across the country.
The governor became an early critic of former National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, saying last year that “someone needs to grab that little elf and chuck him across the Potomac.”
In a veiled jab at former President Donald Trump last month, DeSantis criticized “leaders” who “subcontract out their leadership to health bureaucrats like Dr. Fauci.”
DeSantis was later than most governors in imposing lockdowns on April 1, 2020, and started loosening restrictions after only 28 days. By Sept. 25, 2020, he lifted the sanctions, declaring in his executive order that Florida had “suffered economic harm.”
Paragon Health Institute President Brian Blase told the Washington Examiner, “DeSantis’s policies to target protective measures for the most vulnerable, avoid mandates, and keep schools and businesses open led Florida to have one of the best overall COVID responses in the country.”
The “biomedical security state”
In January 2023, DeSantis launched the “Prescribe Freedom” initiative, which passed the Florida legislature, aimed at permanently ending mask and vaccine requirements and allowing “protecting medical freedom of speech” of physicians.
The bill allows doctors to “disagree with the preferred narrative of the medical community.”
“As a health sciences researcher and physician, I have personally witnessed accomplished scientists receive threats due to their unorthodox positions,” Florida Surgeon General Joseph Ladapo said in support of the bill. “However, many of these positions have proven to be correct, as we’ve all seen over the past few years.”
Dating to the very beginning of the virus, there was an “attempt to suppress real scientific debate and discussion,” Robert Moffit, a senior research fellow at the Heritage Foundation’s Center for Health and Welfare Policy, told the Washington Examiner.
“Science requires open debate and open discussion. You can’t have anything less than that,” he continued. “If you establish a party line, you’re shutting down scientific inquiry,” and that “exercise of raw political power … undermines public safety.”
Not all physicians agree with the move and believe DeSantis’s national presence and potential run for president will “bring more prominence to this ideology,” according to Johns Hopkins Bloomberg School of Public Health associate professor Dr. Rupali Limaye.
“This idea of — we are going to reject, essentially, anything that is science-based because that’s part of our identity,” Limaye continued. “The government can’t tell us what’s true, what’s not true. We make our own decisions. We make our own truth.”
Public Health Integrity Committee
DeSantis is pushing back even further on the coronavirus response, starting the Public Health Integrity Committee, overseen by Ladapo, to assess federal public health recommendations to decide whether Florida will follow them.
The move comes with the state filing a petition for a grand jury to “investigate crimes and wrongdoing committed against Floridians related to the COVID-19 vaccine,” as well as an inquiry into “sudden deaths of individuals that received the COVID-19 vaccine.”
Treatment for gender dysphoria in children
Under DeSantis, Florida has taken on the American Medical Association and American Academy of Pediatrics, which push the “gender-affirming care” model of responding to children presenting with gender dysphoria.
In 2022, Ladapo issued guidance stating social transitions — like allowing children to use different names, pronouns, and restrooms — and genital mutilation surgeries “should not be a treatment option for children.”
The guidance also says children should not be prescribed drugs such as puberty blockers and hormone therapies.
Citing several studies, including medical determinations from Sweden, France, Finland, and the United Kingdom, the guidance says, “Encouraging mastectomy, ovariectomy, uterine extirpation, penile disablement, tracheal shave, the prescription of hormones which are out of line with the genetic make-up of the child, or puberty blockers, are all clinical practices which run an unacceptably high risk of doing harm.”
Florida’s legislature recently passed several bills related to the treatment of gender dysphoric children, which DeSantis is expected to sign.
One bill bans the use of puberty blockers, hormone therapies, and surgeries on children, allowing courts to remove children from homes that allow such treatment. Doctors who provide treatment will also have their medical licenses suspended and can be subjected to felony charges.
Another bill bans the required use of “preferred pronouns” or alternate names for children in schools, as well as banning the teaching of gender identity and sexual orientation until the ninth grade.
Similarly, a bill requires gender-exclusive restrooms and that students must use restrooms that align with their sex.
Dr. Stanley Goldfarb, chairman of the medical advocacy group Do No Harm, told the Washington Examiner that Ladapo’s guidance “is a well-thought-out and evidence-based approach to this difficult and controversial critical topic.”
Abortion and child care
Like many other Republican-led states, Florida restricted abortion after the overturn of Roe v. Wade.
Currently, Florida bans abortion at 15 weeks gestation, but in April, DeSantis signed a heartbeat bill that would ban the procedure at around six weeks. That bill is waiting for a state Supreme Court decision to take effect.
Florida has also prioritized things like child care, foster care, and maternal health to make it easier for women to bring their babies to term.
According to the Florida Health Department, the Sunshine State has invested over $308 million in maternal and child care over the past four years, telling the Washington Examiner the state is on track to meet its 2030 benchmark of lowering infant mortality to five deaths per 1,000 live births. Other achievements include 94% of babies receiving all immunizations by 24 months.
DeSantis’s “Framework for Freedom” budget includes a permanent sales tax exemption for baby and toddler necessities, $96 million in foster care and child care, and $143 million in aid to pregnant and postpartum women.
Addiction and opioids
To combat opioid addiction and overdose, as well as enhance recovery efforts, Florida launched the Coordinated Opioid Recovery network, a partnership of addiction care centers and infrastructure in 12 Florida counties.
The initiative aims to stop the “revolving door of addiction and overdose” by bolstering recovery from emergency response to rehabilitation.
After responding to an overdose, the system would bypass other hospitals and send patients to a specialty center “similar to a trauma center” and pursue treatment through recovery.
The program focuses on treating other medical and mental health problems alongside addiction, as well as involving social services for job training, housing, and food assistance.
According to the Department of Health, since its August 2022 launch, the program has provided 100,000 services to patients, transported 5,000 overdoses to specialized care, stabilized 2,000 overdoses, and placed 98% of opioid use patients on medicated assisted treatment.
“We are giving Floridians the tools they need to break the substance abuse cycle,” DeSantis said. “Substance abuse can affect any family at any time, so from education to law enforcement to treatment, we are going to make sure that Floridians can take advantage of this new addiction recovery model.”
Prescription drug prices
DeSantis has made several moves to reduce prescription drug prices and regulate the pharmaceutical industry.
Last week, DeSantis signed a bill to regulate pharmacy benefit managers, the organizations that acquire medications from drug companies and distribute them to pharmacies.
The measure requires more transparency from PBMs, which bill authors say have been “allowed to operate virtually unchecked,” and increases consumers’ pharmacy choices. It also requires pharmaceutical companies to disclose when drug prices increase and why that is the case.
In 2020, Florida became the first state to submit a proposal to the Department of Health and Human Services to begin importing prescription drugs from Canada.
The program would allow Florida to import drugs from Canada, which are less beholden to market changes because the Canadian government controls pricing.
HHS stopped the implementation of the program, citing quality and safety standards of foreign countries. Pharmaceutical companies in the United States have successfully lobbied against foreign importation of drugs.
“They have unlawfully withheld and unreasonably delayed this program, and we think this violates federal law,” DeSantis said when filing a lawsuit against HHS.
Medicaid
Florida is one of 10 states that has not adopted a Medicaid expansion through the Affordable Care Act that would have increased eligibility for people earning up to 138% of the poverty line.
As a member of Congress, DeSantis voted for one of the more extensive options to repeal the Affordable Care Act, initially voting against a softer undoing.
The pandemic saw Florida’s Medicaid recipients increase from 3.8 million in March 2020 to 5.5 million. Because the “continuous coverage” benefit expired March 31, 2023, Florida is determining whether recipients still qualify — a process that can take a year.
DeSantis has pursued several changes to Medicaid, such as an expansion of the program’s postpartum eligibility from 60 days to 1 year post-delivery to reduce maternal mortality rates.
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The Agency for Health Care Administration also issued a rule prohibiting Medicaid reimbursements to providers for puberty blockers, hormone therapies, and transgender surgical procedures.
“There is a lot of great work being done to advance public health in Florida,” Ladapo told the Washington Examiner. “Our accomplishments demonstrate the dedicated and tireless efforts of the Florida Department of Health’s staff and partners throughout the state.”