A new analysis of potential budget cuts for safety net programs such as Medicaid and in food aid provided to low-income families says the impact could be crushing and far-reaching in Florida and other states.

The new report from the Commonwealth Fund and the George Washington University Milken Institute School of Public Health estimates that Florida could lose nearly 45,000 jobs in 2026 and see its overall gross domestic product shrink by more than $4.5 billion. The report projects the majority of those jobs, or 33,200, would be lost due to the Medicaid reductions as hospitals and nursing homes, reduce their workforce. The remaining jobs will be lost from reductions to SNAP.

Nationally the cuts could lead to a projected loss of one million jobs $8.8 billion in state and local tax revenue in 2026.

The analysis looked at what could happen if a budget resolution by the Republican-controlled House is carried out. The House called for reducing federal spending by $880 billion in the House committee that oversees Medicaid in the next 10 years and at least $230 billion under the House Agriculture Committee, which oversees the Supplemental Nutrition Assistance Program or SNAP.

Medicaid is a safety net program jointly funded by the state and federal government that provides the poor, elderly, and disabled access to health care. SNAP, too, is meant for low-income people, and provides monthly benefits through an Electronic Benefits Transfer card.

Republican leaders have pushed back against that they plan to cut these programs noting for example the budget resolution did not mention Medicaid specifically. But Democrats assert there’s no way for the House to meet its targets without cutting Medicaid or SNAP.

The analysis put together by the Commonwealth Fund and the Milken Institute calculated what would happen if the cuts were spread out over the next decade and proportionally to all 50 states and the District of Columbia.

“The proposed Medicaid and SNAP funding reductions would cause a ripple effect across state economies,” states the report. “As hospitals, health care providers, and food retailers face lost revenue, they would be forced to reduce jobs and services, which would further reduce economic activity in other sectors. This decline in employment and wages would lead to decreased consumer spending, impacting businesses across various industries.”

While Florida has not expanded Medicaid to low-income childless adults, as allowable under the Affordable Care Act, the analysis still concludes that Florida would be among the five states hit hardest by the cuts that would lead to a loss of jobs in the health care and food sectors as well as other indirect jobs affected by the elimination of federal spending.

“Medicaid and SNAP programs are not just designed to strengthen individual health and nutrition — they support the economic well-being of communities and businesses nationwide. Cuts of this magnitude will not be harmless. In fact, such drastic reductions would harm millions of families and also trigger widespread economic instability and major job losses,” Leighton Ku, lead author of the analysis and director of the Center for Health Policy Research and professor of health policy and management at GWU’s Milken Institute School of Public Health.

Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: info@floridaphoenix.com.

More than 4.6 million Florida residents enrolled in an Obamacare plan through the “Marketplace” for 2025 health insurance coverage.

Data released by the Centers for Medicare & Medicaid Services show that 4,633,650 residents signed up for insurance coverage through the Marketplace by the end of 2024.

Nationally, CMS reports that 23.6 million people enrolled for 2025 coverage, including 3.2 million new consumers. Total enrollment is record-breaking, CMS said in a statement.

Four insurance companies and 12 health maintenance organizations (HMOs) are participating in the Florida Marketplace, the Florida Office of Insurance Regulation website shows. HMO coverage is regional and people must live in the area an HMO is authorized to operate in to enroll in the managed care plan.

The Marketplace is a centerpiece of the Affordable Care Act, often referred to as Obamacare. President-elect Donald Trump has vowed to repeal the program but has offered no details.

“The Affordable Care Act health insurance marketplace and reforms have proven to be successful and critically important for millions of Americans and their families,” Health and Human Services (HHS) Secretary Xavier Becerra said in a prepared statement. “Every American should have access to quality, affordable health care — and thanks to the ACA, they do. The Affordable Care Act now stands along with Medicare, Medicaid, and Social Security as one of the most consequential social programs in the history of our nation.”

The CMS data does not show how many of the Florida consumers are new enrollees versus returning customers. But with 4,633,650 people enrolled, the data show that Florida leads the nation in enrollment. Rounding out the top three states for the most enrollment is Texas and California with 3,861,244 and 1,895,558 enrollees, respectively.

“Help is still available”

“We can’t lose sight of what’s behind our tremendous, record-setting progress: Millions of individuals and families who now have a critical connection to the lifeline of health care coverage,” said CMS Administrator Chiquita Brooks-LaSure. “To the millions more who may still need coverage: Don’t delay. Help is still available, including tax credits that have made coverage more accessible by reducing the barrier posed by high costs.”

Open enrollment for 2025 health insurance coverage began Nov. 1 and runs through Jan. 15. Health insurance coverage took effect Jan. 1 for consumers who enrolled by Dec. 15. Health insurance coverage takes effect Feb. 1 for those who enroll by Jan. 15.

Although Republicans in Florida have not expanded Medicaid to lower-income childless adults as the ACA allows, the federal health law is popular with residents who annually have flocked to the marketplace for health coverage. President-elect Donald Trump has promised to repeal the ACA but has provided no details.

“Nearly 24 million people, a record number, have signed up for Marketplace coverage — and the Open Enrollment Period is not over yet. The Affordable Care Act health insurance marketplace and reforms have proven to be successful and critically important for millions of Americans and their families,” said Becerra.

Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: info@floridaphoenix.com.

The state’s medical board has revoked the license of a Florida physician who perforated a patient’s abdominal organs at least five times during a Brazilian butt lift procedure that led to her death.

The Florida Board of Medicine sanctioned Dr. Christopher Walker for falling below the standard of care, performing liposuction without being qualified as well as two additional charges related to his plastic surgery businesses, Beja Body Med Spa, as well as his other practice area as a medical expert in class actions conducted through Urogyn Specialists of Florida.

In doing so, the board adhered to a June 4 recommendation from state Administrative Judge Andre D. Manko. Walker appeared before the board on Dec. 5 and asked that it allow him to keep his license with restrictions.

“Board members, I come before you today completely broken. For 28 years I’ve been privileged to be a physician, and I’ve dedicated my life to the practice of medicine with a fervent design to help others and make a positive impact in the life of my patients,” he said.

Brazilian butt lifts are plastic surgeries that involve a minimum of two procedures — liposuction and fat injection into the gluteal area.

The record shows that Walker performed a two-hour liposuction on a patient, identified in the record as “U.O.”, in 2021. Walker perforated U.O’s abdominal muscles at least five times, causing damage to the patient’s liver, stomach, small intestine, pancreas, veins, and arteries, including the artery supplying blood to the colon.

Walker “did not not realize he had perforated the patient’s abdominal muscles or caused injuries to her internal organs” until a nurse anesthetist told him she could not find the patient’s pulse. Walker tried to resuscitate the patient, who was transferred to a hospital.

“Sadly, emergency efforts to stabilize the patient were unsuccessful. She had lost too much blood to clot and her internal bleeding could not be stopped. Patient U.O.’s death certificate identifies her cause of death as hemorrhagic shock due to penetrating abdominal injuries,” the record shows.

Not board-certified

Walker was not a board-certified plastic surgeon, but that is not a requirement to perform plastic surgery in Florida. He had performed upward of 500 liposuctions throughout his career, he told the board. The record also shows that Walker had taken a number of training courses over the years but hadn’t attended seminars on liposuction over an eight-year period between 2009 and 2017.

In 2017, he attended a two-day course in Massachusetts on tummy tucks that involved observational training on liposuction. He didn’t participate in procedures because he wasn’t licensed in that state.

“Although one bad incident does not necessarily indicate a lack of competency, Respondent’s actions during Patient U.O.’s procedure, his failure to recognize the damage being caused, and his explanations therefore at the hearing showed a lack of competency, ” Manko wrote in his recommended order.

Walker told the board that the incident occurred while he was in the midst of a criminal prosecution, the result of him “unwittingly” violating a federal law regarding interstate commerce of medical patients and kickbacks. That violation stemmed from Walker’s work as a medical expert witness.

“During this turmoil when I was being criminally charged my freedom and my livelihood were threatened. I tragically lost a patient. This indescribable tragedy has left me with profound grief. In my 25 years of being a surgeon, operating on over 15,000 patients and saving many lives, that was my first loss. Looking back now, I see where, in my distress, my judgment was flawed in my effort to survive under the weight of a criminal indictment. And I accept full responsibility for my mistake and the grave error I made.”

Board of Medicine member Dr. Scot Ackerman said Walker’s testimony conflicted with the record of his medical training and that the board should deny his request.

“Petitioner just told us his first love or first passion was surgery and to be a surgeon. He never did training in surgery,” Ackerman, who practices in Jacksonville, said. “Petitioner told the board he was a medical resident in Jamaica, he did a gynecology residency in Jamaica, he did OBGYN in the United States, he did OBGYN and family practice. So, it’s nice hearing you say that, but I think what he’s saying is inconsistent with his history and his training.”

BBL crackdown

In addition to the standard-of-care charges, Walker was charged with failing to ensure his clinic complied with Florida’s requirements for plastic surgery centers that perform Brazilian butt lifts. Walker failed to timely register with the state the names of two physicians who worked at the clinic

Those requirements were imposed by the Legislature following news reports exposing a spate of deaths at plastic surgery centers in Florida involving Brazilian butt lifts.

As the deaths continued, more changes were made to further protect patients and in 2024 the Legislature began requiring clinics to carry liability insurance — a vast change in Florida, which had allowed physicians to practice medicine without having medical malpractice coverage.

Walker was also charged with fraudulently renewing his medical license by not disclosing his guilty plea to the federal kickback violations.

Those violations stem from a portion of Walker’s practice dedicated to surgically removing transvaginal mesh, which is used to manage urinary incontinence for women. The mesh has been the subject of thousands of lawsuits against multiple product manufacturers. Walker served as an expert in product-liability litigation arising from the mesh’s use. The record shows that Walker performed surgeries on patients from Florida and around the nation. The referrals were made by other physicians, law firms, and online blog sites.

For patients outside of Orlando, Walker used a company called Surgical Assistance to arrange transportation, provide lodging, and cover the costs of laboratory work, pathology, and nursing care. Walker paid Surgical Assistance $3,000 per patient for those services. He also accepted referrals from Surgical Assistance, although they represented just 10% of his referrals.

He was indicted in the U.S. District Court for the Eastern District of New York for allegedly violating several provisions of federal law, including the Travel Act, for his arrangement with Surgical Assistance. The law bans bribes or kickbacks in the interstate commerce involving referral patients.

Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: info@floridaphoenix.com.

Florida leads the nation in Obamacare enrollment after a month of open enrollment.

Data released by the Centers for Medicare and Medicaid Services show that 1,458,792 Florida residents signed up for insurance coverage through the “Marketplace” for 2025. The Marketplace, obtainable through Healthcare.gov, is where customers can compare health plans and provides enrollment services and other help.

Nationally, 5,364,197 people signed up for coverage between Nov. 1 and Nov. 30. Nearly 4.4 million people are returning customers but 988,000 obtained new coverage, the federal data show.

The Marketplace is a centerpiece of the Affordable Care Act, often referred to as Obamacare. President-elect Donald Trump has vowed to repeal the program but has offered no details.

“ACA Marketplace open enrollment continues with more than 5.3 million people signing up for coverage since the beginning of the open enrollment period,” said CMS Administrator Chiquita Brooks-LaSure. “These numbers reflect the strong and ongoing demand that individuals and families have for affordable, high-quality health care coverage and we expect this year will set another plan selection record.”

Open enrollment for 2025 health insurance coverage began Nov. 1 and runs through Jan. 15. Consumers who enroll by midnight Dec. 15 will have coverage effective Jan. 1. Health insurance coverage doesn’t kick in for others until the following month.

What Florida Politicos hate people love

Although Republicans in Florida have not expanded Medicaid to lower-income childless adults as the ACA allows, the federal health law is popular with residents who annually have flocked to the marketplace for health coverage.

Florida has consistently led the nation in ACA enrollment and this year is no different with enrollments far out pacing Texas, which saw the second highest rate with 1,077,883 sign-ups since Nov. 1.

Four insurance companies and 12 health maintenance organizations (HMOs) are participating in the Florida marketplace, the Florida Office of Insurance Regulation website shows.

“Through the Marketplace millions of Americans seeking health coverage continue to find a high-quality plan at a low cost,” said U.S. Health and Human Services Secretary Xavier Becerra. “With many people shopping online for holiday gifts, you’ll find the best deal in town at HealthCare.gov. Sign up for a health plan that meets your needs — and gives you peace of mind.”

Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: info@floridaphoenix.com. Follow Florida Phoenix on Facebook and X.

The administration of Gov. Ron DeSantis wants to punish a doctor who violated the state’s 24-hour rule on abortion by stripping away her medical license.

The push to revoke the license is going forward even though an administrative law judge (ALJ) who looked at the physician’s actions suggested a $10,000 fine and a reprimand.

But the Florida Department of Health has taken exception to the judge’s position and is asking the Florida Board of Medicine (BOM) to revoke the license of Dr. Candace Cooley.

“The Board [of Medicine] should send a clear message to Respondent and every other physician in Florida that knowing and complying with the laws governing their practice is not optional, and serious breaches of this duty will be met with serious consequences,” DOH Chief Andrew Pietrylo Jr. wrote in a 19- page exception to Administrative Law Judge James Peterson’s recommended order.

Gov. Ron DeSantis signed Florida’s 15-week abortion ban into law on April 14, 2022. Credit: Governor Ron DeSantis Facebook.

The case against Cooley is slated to be discussed during the Board of Medicine’s Dec. 6 meeting in Orlando. That would be shortly after voters in the state decide whether to pass Amendment 4, an initiative that would bar government interference with abortion up to the point of viability. The DeSantis administration has been actively engaged in a campaign designed to convince voters to vote down the amendment.

Cooley was charged with a single violation of “failing to perform any statutory or legal obligation placed upon a licensed physician” stemming from 193 abortions she performed between April 25 and May 7, 2022, without waiting 24 hours between consultation and the procedure — one of the mandated informed consent requirements that are part of the state’s abortion laws.

In his recommended order, Peterson said the state cannot discipline Cooley on charges not alleged in the complaint. The DOH alleged a single violation of the law, not 193 separate violations.

Pietrylo argued Peterson’s conclusion is “illogical” and that since the filing of the complaint Cooley has known the state is seeking discipline based on her performing 193 abortions without adhering to the waiting period.

“According to the [administrative law judge] reasoning, the Department would have to plead 193 separate counts in its Administrative Complaint in order for the Board to consider the number of offenses as an aggravating factor. This would result in an entirely unwieldy and repetitive pleading for the parties and the ALJ to muddle through, and it would fail to provide Respondent with any additional meaningful notice of the charges against her,” Pietrylo wrote.

In legal filings Julie Gallagher, the attorney representing Cooley, said the state’s push to revoke Cooley’s license is “extreme and unwarranted.”

Inadvertent, unknowing and unintentional

Cooley practiced medicine in Florida between 1999–2011 and 2014–2023. She is certified by the American Board of Obstetrics and Gynecology. She provided both surgical and medication abortions with the “majority being medication abortions,” the record shows. She had previously been disciplined by the state medical board in 2019 and had restrictions placed on her license.

Cooley had been working at the Center of Orlando for Women, an abortion clinic, since 2019 but was unaware that Florida had a 24-hour waiting period for abortions. The restriction was passed in 2015 but had been put on hold pending litigation. Circuit Court Judge Angela Dempsey in early April upheld the law pending a written final order, which she issued on April 25, 2022.

Clinic management started contacting state health care regulators on April 14, asking about the effective date of the 24-hour waiting period. Julie Murano, the clinic’s human resources director, made 14 calls to the state Agency for Health Care Administration (AHCA).

“Each time she communicated with AHCA, she was told ‘we are aware of the ruling and we have no information’ or words to that effect,” the record shows. “On May 3, 2022, the contact at AHCA told Ms. Murano to stop calling every day and to check the website as the information would be posted on AHCA’s website when they received the information.”

The clinic implemented its 24-hour waiting period policy on May 9. Cooley, the only physician who performed abortions at the clinic, provided the 193 abortions between the date of the ruling and May 7.

AHCA ultimately fined the clinic $193,000, nearly three times more than an ALJ’s recommendation. The clinic raised the money it needed to cover the fine through crowdfunding.

AHCA regulates health care facilities but has no authority over health care professionals. So, the agency referred Cooley to the Department of Health, which houses the state’s medical and health care boards, for prosecution.

Retaliatory

Sixteen medical doctors had their licenses revoked by the BOM in state fiscal year 2022-23, the latest available data. By comparison, the BOM placed restrictions or limitations on 75 licenses during the same period.

“Revocation is traditionally reserved for the most egregious cases in which the board finds the physicians is an immediate threat to the safety of Florida patients,” said Jacksonville health care attorney and lobbyist Chris Nuland, who regularly attends the board meetings.

In her response to the department’s exceptions, Gallagher said none of the 193 patients who had abortions were injured as a result of Cooley’s actions and none filed complaints.

Cooley complied with all the other informed consent requirements in Florida’s abortion laws, including providing an ultrasound that confirms gestational age and information about abortions and the risks involved.

“To say she performed 193 abortions without informed consent is misleading,” Gallagher wrote.

Gallagher in her response also accuses the DeSantis administration of taking “retaliatory” action against Cooley, who chose not to waive her right to an administrative hearing. Before the administrative hearing, Gallagher contends, the board sought restrictions against Cooley’s license that would have prohibited her from performing abortions again in Florida.

“There was no indication Petitioner might seek revocation of Respondent’s license if she did not accept the offer, until the Department filed its Proposed Recommended Order and recommended revocation. This increase in penalty recommendation appears to be motivated by retaliation for Respondent taking the Department to a trial so she could present mitigation to the Judge which, in this case, took an hour.”

The move to revoke the license, Gallagher argues, is “extreme” because the board did not revoke Dr. Christopher Saputa’s license after he failed to provide emergency care to patients following abortions. Gallagher noted that his malpractice was found to be so severe that two patients nearly died and at least one lost her fertility.

‘In those grievous cases, the Board did not revoke Dr. Saputa’s license. Rather, it suspended him for one year and restricted him from performing abortions in Florida,” Gallagher wrote. “Similarly, some physicians with patient deaths related to the Brazilian Butt Lift procedure have not had their licenses revoked but, rather, have been given remedial education and monitoring.”

The DOH’s Pietrylo, though, argues the 193 women were exposed to “significant potential harm” and that revocation, not a fine, is the fitting punishment.

“Respondent’s violation was inherently severe because it deprived women of their right to make a fully informed decision about whether to terminate their pregnancy. It also exposed the women to significant potential harm — even if no actual harm resulted. These patients proceeded with a medical procedure that could lead to excessive bleeding, infection, organ perforation, adverse reactions to medications, and even death, without having the full amount of time required to consider these risks.”

Anti-abortion board members

The Florida Board of Medicine is a 15-member panel appointed by the governor and charged with disciplining physicians and establishing rules and standards of care for medical doctors in the state.

The case against Cooley is slated to be discussed during the Board of Medicine’s Dec. 6 meeting in Orlando.

DeSantis’s choice to appoint Dr. Steven Christie, an oncological radiologist in Miami and creator of the website Speaking for the Unborn, to the board made headlines earlier this year.

In addition to practicing medicine, Christie lectures regularly on “marriage, family, and the dignity of life,” according to Catholic Charities of Central Florida’s website. He’s also an attorney and creator of a book and video teaching series on abortion that New York Archbishop Timothy Dolan called a “must-read.”

DeSantis reappointed Dr. Hector Vila to the board. Vila is politically active on the abortion issue. The anesthesiologist was a witness for the state when the 24-hour waiting period was being litigated and testified that he was “not aware of another area of medicine, besides abortion, in which a non-emergency outpatient invasive procedure is performed without a prior visit and consultation.”

He stated that the lack of a 24-hour waiting period “would fall below the acceptable medical standard of care.”

Gallagher told the Florida Phoenix Thursday that her client received a “reasonable recommendation from the ALJ but the department is trying to increase the penalty to revocation. We will see what the board does.”

Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: info@floridaphoenix.com. Follow Florida Phoenix on Facebook and X.