Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

— It’s a trend —

Florida’s Safety Net Hospitals say the newest round of Graduate Medical Education data confirms a report from earlier this year showing the hospitals that provide the state’s most complex care are also training the most doctors.

The new update from the Safety Net Hospital Alliance of Florida shows its members once again outpacing the rest of the state in residency Match Rates, program performance and physician retention.

It’s an extension of the findings from the Alliance’s 2020-24 Florida Hospital GME Match Rates & Quality report, which found that Safety Net systems are not only filling nearly all their residency slots, but doing so at rates above both the statewide and national averages.

This year’s numbers reinforce those findings.

According to the Alliance, Safety Net Hospitals draw nearly half of all new residents choosing to train in the state. Their combined Match Rate reached 100% after the supplemental match, and their newer GME programs continue to post perfect fills year after year — a sign, the group argues, that program quality matters more than program age.

“This 2025 data proves, once and for all, that Safety Net Hospitals set the pace for training the next generation of Florida’s doctors. Safety Net Hospitals comprise only 14% of hospitals, yet almost 50% of the new doctors are choosing our hospitals to complete their training,” said Safety Net Hospitals President & COO Lindy Kennedy.

”This is because medical school graduates seek out high-quality programs when considering where to do their training. For Florida families, that means more communities gaining access to well-trained, compassionate doctors.”

Statewide trends are moving in the same direction. Since 2020, Florida has increased the number of new doctors in training by nearly 50%, expanded GME slots by more than 40%, and increased the number of hospitals administering GME from 58 to 65.

“Excellence in care and excellence in training go hand in hand, and that is why our hospitals consistently lead in both. Every physician we train represents another step toward ensuring every Florida family continues to have access to outstanding care close to home,” Safety Net Hospitals CEO Justin Senior said.

— Tick Tock —

As the calendar ticks toward the Dec. 31 expiration of the enhanced Affordable Care Act premium tax credits, Florida health advocates are sounding increasingly alarmed about what they describe as a slow-moving but entirely predictable coverage shock.

Multiple recent reports point to the same conclusion: Florida has the most to lose if Congress allows the subsidies to lapse. Roughly 4.7 million Floridians are enrolled in ACA marketplace plans — more than any other state — and about a quarter of all non-elderly residents rely on the marketplace for coverage.

Analysts warn that premiums could spike dramatically without the enhanced credits, with some estimates projecting average increases of more than 100% for subsidized enrollees. That kind of jump would price out as many as 1.4 million Floridians, according to Florida Voices for Health, and leave many others making trade-offs between health care and basic necessities.

Carriers, meanwhile, have signaled steep rate increases if federal support ends, which could trigger a classic “death spiral.” As younger people are priced out, the pool of insured Floridians shrinks, raising average risk and, by extension, premiums for those who maintain coverage.

Florida’s lack of Medicaid expansion leaves many of those priced out of marketplace plans without a fallback option. With the deadline now weeks away, stakeholders are urging Congress to extend the credits before the state tumbles off what they say is a preventable coverage cliff.

Floridians can estimate how much their premiums would increase if the credits aren’t extended via KFF’s calculator, which accounts for required contribution caps released by the IRS for 2026 and updated federal poverty guidelines.

— Cracks in the infrastructure —

A new national analysis warns that the country’s unpaid family caregiver network is nearing a breaking point, with Florida landing in the middle of the pack for overall burden but still facing steep pressure points.

The report on the “invisible infrastructure,” released by Seniorly, finds that 38 million Americans provide an average of 3.9 hours of unpaid eldercare each day, up sharply from a decade ago. The trend is driven by rising life expectancy, the rapid growth of the 85-plus population, projected to more than double by 2050, and the escalating cost of home- and community-based services.

Florida ranked No. 28 for overall caregiver strain, but the state still posted some red flags. It had the worst ratio in the nation of residents receiving Medicaid home-based services to those stuck on waiting lists and one of the highest shares of multigenerational households. This structure lends itself to constant caregiving.

Adult day care is comparatively affordable, with a median cost of $85 per day. Still, annual home health costs roughly 1.24 times higher than the median income of senior households, showing how paid support is out of reach for many Florida seniors.

The study also highlights the toll on caregivers themselves: higher rates of depression and deteriorating health, reduced work hours, and lost wages and benefits. The financial impacts are estimated to exceed $1 trillion a year nationwide, according to an analysis by the nonprofit National Partnership for Women & Families.

— Power leader —

Simply Healthcare’s Medicaid Plan President Dana Gryniuk was recently named one of the South Florida Business Journal’s 2025 Power Leaders in Health Care. She oversees the Florida-based Medicaid plan’s delivery of patient-centered and whole-person care to more than 675,000 Medicaid and Florida Healthy Kids members. 

Gryniuk is instrumental in crafting the evolving landscape of health policy and care delivery for Floridians. Through her leadership, Simply Healthcare consistently launches innovative initiatives that expand access to care and positively transform lives. Recently, these efforts have included the Florida Self-Sufficiency Council, statewide health literacy efforts and enhanced mental health support services at Wolfson Children’s Hospital, among numerous other impactful projects. 

Testifying before the Florida House Health Care Budget Subcommittee on Tuesday, November 18, as part of a panel of Medicaid providers, Gryniuk underscored Simply Healthcare’s core philosophy of empowering Floridians to be proactive in their health and well-being. 

“We like to empower our members in their health care journey,” she said. “We want to educate them on the options that they have being served by a Managed Care Plan — whether it’s value-added benefits, whether it’s wraparound services. Is it food insecurity? Are they looking for employment? We want to be able to help mom, dad, grandma or any legal guardian in empowering them to have a better health care experience.”

— Holiday cheer —

The Tampa General Hospital Foundation is teaming up once again with jewelry designer Kendra Scott for a holiday-season fundraiser benefiting Muma Children’s Hospital.

This year, a young patient got the opportunity to design her own line to help others.

Charlize Davis, now 10, survived a devastating house fire last year and has spent the months since undergoing ongoing procedures at Muma Children’s Hospital at TGH. Her mother describes the hospital as the family’s “anchor” through a long and challenging recovery.

“The exceptional medical care, paired with the love, kindness and remarkable encouragement from the doctors, nurses and staff at Muma Children’s Hospital, transformed an unbearably dark time into one filled with hope,” Jamie Davis said.

Charlize returns to the hospital monthly for procedures that she’ll need for a few years and is known for her courage and positivity. She was invited to Scott’s shop at Hyde Park Village in Tampa to design personalized pendants as part of the Kendra Gives Back program. She created the Brave Heart Collection by Charlize, which her mom said reflects Charlize’s spirit.

“Creating this collection is her way of giving back, celebrating the hospital that continues to change her life, and helping other children receive the same level of care,” Davis said.

“Despite everything she has been through, Charlize remains the same loving child who sings and dances in the hallways, hugs everyone she meets, and believes every day is full of rainbows. That joy shines through every colorful piece in this collection — a little girl with a huge heart and extraordinary resilience.”

Kendra Scott will host an in-store fundraiser benefiting Muma Children’s Hospital from 5-7 p.m. on Tuesday, Dec. 9, at its Hyde Park location, with 20% of sales supporting the Child Life Fund, which provides toys, games and enrichment activities for pediatric patients.

Both the Brave Heart Collection and the TGH Blue Collection are available online. Shoppers can also use code GIVEBACK-TGH2025 at kendrascott.com from Dec. 9-18 to direct 20% of their purchase to Muma Children’s Hospital.

— ICYMI —

“Activists have right to leaflet within 5 feet of Clearwater abortion clinic, appeals court says” via Liv Caputo of Florida Phoenix — Anti-abortion activists have the right to hand leaflets to women in the driveway of a Clearwater abortion clinic, a federal appeals court ruled Thursday. In a 2-to-1 decision, the U.S. Court of Appeals for the 11th Circuit tossed a trial judge’s decision preventing the Florida Preborn Rescue organization from entering within 5 feet of the Bread and Roses Women’s Health Center’s driveway. Instead, the lower court must pause the Clearwater ordinance preventing the group — and any other pedestrians — from entering the center’s “buffer zone” — a 38-foot stretch of public sidewalk, 28 feet of which cross the clinic’s driveway. “The Ordinance seriously burdens Florida Preborn’s speech … by restricting the sidewalk counselors’ ability to distribute leaflets to patients as they arrive at the clinic,” the majority opinion reads.

“Bills would expand health care providers’ right to sue under 2023 medical conscience objection law” via Christine Sexton of Florida Phoenix — Health care providers and insurers in Florida could opt out of providing or paying for health care services, such as abortion, that violate their conscience and under a 2023 state law, they cannot be sued in court for denying the care based on their beliefs. A pair of Republicans have filed bills that would allow health care providers and insurance companies to file lawsuits seeking damages, injunctive relief, and attorney fees for adverse actions taken against them for exercising their medical conscience rights. Rep. Dean Black sponsors HB 551; Sen. Clay Yarborough is offering the identical Senate companion bill, SB 670. “Well, I think in this situation, the concern is that a provider — a doctor, a nurse, a lab tech — whatever, is being compelled to perform a service that violates their conscience. … So, think, you know, being forced to perform transgender surgery or an abortion, something like that,” Black said.

“State’s federal Medicaid payment undermines Ron DeSantis claim about Hope Florida donation” via Jeffrey Schweers of the Orlando Sentinel — Florida’s $10 million diversion from a Medicaid fraud settlement to the Governor’s favored Hope Florida charity is facing new scrutiny after state payment records show Florida repaid the federal government based on the full $67 million settlement, contradicting earlier claims that the $10 million wasn’t Medicaid money. DeSantis had called the donation a discretionary “cherry on the top,” but the state’s 57% federal pass-through indicates otherwise. “Not only did we lose $10 million, but we are still paying the feds back for it,” said Rep. Alex Andrade, who led the Legislature’s probe and argues the entire settlement “was Medicaid money.” The repayment revelation deepens a scandal that sparked investigations, fueled criticism of Casey DeSantis’ Hope Florida network, and raised allegations that Medicaid funds were steered into political fights.

“Florida’s health department eyes changes to childhood immunizations” via Katelyn Ferral of the Tampa Bay Times — State health officials will meet Dec. 12 in Panama City Beach to begin rolling back childhood immunization requirements, three months after DeSantis and Surgeon General Joseph Ladapo announced plans to end all vaccine mandates. The Department of Health will review administrative-code vaccine rules, including chickenpox, hepatitis B, Hib and pneumococcal shots, which the agency can change without legislators. Other long-required vaccines, such as polio and mumps, are written into statute and cannot be removed without a bill and none has been filed. Florida would become the first state to scale back school vaccine mandates, even as kindergarten vaccination rates fall and health experts warn of increased risk to vulnerable children. DeSantis and Ladapo frame the move as a protection of personal freedom.

— RULES —

The Board of Osteopathic Medicine’s final rule regarding physician assistant fees (64B15-6.013) goes into effect on Dec. 15. More here.

The Board of Medicine’s final rule regarding physician assistant fees (64B15-6.019) goes into effect on Dec. 15. More here.

The Board of Pharmacy’s final rule regarding pharmacist licensure and pharmacist technician registration by endorsement goes into effect Dec. 14. More here.

The Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling’s final rule regarding application for licensure endorsement goes into effect Dec. 14. More here.

— PENCIL IT IN —

Dec. 9

Happy birthday to Rep. Webster Barnaby!

9 a.m. — The EDR Social Services Estimating Conference meets to review KidCare expenditures. Room 117, Knott Building, the Capitol.

10 a.m. — The Senate Health Policy Committee meets to consider SB 312 on patient-directed medical orders and hear the Department of Health’s presentation on the Cancer Connect Collaborative’s Annual Report and the Cancer Innovation Fund. Room 412, Knott Building, the Capitol.

12:30 p.m. — The House Health Professions & Programs Subcommittee meets to consider bills, including the Social Work Licensure Interstate Compact and Dental Therapy. Members will also hear a briefing from Dr. Almut Winterstein of UF’s Consortium for Medical Marijuana Clinical Outcomes Research. Room 102, House Office Building, the Capitol.

3 p.m. — The House Human Services Subcommittee convenes for a series of briefings on quality guardianship, DOEA investigations, and the Auditor General’s findings related to the Office of Public and Professional Guardians. DOEA Secretary Michelle Branham is scheduled to present. Room 314, House Office Building, the Capitol.

Dec. 10

Happy birthday to Rep. Alex Rizo!

1 p.m. — The House Health Care Facilities & Systems Subcommittee receives updates from AHCA on nursing home resident satisfaction and patient safety culture, as well as Medicaid managed care outcomes related to maternal health and infant mortality. Room 404, House Office Building, the Capitol.

Dec. 11

9 a.m. — The House Health Care Budget Subcommittee meets for a presentation on the Department of Health’s use of artificial intelligence, including the Medical Quality Assurance Enforcement Licensure Information (ELI) System. Room 314, House Office Building, the Capitol.

12:30 p.m. — The House Health & Human Services Committee considers HB 355 and hosts a panel discussion on AI in health programs, with leaders from Cleveland Clinic Florida, FAHP, Lakeview Center, DCF, the National Health Law Program and FSU’s College of Nursing. Room 17, House Office Building, the Capitol.

Dec. 18

Happy birthday to Rep. Rita Harris!

Dec. 19

Happy birthday to Sen. Jonathan Martin!

10 a.m. — The EDR Self-Insurance Estimating Conference meets to review State Employees’ Health Insurance enrollment. Room 117, Knott Building, the Capitol.

A federal watchdog says the Energy Foundation China (EF China) and U.S. Energy Foundation (US EF) violated Florida fundraising regulations.

Americans for Public Trust (APT), a group focused on foreign dark money fundraising, sent a letter to Agriculture Commissioner Wilton Simpson alleging the nonprofit groups broke Florida’s Solicitation of Contributions Act. That requires any nonprofits soliciting donations in Florida to register with the Department of Agriculture and Consumer Affairs — and now bars registered entities from taking money from any “foreign source of concern.”

“EF China, an organization ‘that works with the Chinese government on climate change issues,’ is one of the most prolific processers of foreign dark money,” wrote Caitlin Sutherland, Executive Director of APT, in a six-page letter to Simpson.

The organization says EF China directs money in different nations through other nonprofits.

“While this foreign funding — which is mostly pushing extremist environmental policies — has been exposed, countless more millions could very-well be flowing into EF China from the United States’ adversaries, as EF China has selectively disclosed only certain ‘key funders.’ As such, the systemic interconnectedness between EF China and the Chinese Communist Party (CCP) accentuates the urgent need for extensive inquiry,” the letter reads.

The message ties several EF China officials, including organization President Ji Zou and Executive Director of International Cooperation Huiyong Zhang, to the Chinese Communist Party.

EF China has registered in Florida as a charitable foundation since 2018. US EF, a San Francisco-based organization with the same U.S. address as EF’s China’s American office, has registered in Florida since 2022.

But APT said changes signed by Gov. Ron DeSantis in 2024 mean any connection to a “foreign country of concern” puts both groups in conflict with Florida law. State statute lists China specifically as a nation registered nonprofits cannot be funded by and still solicit charitable contributions in Florida.

“There is substantial evidence suggesting that both EF China and U.S. EF may have accepted funding or other things of value directly or indirectly from Chinese sources or facilitators,” the letter reads.

Besides EF China listing in its mission statement a desire of “contributing to China’s accomplishment of an early carbon peak and carbon neutrality,” the nonprofit has an office in Beijing and acts there under oversight of the National Development and Reform Commission of China, a Department of the nation’s State Council.

While the Beijing office is listed as a foreign branch on registration paperwork, APT says more employees for EF China work in China than in the U.S. Moreover, a number of employees for the nonprofit previously held positions with the Chinese government or communist party there.

US EF, meanwhile, has always operated as a U.S. spinoff of EF China, receiving reimbursements for expenses. That means that group, too, should not be able to solicit funds in Florida, by APT’s read.

Sutherland urges Simpson’s Department to investigate whether and to what extent both nonprofits have operated in violation of state law.

“We further request that, if so determined, the Department pursue appropriate civil and criminal penalties for any violations of the Act that it uncovers in the course of its investigation of EF China and US EF,” the letter concludes.