Miriam Harmatz is a senior attorney at Florida Legal Services and an adjunct professor in the Health Law Clinic at Florida International University College of Law. Miriam has had a life-long interest in health care access issues and began her studies and advocacy in college, when she wrote her senior thesis on why Congress failed to pass any of the promising universal health care proposals being debated in 1974. As a legal services lawyer in Miami, Miriam has worked on expanding local access to health care, including a Hill-Burton Act class complaint against the public hospital challenging inpatient admission deposits for indigent residents. Miriam led a coalition that challenged the hospital’s denial of free or reduced-cost care to foreign-born county residents. She has helped ensure due process and prescription coverage for Medicaid recipients as lead counsel on successful federal court class actions including Edmonds v. Levine and Hernandez v. Medows, No. 02-20964, 2002 WL 31060425 (S.D. Fla. Aug. 26, 2002), and helped to establish a toll-free prescription helpline for low-income Floridians. She was lead or co-counsel on federal and state court Early and Periodic Screening, Diagnosis and Treatment cases such as K.G. ex rel. Garrido v. Dudek; Smith v. Benson; and C.F. v. Dept. of Children and Families, 934 So. 2d 1 (Fla. 3rd Dist. Ct. App. 2006).
What’s a case or client or piece of advocacy that comes to mind as giving you particular personal satisfaction? Why?
In 1995 a client named Hannelore Kurnik came into my office and opened up a briefcase full of prescription drug bills she’d incurred due to ongoing Medicaid agency delays. She wanted and needed to be reimbursed, but Florida had a rule prohibiting any reimbursement to recipients—regardless of agency error. Shortly after we challenged the rule as violating the Medicaid corrective action regulation, the state offered to pay her bills if she dropped the appeal.
To my surprise, Hannelore rejected the settlement offer. It was over $1,500 and her income was only about $700 a month. She told me that since she’d become disabled (and thus impoverished) as a young woman, she could only struggle to survive economically; she said she never had any “choices” about money. Now she felt empowered to “choose” a course of action that could cost her a great deal if we lost. But, if we won, she could help other people. Fortunately we won. Hannelore got her reimbursement; the state changed its policy; and we stayed in touch until she died. Hannelore had an incredibly generous and compassionate spirit, and I’m grateful that we made “good law” together (Kurnik v. Department of Health and Rehabilitative Services).
What’s a case or client or piece of advocacy that comes to mind as causing you particular anxiety? Why?
Living and working in a state that refuses to expand Medicaid coverage under the Affordable Care Act is anxiety producing. While history suggests that non-expansion states will ultimately accept the federal money for expansion, it’s impossible not to be stressed when our clients are suffering and dying in the meantime.
If you were in charge, what’s one way (other than having more funding!) that public interest legal work would be different?
Legal Services advocates would be working closely with Affordable Care Act community enrollment assisters, identifying and working with consumers who did not get the appropriate level of assistance or who fall in the coverage gap and need help accessing the overstressed safety net.
Why is health law an important practice area for advocates concerned about low-income Americans?
The Affordable Care Act’s current and potential impact—not just on our clients but on the entire country—cannot be overstated. Much of the new health law is working well for the middle class, but for poor people—especially in non-expansion states—much needs to be done. Virtually all of our current and future clients (or someone in their families) has or will have health coverage or access issues. However, unlike food stamps or housing cases, where clients know when they have a legal issue and seek assistance (e.g., food stamps get reduced or a foreclosure notice is received) people with health care issues—whether related to eligibility or services—often don’t know they have legal rights, and they don’t come into our offices. Advocates can make a tremendous impact if we can identify and work with these folks, and we have a whole new and complicated law with which to do so.
What’s one of your guilty pleasures?
Roller blading at lunch-time.