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Senate passes version of budget that changes Medicaid, keeps prisons open

TALLAHASSEE — The state Senate shifted rightward Wednesday by pushing plans to give private companies more tax money to manage prison operations and health care for the poor.

As debate over the state budget began in earnest, the one-two privatization punch drew opposition from Democrats. They managed to soften the blow to the public prison system — job cuts had been on the table — but failed to halt a sweeping change for the Medicaid program that Republicans proposed in reaction to President Barack Obama's signing of the health care reform law.

In the end, senators unanimously adopted a budget proposal, backing off a controversial plan to save money by opening a privately run prison and closing two state-run lockups.

The Senate budget would allow the 2,200-bed, $113 million private Blackwater River prison in Milton to open Nov. 1. It would be run by the GEO Group, with its cell blocks filled with inmates from other state-run prisons.

The House has not yet approved a budget proposal.

"Prisons won't be closed, and officers won't lose their jobs," said David Murrell of the Florida Police Benevolent Association, the guards union that initially faced the loss of more than 600 jobs.

The Medicaid privatization effort, also wrapped into the Senate's proposed $69.4 billion budget, passed despite Democratic concerns about restructuring Medicaid, a nearly $19 billion state-federal health program for the poor that serves 2.7 million people, or 14 percent of Florida's population.

Republican Sen. Joe Negron of Stuart, part of a wave of new conservatives in the Senate, sponsored what was called the "transformation of how Medicaid works," because the program's costs and rolls are climbing and "ObamaCare" could add 1.8 million people to the Florida rolls by 2019.

"I don't think we can afford to wait," Negron said. "The reason we can't put money into education, we can't put money that we want into other areas of the budget is because the way Medicaid works now is they (federal officials) just come and hand us an invoice: 'You owe us $1.8 billion this year. You owe us $2 billion.' "

In recent years, the Senate was a more moderate body that would put the brakes on conservative education and health care policies, but no more. Such measures are flying out of the Senate this year.

In just 168 words that had never before been publicly debated in the Legislature, Negron and two top Senate leaders, Mike Haridopolos and Don Gaetz, proposed the language that would transform Medicaid by capping its yearly budget, changing some benefits, instituting co-payments and deductibles, and giving recipients vouchers to buy private insurance.

The Medicaid changes are not guaranteed. They must be approved by the federal government, which is controlled by Democrats. And the state House didn't take up a similar proposal as it began debate on its proposed $67.2 billion budget Wednesday.

Though Republicans have fretted about the cost of Medicaid, the state's proportion of the health program's costs have declined in recent years because of federal stimulus money. Also, the Legislature last year transferred $1.8 billion in state and federal money that would have gone to Medicaid to plug other holes in the budget and avoid raising more taxes.

A leading critic of Negron's plan, Democratic Sen. Nan Rich of Weston, called it a giveaway to insurance companies. Already, the Senate and House want to expand the role of Medicaid managed-care companies that stand to profit by gaining enrollees under Obama's health plan, which also requires nearly everyone to buy health insurance or face fines.

Rich said Negron's plan to issue Medicaid vouchers to recipients would further undermine the public health care system. "This is the privatization of Medicaid," Rich said.

The House is expected to pass its budget today, setting in motion weeks of House-Senate negotiations. Debate on Wednesday focused on cost-cutting plans in health care, education and public safety to plug a budget shortfall of up to $3.2 billion.

House Republicans said their budget is responsible in a "historically difficult" time, as Rep. Anitere Flores, R-Miami, put it. Democrats assailed Republican plans to cut state worker pay by 3 percent and lower pension benefits for 300,000 retired state employees.

"It's a terrible budget," said Rep. Darryl Rouson, D-St. Petersburg.

The House hotly debated a proposal to balance the budget by siphoning $438 million from the state's road-building fund, jeopardizing construction projects and eliminating up to 8,000 jobs a year. The road fund raid is not included in the Senate budget.

Both chambers' budgets whittle away some benefits of working for the state. The House eliminates a monthly health insurance subsidy for retirees that offsets the cost of their retirement health insurance. The Senate requires all current employees to start paying into the retirement fund. Both changes seek to close the $15.4 billion deficit now in the Florida retirement system.

Unlike the House, the Senate uses $435 million in hoped-for gambling money and tentatively budgets $880 million in new Medicaid stimulus money yet to be approved by Congress. With the extra cash, Senate Republican leader Alex Diaz de la Portilla of Miami led an effort to block cuts to senior meal programs being contemplated by the Senate.

The Senate budget also seeks to expand former Gov. Jeb Bush's managed-care-based Medicaid reform plan to 19 counties, including Hernando, Hillsborough, Pasco and Pinellas.

Negron warned the extra Medicaid money from the stimulus will soon run out, and Medicaid recipients need to be treated like regular folks seeking insurance.

"We're not going to give people a pot of money," Negron said. "We're going to give them an insurance card."

Times/Herald staff writer Mary Ellen Klas contributed to this report. Marc Caputo can be reached at mcaputo@miamiherald.com.

Senate passes version of budget that changes Medicaid, keeps prisons open 03/31/10 [Last modified: Wednesday, March 31, 2010 11:15pm]
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