One week after President Bush declared access to health care a top priority, Gov. Jeb Bush on Tuesday unveiled his own proposals to lower insurance costs for families, employers and the state.
His proposal comes as the governor remains under attack by Democrats and social service advocates for refusing to eliminate a 100,000-child waiting list for a popular health insurance program for the working poor.
Democratic lawmakers failed Tuesday to force a special session on the issue, but Republican leaders said they think the Legislature can deal with it during the regular session that begins March 2.
Using an obscure and rarely used state law, Democrats gathered enough petitions to the secretary of state to force the full Legislature to say whether they wanted a special session to eliminate most of the KidCare waiting list.
But the effort fell 41 votes short, 33 in the House and 8 in the Senate, a spokesman for House Democrats said Tuesday.
The vote was announced after Bush laid out a broad agenda for health care, from creating a medical records database to allowing the uninsured to get discounts on hospital bills.
The plan seeks to close the gap for the 2.8-million Floridians who lack health insurance, Bush said. Details are sketchy and no specific legislation has been released. Bush said some of his proposals could be adopted during this legislative session, while others could be years in the making.
"Uncharacteristically, I'm actually going to be patient on this because it's very complicated and it's going to take time," Bush said. "The larger issues will take more than a year to figure out," he added.
Like his brother the president, Bush favors an approach that uses promising health information technology, with the goal of a unified system of computerized medical records the Bush brothers say would reduce errors and save money.
Doctors would be able to see instantly what other doctors have prescribed, steering a patient away from medicines that don't mix, or curb illegal doctor shopping. Removing much of the paperwork of modern medicine would save time and money, Bush said.
But privacy remains a concern, Bush acknowledged. An electronic system has been proposed before but failed to win sufficient support largely because of fears that private medical information could end up in the wrong hands, or even in the hands of insurance companies that could refuse to cover a patient based on the database.
"If there were ever an instance in which the devil is in the details, this is it," said Howard Simon, director of the ACLU of Florida.
"It's great to bring technology to the health care field, but still we have to preserve the principle that people have control over their medical records, and that they can't be shared without people's knowledge or consent," Simon said.
Bush also wants to expand a pilot project that allows some insurers to bypass laws on mandated benefits in order to offer cheaper coverage for low-income patients. The plans, which often have high deductibles, cover basic services such as outpatient primary care visits, lab work and mammograms.
"Not every Floridian needs full coverage, which drives up costs," Bush said.
Bush also wants to give patients, especially those with high deductibles, easy access to price comparisons for drugs and other medical services, such as through the Internet. He wants to promote health savings accounts, open up a high risk pool for some of the state's sickest residents and allow small businesses to pool their purchasing of medical services.
One part of his plan likely to meet with resistance from Democrats deals with Healthy Kids, a state subsidized health care program. Bush wants to restrict enrollment only to kids whose parents have no access to private insurance. Some parents who have access to private insurance but who can't afford the premiums enroll their children in the program.
Lawmakers froze enrollment in the program last year to save money.
Democratic leaders said the state has the money in reserves to eliminate the waiting list immediately. "It's a question of who we are and where our morals and values lie," said Senate Democratic Leader Ron Klein, D-Boca Raton.
The vote against a special session fell largely along party lines, with Democrats voting for and Republicans against. Of the 30 Tampa Bay lawmakers, seven Republicans did not vote.
VOTING FOR A SPECIAL SESSION
Sen. Les Miller, D-Tampa; Rep. Bob Henriquez, D-Tampa; Rep. Arthenia Joyner, D-Tampa; Rep. Charlie Justice, D-St. Petersburg; Rep. Frank Peterman, D-St. Petersburg
VOTING AGAINST A SPECIAL SESSION
Sen. Nancy Argenziano, R-Dunnellon; Sen. Victor Crist, R-Tampa; Sen. Paula Dockery, R-Lakeland; Sen. Mike Fasano, R-New Port Richey; Sen. Dennis Jones, R-Treasure Island; Sen. Tom Lee, R-Brandon; Sen. Jim Sebesta, R-St. Petersburg; Rep. Kevin Ambler, R-Lutz; Rep. Thomas Anderson, R-Dunedin; Rep. Kim Berfield, R-Clearwater; Rep. Faye Culp, R-Tampa; Rep. Charles Dean, R-Inverness; Rep. Heather Fiorentino, R-New Port Richey; Rep. Bill Galvano, R-Bradenton; Rep. Sandra Murman, R-Tampa; Rep. Ron Reagan, R-Bradenton; Rep. Dennis Ross, R-Lakeland; Rep. Leslie Waters, R-Seminole
Rep. Gus Bilirakis, R-Palm Harbor; House Speaker Johnnie Byrd, R-Plant City; Rep. Frank Farkas, R-St. Petersburg; Rep. Edward Homan, R-Tampa; Rep. Ken Littlefield, R-Wesley Chapel; Rep. David Russell, R-Brooksville; Rep. Don Sullivan, R-Seminole