State Rep. Ed Homan is floating a bill that would let more hospitals treat people whose medical costs are covered by Hillsborough County's health plan for the poor.
His hospital, for instance.
Homan, R-Tampa, is a staff orthopedic surgeon at University Community Hospital, which requested the legislation. He is a former chief of staff there.
His bill would let medical providers bid for the opportunity to treat people who use the health plan, and get reimbursed for that care. The indigent health plan serves as a base-level insurance for poor people who can't get coverage elsewhere.
In the alternate, Homan's bill would let UCH and other hospitals transfer poor people to hospitals that can be reimbursed, such as Tampa General or St. Joseph's.
Like all hospitals, UCH must accept all patients who show up for emergency care, regardless of ability to pay. They can't transfer them against their will.
Because UCH is not part of the health plan's network of providers, it can't seek reimbursement. University Community officials say they have identified about 400 health plan patients it treats annually. The hospital foots the bill, more than $700,000 a year.
Homan said he isn't trying to get special treatment for his hospital.
"It's an issue of fairness," Homan said. "And a patient ought to be able to go to the hospital they live closest to."
Homan, also a University of South Florida assistant professor of orthopedic surgery, said the hospital treats more and more poor people who qualify for the plan. That's particularly true for the hospital's facilities near USF.
The redevelopment of central Tampa public housing complexes has pushed more poor people to the USF area. And they are visiting the hospital nearest to them, Homan said.
The bill would require the county to seek bids from Hillsborough medical providers interested in participating in the health plan.
Homan said the county hasn't sought open bids for new providers since the health program was started in 1992.
His is one of six local bills proposed by Hillsborough legislative delegation members. It is the only one county commissioners have voted to oppose.
The Hillsborough delegation meets Wednesday to take public comment on local bills, including a lunchtime audience with commissioners.
Commission Chairman Jim Norman said the bill represents an unknown potential cost to a program that the board has struggled to keep solvent.
"At what cost?" Norman said. "It could be massive."
County Health and Social Services Director David Rogoff said his staff is analyzing health plan finances. He said he expects an overhaul of services and eligibility, followed by a request for bids from providers.
Homan's bill could preempt that, Rogoff said.
"It particularly complicates matters," Rogoff said, "because we're at a point where we're having to contemplate the future, and there's a possibility we may have to rebid these things."
The health plan is funded by a half-cent sales tax and offers health coverage to a fluctuating membership averaging about 15,000 people. Four networks of medical providers care for them, two built around Tampa General and St. Joseph's, the other two through private medical groups.
Those providers are reimbursed at discounted prices, comparable to what Medicaid pays.
Calvin Glidewell, chief executive officer for University Community's Medical Center, said it was not feasible for his hospital to join the network when it began. The hospital turned down a later overture to join because it felt a cap on overall reimbursements was unreasonable.
Hospital officials have been discussing how to create an arrangement with the county that would benefit both, but without success. So they turned to Homan, Glidewell said, not because of his relationship with the hospital, but because it's in his north Hillsborough district.
"What we're trying to get out of this is not special consideration for our hospital but an opportunity to participate in a meaningful fashion, or at least be able to bid to participate in the Hillsborough County health plan," Glidewell said. "If this can be resolved at the county level, certainly I'm open to doing that."
Homan said he has been talking with county officials about the health plan review. He said he understands their concerns about having back-to-back bid requests for providers and he's not trying to complicate the matter.
But he said UCH has a legitimate concern about having to write off costs for which other hospitals receive at least partial compensation.
He said if the county gives him a written, specific and not-too-distant time frame for its plan to seek bids, he will withdraw his bill.