In a bout of political horse trading that disgusted some lawmakers, a Florida Senate committee on Thursday reversed weeks of work and passed sweeping changes to hospital regulations.
The move had the extraordinary effect of having Republicans grilling each other about the wisdom of making massive changes to the state’s health care landscape with just days left in the legislative session.
“I just have to say the process stinks to high heaven,” said Sen. Tom Lee, R-Thonotosassa, after voting for the bill. “To have a radical, radical shift in a first committee of reference chairman’s bill, in appropriations, makes a mockery of the entire committee process of this institution.”
The Senate Appropriations Committee on Thursday voted on mixed party lines to appease their colleagues in the House, who want repeal certificates of need requirements this year.
Under those requirements, hospitals, nursing homes and hospice centers currently have to get state approval before opening up new locations or offering new services. Nearly 40 other states have similar rules.
For years, repealing those rules have been a target of Republican lawmakers, who believe that opening up hospitals to free market competition will result in better care and lower costs.
But this year, it’s a top priority for the new House Speaker José Oliva, R-Miami Lakes, and his chamber has had a sharply different vision of how to do it than the Senate.
His chamber passed a bill repealing the requirements this year.
The Senate, however, has spent weeks crafting rules that would soften the potential blow to hospitals.
Their bill would have limited the repeal to just general hospitals, omitting smaller specialty hospitals. It also required new hospitals to accept Medicaid and Medicare, required them to provide charity care and have at least 100 beds along with emergency room facilities.
Instead, the Senate passed a bill that would simply repeal the requirements outright in two years. And it gutted the Medicaid and Medicare requirements, the charity care requirements and removed the restrictions on specialty hospitals.
What disgusted Lee — and what was left unsaid during the committee — is the political gamesmanship at the heart of the committee’s decision.
If Oliva wants his vision for hospital regulations to become reality, he needs the Senate to pass it.
But Senate President Bill Galvano, R-Bradenton has priorities of his own that he needs the House to pass, including a massive toll road project that has stalled in Oliva’s chamber.
The committee also passed two other Oliva priorities Thursday, one that would create a Canadian prescription drug importation program and another that would encourage insurers to cover telehealth services.
Oliva all but admitted the political wrangling over the hospital regulation bill Wednesday night.
“We’re working in earnest to try to better understand what each other’s priorities are and why those bills are written the way they’re written,” he said. “You’re going to see movement on the House and Senate side on policies that are important to each other.”
With Thursday’s vote, the Senate is now much closer to Oliva’s vision.
Nevertheless, Republican senators were sharply divided over the idea of making sweeping policy changes with virtually no chance to vet them. They didn’t see the new bill until Wednesday afternoon.
“I’m a big boy, I know where we’re at, and I know what’s at stake here,” Lee said. “It’s no way to run a railroad.”
The bill sponsor, Gayle Harrell, R-Stuart, danced around the backroom deal despite being grilled by Republicans and Democrats alike about the sudden changes.
Sen. Aaron Bean, R-Jacksonville, noted that Harrell and Senate committees have spent weeks and weekends trying to craft a careful bill that would protect indigent patients.
“We have really just thrown that away,” Bean said. “So my first question is, what happened?”
Harrell wouldn’t say, just saying the new bill is “the direction we’re moving at this time."
With their new bill, she said they’ll now have two years to figure it out how best to implement the changes.
“So rather than craft a bill over a weekend, and many weeks … now we’ll have two years to really listen and hear and be very mindful and careful in how we craft those licensure provisions,” Harrell said.
Hospitals are scared of the changes, though. They fear losing valuable business to smaller, cheaper specialty hospitals that don’t have the burden of requiring emergency rooms or having to take Medicaid and Medicare patients.
Harrell admitted that she doesn’t know what effect the changes will have, and she urged her fellow senators to request the Legislature’s Office of Program Policy Analysis and Government Accountability to do a study on it.
Bean, however, strongly denounced the changes, saying it will lead to unfair competition.
“Our hospital community is saying ... ‘Bring on the competition. We’re ready to compete, but please allow a fair fight,’” said Bean, who works as a spokesman for UF Health in Jacksonville.
Rather than evaluating a community’s needs before opening a facility, smaller specialty hospitals will have a new analysis before opening up, Bean said.
“The only analysis will be on Wall Street: Can we make money?”