1. Opinion

Florida Legislature looking for a compromise on health care

Published Jan. 9, 2016

The Medicaid expansion debate that paralyzed the 2015 legislative session isn't likely to resume when lawmakers return to Tallahassee this week.

But that doesn't mean health care will be on the back burner in 2016.

The issue will play a central role in the budget negotiations, largely because lawmakers must decide whether to backfill $400 million in federal cuts to a program that helps hospitals pay for charity care.

What's more, leaders in both the House and Senate have said they want to improve access to health care while also driving down costs. Plans intended to accomplish that goal — including one that would let patients see primary care physicians without involving insurance companies — are already gaining traction.

"Over the last two years, we haven't seen much movement on a host of issues because (the session) has been bogged down by a discussion on Medicaid expansion," said Tim Stapleton, of the Florida Medical Association, which represents physicians. "There are ideas that have emanated in the House that are going to get a hearing in the Senate this year."

Last year, the House and Senate clashed over whether to accept $2.8 billion in federal Medicaid expansion money. The Senate advanced a plan to spend the money on coverage for more than 600,000 working, low-income Floridians. The House rejected it.

The debate became so contentious the House adjourned days early.

"It was a disaster," said Senate Health Policy Committee Vice Chairwoman Eleanor Sobel, a Hollywood Democrat.

Sobel and other leaders don't expect the issue to come up in 2016.

"What the Legislature is doing is finding areas where we can agree and work out compromises — and not approaching those areas where there is no compromise," she said.

A bill almost certain to win support in both chambers would allow physician assistants and advanced registered nurse practitioners to prescribe medications under certain circumstances. One such proposal (SB 152) has already won the support of two Senate committees.

Both chambers have also shown interest in allowing primary care physicians to contract directly with patients without having to go through insurance.

The House is advancing a number of additional measures its leaders say will improve access and bring down costs. Among them: creating new "recovery centers" for postsurgical care; allowing patients to spend the night at same-day surgery centers; and eliminating the state process that dictates where new hospitals can be built.

"There is no one pill that's going to solve this problem," said House Health and Human Services Committee Chairman Jason Brodeur, R-Sanford. "But we can make a difference with these reforms."

The issues also will be in play in the Senate; several are being proposed by former Senate President Don Gaetz, R-Niceville. But with opposition already bubbling up from some hospital groups, they may have a tough time winning support in the upper chamber.

Bruce Rueben, president of the Florida Hospital Association, said his organization intends to fight some of the policies, particularly those that could actually increase costs.

His take on the ambulatory surgery center proposal: "You might be able to get an outpatient procedure at the ambulatory surgery center. But when you have to go in for inpatient surgery, it is going to cost a lot more."

Expect at least one additional voice in the health policy conversation.

Republican Gov. Rick Scott, a former hospital executive, has proposed legislation that would limit what hospitals can charge patients. He also intends to work with the Legislature on "reforms that will allow patients to see what revenues hospitals are collecting and what they are billing patients for medical procedures," he said last month.

The biggest challenge, however, will likely be budget-related.

Federal health officials recently said Florida's Low Income Pool, which helps hospitals cover the cost of charity care, will be capped at $608 million for 2016-17, down from $1 billion this year.

That leaves Florida lawmakers facing a difficult decision: whether to use state dollars to make up the difference.

Scott has already made his opinion known. Despite a projected surplus somewhere between $635 million and $1.3 billion, he did not include any extra funding for hospitals in his budget proposal.

Sen. Rene Garcia, a Hialeah Republican who chairs the Health and Human Services Appropriations Subcommittee, has hinted that the hospitals may have to shoulder some cuts.

But some lawmakers, including Sobel, say they would be hesitant to approve a budget that hurts safety-net hospitals.

"Rick Scott is saying the hospitals are making a lot of money, but that's not true for all hospitals," she said. "The hospitals will suffer if we don't replace the funding."