1. Florida Politics

Can't keep up with the health care debate in Tallahassee? This Q&A breaks it down

Published Jun. 9, 2015

It has been a head-spinning time in Tallahassee. Lawmakers adjourned the 2015 legislative session last month without finishing a state budget, then returned last week for a special session and finally reached some consensus over the weekend.

At issue: how to compensate hospitals that provide health care for the state's low-income residents.

For those who haven't followed every twist and turn, here's a look at the developments so far and where lawmakers stand on the budget:

What progress was made over the weekend?

Leaders in the House and Senate agreed Saturday to use $396 million in state taxpayer money to help hospitals across Florida cover the cost of charity care.

I thought charity care was paid for by the federal government.

It used to be — and to some extent, still is. In 2005, the federal government approved a program known as the Low Income Pool, or LIP, to help compensate Florida hospitals that treat uninsured, under-insured and Medicaid patients. For nearly a decade, Florida received more than $1 billion in annual LIP payments from the federal government. But last month, the feds asked Florida to phase out the program, and hinted that federal LIP funding would be reduced to about $360 million for the forthcoming fiscal year.

Why does the federal government want Florida to phase out the LIP program?

The Obama administration is driving a nationwide effort to expand health insurance to the poor. Federal health officials argue that expanding coverage using Medicaid dollars would enable more people to visit doctors — and reduce the amount of charity care in hospitals. A report published last week by the White House Council of Economic Advisers estimated that the cost of uncompensated care would drop by $790 million next year if Florida expanded coverage. Medicaid expansion, however, is a state decision.

So why doesn't Florida expand coverage?

The Republican-led Florida Senate proposed a plan that would have used $2.2 billion in federal Medicaid expansion money to provide subsidized insurance coverage to about 600,000 low-income working residents. But the more conservative House rejected the proposal on Friday, characterizing it as a handout for able-bodied adults that would have increased Florida's reliance on Medicaid.

What does all of this mean for local hospitals?

The reduction in federal LIP funding would have meant serious cuts for hospitals like Tampa General Hospital and All Children's Hospital Johns Hopkins Medicine in St. Petersburg. Together they provide the most charity care in the region. The new plan to use $396 million in state money for charity care would offset most of the losses. But lawmakers have not yet said how the money would be distributed, meaning hospital executives are still holding their breath.

Would the federal government have to weigh in?

Yes. Florida could use the $396 million to draw down $604 million in federal matching money. That would require approval from Washington.

What happens next?

The Legislature still needs to agree on the specifics of the plan, namely how to divvy up the nearly $1 billion in state and federal money. The House and Senate must then formally approve it as part of the state budget.

What is their deadline?

The Legislature must pass a budget before July 1, when the new fiscal year begins.

Where does Republican Gov. Rick Scott stand on all of this?

Scott opposes using state money to make up for shortages from the LIP program. He recently proposed his own plan to help the hospitals, which would have used local property tax revenues to draw down federal money. But the plan quickly met opposition from "safety-net" hospitals such as Tampa General and All Children's, which could have lost hundreds of millions of dollars collectively, and was ultimately cast aside by the Legislature.

Would Scott veto a budget that uses state money for charity care?

He has not said. On Monday, Scott spokeswoman Jackie Schutz said the governor was "continuing to monitor the progress" in the Legislature.

Isn't Scott suing the federal government over the Low Income Pool?

Yes. The lawsuit alleges that the federal government tried to coerce Florida into expanding Medicaid by threatening to withhold federal LIP money. Scott filed a petition Monday asking for court-ordered mediation in the case. The federal government has until noon today to respond.

Kathleen McGrory can be reached at kmcgrory@tampabay.com or (727) 893-8330. Follow @kmcgrory.


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