1. Florida Politics

Lawmaker doctors propose alternative ideas for health care reform

Published Oct. 1, 2015

TALLAHASSEE — A pair of Republican state legislators who are also doctors are pushing an alternate plan to reform health care that runs counter to the proposed overhaul laid out by their party leaders.

Reps. Julio Gonzalez, R-Venice, and Fred Costello, R-Ormond Beach, want to keep doctors in control of health care decisions and give individuals incentives to negotiate health care costs. They even want the state to run its own Medicaid program, cutting federal regulations out entirely.

The plan, laid out in a 29-page missive to a House panel Thursday, is an eight-year road map for where the two freshman lawmakers want the state to go. While some of it aligns with House leaders such as soon-to-be Speaker Richard Corcoran, R-Land O'Lakes, many of their ideas conflict with those of lawmakers who are influential in health care.

The goal, according to Gonzalez and Costello, is to cap the total cost of delivering health care at one-third of the state's budget. Medicaid totals $25.7 billion in the current state budget, about 32 percent of the total.

There is a need for a "safety net," they say, but the system as a whole should be built on the idea of "individual ownership" of people's own health care.

Just three months ago, the Florida House voted down a plan to request federal Medicaid money as a way to fund private health insurance for needy Floridians. Gonzalez, an orthopedic surgeon, and Costello, a dentist, were in the 72-vote majority.

Instead of expanding Medicaid, they suggest that the state create its own program to pay for needy Floridians' health care.

Under the plan, Florida would still use federal Medicaid dollars but would seek waivers for federal regulations.

"The states are in a much better position to decide how to allocate the funds to meet the particular needs of that state," Gonzalez said. "The cookie cutter plan from the federal government — I think we've already demonstrated that does not work.

Their plan would let patients negotiate with doctors and hospitals to get the best price and for cost savings to be split between the state and the patient. Patients could also use tax credits as an incentive to use health savings accounts, limiting insurance companies' roles as negotiators.

This is one of the tougher ideas in the proposal, Gonzalez said, and it likely won't come to fruition for at least a few years when new leaders will control the House.

Much of Gonzalez' and Costello's proposal is intended to increase competition within the health care industry, which Corcoran championed last year as part of the House's refusal of a Medicaid expansion plan.

For example, they would limit telemedicine — doctors treating patients in another facility using video technology — to only physicians licensed in Florida. Like Corcoran and other House leaders, they would allow advanced registered nurse practitioners to prescribe medicine, but they would only allow it under the direct supervision of a doctor.

They would also add a layer of protection for doctors, suggesting that the constitution be amended to repeal language that strips doctors of their licenses after three successful medical malpractice claims.

But Rep. Cary Pigman, R-Avon Park, says the Gonzalez and Costello plan does not open the industry up to enough competition. Pigman, an emergency room doctor who sits on the House Select Commitee on Affordable Health Care Access, hadn't yet read the entire plan when he spoke with the Times/Herald but said he takes issue with some of the ideas he saw in it.

"It just too much sounds like an effort to protect one professional class," Pigman said. "I would submit to you that physicians are doing perfectly fine."

Pigman works with a telemedicine company to bring in doctors from other areas to conduct evaluations when the neurologist he works with is not on shift. One recent time that he used the service, the neurologist on the other end of the line was from Boston.

"When you read the recommendation that telehealth be limited to those whose license is in the state of Florida, it really raises questions," he said.

Gonzalez contends that his and Costello's plan would expand access to health care but that it comes with quality controls, like having doctors be responsible for the work of nurse practitioners and ensuring that people using telemedicine are at least licensed in Florida, even if they don't live in the state.

"Let's make sure… we don't get an OK Corral kind of situation where all of a sudden anybody can practice in the state of Florida," Gonzalez said.

Times/Herald staff writer Jeremy Wallace contributed to this report. Contact Michael Auslen at Follow @MichaelAuslen.