Welcome to Florida, where the rules really are different and the attitude toward affordable health care is callously indifferent. While most states have expanded Medicaid to cover more low-income residents, the Florida Legislature refuses to consider it. While most states regulate hospital construction, Republican lawmakers just deregulated it. Patients aren’t car buyers and hospitals aren’t auto dealerships, but they are all the same in the state capital where the free market is king and the uninsured are on their own.
Three dozen states have expanded Medicaid, and more than 800,000 uninsured Floridians could be covered if Republican legislators would embrace expansion. Yet they refuse to touch it even though the federal government would cover 90 percent of the cost and the uninsured rate in Florida is rising while it is falling in other states. Instead, the Legislature made it even harder on Tampa General, BayCare Health System hospitals and other nonprofit hospitals that provide most of the care for Medicaid patients and the uninsured in this state.
After years of trying, Republican legislative leaders passed a repeal of the certificate of need requirements for building or expanding hospitals. Starting July 1, general hospitals no longer will face state scrutiny about whether another hospital is needed in a particular market. In 2021, the certificate of need process also will go away for hospitals that focus on particular groups such as women or children, psychiatric patients and substance abuse patients. Welcome to the wild west of health care.
Anyone who cares about the future of Tampa General, the region’s only Level 1 trauma center; Bay Care hospitals such as Morton Plant in Clearwater or St. Anthony’s in St. Petersburg; or large urban for-profit hospitals such as Bayfront Health St. Petersburg (a Level 2 trauma center) should ask Gov. Ron DeSantis to veto this bad legislation. He is expected to sign it into law, but at least the governor should be educated about the dangers of this free market frenzy.
All but a dozen other states have a certificate of need process for hospitals, and there are valid reasons for that. If the state doesn’t certify the need for a new hospital, it encourages for-profit chains with lots of capital to cherry-pick sites in the most affluent neighborhoods. They won’t necessarily have emergency rooms or willingly accept Medicaid patients or provide the most difficult, expensive treatments. They will focus their marketing on families with private health insurance and promote the most lucrative health care operations.
Where will that leave hospitals such as Tampa General and Morton Plant? Unlike car dealers, their emergency rooms don’t turn away anyone who cannot pay. Tampa General alone provides more than $100 million in charity care each year. More than a quarter of its patients receive Medicaid, which does not pay the full cost of care. The health care for the poor is indirectly subsidized by insured patients who now may be siphoned away by smaller hospitals in affluent communities.
The Legislature didn’t just repeal the certificate of need requirements. They rubbed salt in the wound by also allowing standalone surgical centers to keep patients overnight. The top procedures at those centers are often routine colonoscopies, biopsies and cataract surgeries. But an overnight stay could add options such as bariatric surgery, spine surgery and more extensive ear, nose and throat procedures. That raises significant patient safety concerns, because if something goes wrong standalone surgical centers will not have the same staffing or resources available as full-service hospitals. The change also can be expected to further reduce hospital revenues that help subsidize charity care.
The evidence that these free-market approaches save patients money is not overwhelming. Indiana repealed certificate of need requirements for hospitals two decades ago, and health care costs for Hoosiers have soared. Georgia is considering restoring its requirements. And there is no valid argument that allowing hospitals to build wherever they want and enabling standalone surgical centers to keep patients overnight will make health care more accessible to low-income Floridians.
Of course, Republican lawmakers in Tallahassee are not particularly concerned about the fate of nonprofit hospitals or the uninsured. Their message is clear: Health care is just another product to be competitively priced and packaged based on supply and demand, then sold to paying customers. If nonprofit hospitals can’t compete or the poor can’t afford health insurance, tough.