1. Opinion

Editorial: The Florida Legislature embraces the wild west of health care.

SCOTT KEELER   |   Times Florida House Speaker Jose Oliva made hospital deregulation one of his top priorities.
SCOTT KEELER | Times Florida House Speaker Jose Oliva made hospital deregulation one of his top priorities.
Published May 10, 2019

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.


  1. Rain drops splatter on a car windshield as rain comes down by the downtown Clearwater city marina. [JIM DAMASKE]
    State lawmakers should protect auto insurance policyholders, writes an investigator.
  2. Boats docked at Central Marine in Stuart are surrounded by blue green algae in 2016. [GREG LOVETT  |  AP (2016)]
    The failure to act on evidence presented by mounting scientific research is placing the long-term health of Floridians at risk, write two advocates.
  3. Workers at Spectrum Solutions in Draper, Utah, process DNA spit kits before they are sent to customers of
    Here’s what readers are saying in Wednesday’s letters to the editor
  4. Justices of the Florida Supreme Court attend a joint session of the Florida Legislature on Jan. 14. Left to Right: Chief Justice Charles T. Canady, Justice Ricky Polston, Justice Jorge Labarga, Justice Alan Lawson and Justice Carlos G. Muniz.  (Two vacant justice positions need to be appointed by Gov. Ron DeSantis.) [SCOTT KEELER  |  Tampa Bay Times]
    Reversing a ruling that required unanimous jury recommendations on death sentences is another backward step for the state’s high court.
  5. Kayakers enjoy a morning paddle down the Weeki Wachee Springs River at Weeki Wachee State Park. [Michele Miller]
  6. Internet crimes are on the rise in Florida. [AP Photo]
    Also: Why were the SunTrust Financial Centre lights purple? And the cost of owning an electric car.
  7. editorial cartoon from times wires [Bill Day --]
  8. Sen. Kelli Stargel, R-Lakeland, has proposed legislation to give lawmakers the same secrecy protections as police and judges. [STEVE CANNON  |  Special to the Times]
    Lawmakers don’t face the same dangers as police officers. Voters also need proof they live in the district they were elected to represent.
  9. Peacocks and peahens at a home on 26th Avenue N in the Disston Heights neighborhood of St Petersburg. [Tampa Bay Times]
    Nitwits have tried to board commercial flights with emotional-support ducks, turkeys, non-frozen Florida iguanas, flatulent pot-bellied pigs and a freaking peacock, writes Carl Hiaasen.
  10. Opponents of the SB 404, known as the "parental consent" bill, gather at a press conference at the Capitol in Tallahassee. The bill requires girls under the age of 18 get a parent's consent before having an abortion and was approved Wednesday in its final committee stop. (AP Photo/Aileen Perilla) [AILEEN PERILLA  |  AP]
    Here’s what readers are saying in Tuesday’s letters to the editor