With three weeks left in Florida’s lawmaking session, changes in the state's health care system proposed by House Republicans have stalled in the Senate.
House Republican leaders have been saying the only way to control health care costs in Florida is to force patients and doctors to understand the true price of their decisions, whether they are considering a knee replacement or surgery as the best option for knee pain.
They offered their own health care overhauls at a time when congressional Republicans have struggled to repeal and replace the Affordable Care Act.
Now health care has taken a back seat in the Legislature, overshadowed by larger fights over Everglades restoration, gambling, charter schools and tax cuts.
The Florida Senate isn't acting on the House bills, and House leaders said they won't sacrifice their other agendas to salvage health care legislation this year.
House Republicans, however, have hoped that at least two measures could pass the Senate: direct primary care, SB 240, and allowing patients to stay in ambulatory surgical centers for up to 24 hours, SB 222.
“I’m open to considering House priorities on health care in the context of Senate priorities being part of those discussions,” said Senate President Joe Negron, R-Stuart, when asked whether he could get on board with those items.
Right now, the House isn’t funding Negron’s top priority: $64 million for Everglades restoration with potential future bonding.
In addition, Negron wants to borrow $281 million for higher education, but the House is against borrowing money and is proposing reducing higher education spending by $100 million, mostly through member projects that were due to receive recurring funding.
“We’re not going to negotiate with ourselves,” said Rep. Jose Oliva, R-Hialeah, a leader in the House health care debate who is set to take over as House Speaker. “Health care in Florida is a priority, but it doesn’t do anyone any good to negotiate it away for some bad policy.”
If the House fails to pass any policy changes, Oliva said, leadership would settle for cutting hospital funds, which they are proposing to slash $622 million from in the House health care budget.
“I would consider that an incremental move, which is better than no move at all … certainly not a defeat,” Oliva said.
The direct primary care bill, which would circumvent insurance companies and allow patients to see their doctors on a subscription-type basis, is robust enough that if it passes between now and the end of session, other policy bills can be tacked onto it and passed as an entire package through a procedure known as a “train,” lawmakers said.
But right now, both direct primary care and the ambulatory surgical bill, which hospitals view as a threat as it would allow patients to stay overnight in stand-alone surgical centers and potentially draw away expensive customers from hospitals, are stuck in committees before they can be voted on by the whole chamber.
Sen. Jack Latvala, the Senate’s budget chief, said it was “hard to say” whether he would ever hear the direct primary care bill and that he “wasn’t ready to talk about that right now.”
Even if Latvala, R-Clearwater, doesn’t want to move the legislation, leadership can technically work around him if the bills get caught up in a trade. But Sen. Bill Galvano, who is set to take over as Senate president, said that was unlikely.
“I’m sure they’ll be part of a discussion, but it’s not a Senate priority to see either of those passed,” said Galvano, R-Bradenton.
Sen. Tom Lee, who sponsored the direct primary care bill, said he thought there was actually a good chance his legislation could pass this year since it’s received minimum objection in the Senate so far. But he acknowledged it was also a political hostage.
“There’s no question it’s being held up pending budget negotiations;, that’s fairly obvious,” said Lee, R-Brandon, who is close with House Speaker Richard Corcoran and is handling another House health care priority known as state group health insurance that has yet to be heard in the Senate.
Rep. Jason Brodeur, the House health care appropriations chairman, has been promoting the state group health insurance plan, HB 7007, in the House for several years.
The measure would, among other things, direct the state to contract with at least one provider that gives average prices for health care services by county and would allow state employees to purchase additional medical procedures through tax-free reimbursements from the state.
“This is a bill I’ve worked on with Speaker Corcoran over the years, so I don’t think its demise will escape his attention,” said Brodeur, R-Sanford, about how likely it is his bill could pass this year.
Brodeur said there's still time to negotiate with the Senate.
“How badly does President Negron want water policy? That’s really the question. Once you get towards the end, issues are no longer siloed but are able to bleed over into other areas,” he said.
Other health care bills that appear all but dead include the deregulation of hospitals, SB 676, and trauma centers, SB 767, neither of which has been heard in the Senate; telehealth, which was part of a massive package in the House and would enable some doctors to remotely communicate with their patients, HB 7011, but was not filed in the Senate; expanding the scope of practice, SB 634, for advanced registered nurses to enable them to diagnose certain mental health patients, which has two committees left in the Senate.
On Monday a bill, HB 7117, that would add work requirements for poor Floridians to receive insurance through the state-federal program known as Medicaid passed in the House’s health care appropriations committee, which must ultimately be approved through a federal waiver.
Rep. Travis Cummings, R-Orange Park, who passed the bill out of his health policy committee last week, said of the federal government, “It’s going to be a challenge for them to approve that."
Negron has supported modest work requirements in the past for Medicaid recipients but only under the effort to expand Medicaid, which the Florida House, led in part by Corcoran, R-Land O'Lakes, blocked two years ago
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