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    Health issues may rise again

    Some health proposals that fizzled during the Legislature's regular session may reappear

    By STEVE BOUSQUET, Times Staff Writer
    © St. Petersburg Times
    published April 27, 2002

    TALLAHASSEE -- With armies of lobbyists on all sides, legislators are working behind the scenes to add a major health care bill to the special session that begins Monday.

    The bill would revive many issues that drew support during the regular session but fell victim to a last-day redistricting logjam.

    Those issues include kidney dialysis care, speeding up insurers' payments to doctors and an Alzheimer's care center at the University of South Florida.

    Health care issues are among the most intensely lobbied in the Capitol, routinely pitting powerful interests such as doctors, hospitals, insurers and employers against one another.

    Lobbyists with an interest in the outcome of the new bill include everyone from the presidents of county medical associations to the wife of Senate President John McKay, R-Bradenton.

    Michelle McKay is a registered lobbyist, in the House only, for the Florida Society of Ophthalmologists, a group that aggressively raises money for lawmakers' campaigns. During the regular session, she also represented two hospitals in Palm Beach and Martin counties, seeking a change in the law so that they could perform open heart surgery.

    The law was not changed, and Mrs. McKay does not currently represent those hospitals, said Karen Chandler, a Senate spokeswoman.

    Ophthalmologists, who are medical doctors, want to drop a provision in some managed health care plans that requires a family doctor to refer a patient to an optometrist before that patient can see an ophthalmologist. The provision, which critics call a "dual gatekeeper," is opposed by optometrists.

    Rep. Frank Farkas, R-St. Petersburg, who chairs the House Health Regulation Committee, questioned Mrs. McKay's role in influencing legislation.

    "I don't like it, but I'm not going to change it," Farkas said. "Michelle's a great person. I respect her. It's just hard to deal with someone who you know is the spouse of the Senate president."

    John McKay said he avoids voting on health care issues in which his wife is a lobbyist, even though, he said, state law and Senate rules do not prohibit it.

    McKay filed a letter with the Senate secretary on March 22, the last day of the regular session, recusing himself from voting on HB 913, the bill that contained many of the same health care provisions in the new bill. "I wasn't involved. I'm not going to be involved. If she lobbies on this issue, I'll file a letter. If she lobbies the House, I won't vote on it," McKay said.

    Michelle McKay declined to be interviewed.

    One issue not likely to surface again is a proposal to make it easier for hospitals to offer open heart surgery.

    Today, 62 of the state's 216 acute-care hospitals perform open heart operations. Many more want to enter the lucrative field, but access is limited by a regulatory system known as certificate of need. House Speaker Tom Feeney, R-Oviedo, has led the charge to encourage competition for open heart beds, but he conceded it's a "long shot" that the issue will resurface now.

    "You have to spend two or three years fighting for a (certificate of need), and your competitors can stop you from getting it," Feeney said. "To not let the free market work is wrong."

    The Florida Hospital Association opposes deregulation of the process. Lobbyist Tony Carvalho said studies show that hospitals that do the most open heart surgeries have healthier patients. Opening the market to many more hospitals will reduce the number of open heart operations at each hospital, he said, jeopardizing quality of care.

    "We think it's bad medicine," Carvalho said. "But it is partly economic, no question about it."

    Health care bills can quickly morph into lengthy "trains" to appease various interests, and compromise can turn to chaos.

    Gov. Jeb Bush doesn't want that to happen. Eager for a peaceful conclusion after the difficult end of the session three weeks ago, Bush has not yet agreed to add health care to the agenda.

    If he does not, it would take a two-thirds vote by both chambers to bring up the bill (SB 14-E).

    "There were bills we thought we were going to pass," Bush said, referring to the regular session. "Either they'll be added to the call, or the Legislature will do that."

    He reserved the right to veto the final version if it goes beyond what was agreed to in advance.

    The health care bill is sponsored by Sen. Burt Saunders, a Naples Republican who chairs the Senate Health, Aging & Long-Term Care Committee.

    "We're either going to deal with some issues that have been agreed upon, or we simply won't have a package," Saunders said. "It's just too short a time."

    -- Staff writer Lucy Morgan and researcher Caryn Baird contributed to this report.

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