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Bush's pick to run health agency gets Senate snub

Lee balks at confirming an official shepherding plans to revamp Medicaid - a strong hint they may not pass this year.

By ALISA ULFERTS
Published April 26, 2005

TALLAHASSEE - The rift between Gov. Jeb Bush and Senate President Tom Lee over Medicaid changes widened Monday.

Lee announced the Senate will not confirm Bush's pick to run the Agency for Health Care Administration.

That gives AHCA Secretary Alan Levine one year to win Lee's favor, or he will have to leave his post. Levine is the architect of Bush's Medicaid restructuring plan, and has been the state's chief negotiator with the federal government over the proposed changes.

Agency heads appointed by the governor must be confirmed by the Senate.

"We really need a balanced, fair arbiter for those reforms," said Lee, R-Brandon.

Lee said Levine damaged himself in the eyes of the Senate during the 2003 fight over medical malpractice insurance, both by aligning himself too closely with hospitals at the expense of doctors and by using state e-mail "to attack senators."

During the heat of the medical malpractice debate, which kept the Legislature in Tallahassee for much of the summer, Levine sent out an e-mail to GOP supporters, suggesting opponents be found to run against Republican senators who opposed Bush on medical malpractice.

Levine was a top aide to Bush, and Lee was one of the senators named.

Levine later called the e-mail a mistake and apologized.

"I'm focused on my job as is expected of me in the House, the Senate and the governor's office," Levine said Monday night.

A Bush spokesman defended Levine. "The governor believes that Secretary Levine is doing a fantastic job. He has the governor's full faith and confidence," Jacob DiPietre said.

Lee said his decision isn't a death knell for major Medicaid changes this year, but it should reaffirm the Senate's role as a check and balance against Bush's office when it comes to restructuring the $15-billion health care program for the poor.

"The problem with Medicaid is bigger than any one man. He is the messenger for the governor," Lee said.

But with less than two weeks left of this year's special session, Lee's decision is likely to fuel speculation, already running rampant, that major Medicaid changes are unlikely this year. And lawmakers already are preparing themselves for the possibility of a special legislative session.

Medicaid already eats a quarter of the state budget, and lawmakers and Bush are looking for ways to control its costs.

Bush has proposed restructuring Medicaid into a government-funded insurance program, in which private HMOs and other health networks are paid a premium to manage patients' care.

The House and Senate each have a bill spelling out their changes to the health care program for the poor, but they are very different and so far neither side has signaled a willingness to compromise. The Senate plan favors a slow approach with pilot projects, while the House prefers the governor's approach, though possibly on a smaller scale.

[Last modified April 26, 2005, 01:04:06]