The Legislature meets this week to approve Gov. Jeb Bush's plan to start turning Medicaid over to private health management companies. Here are some other matters lawmakers should attend to during the special session.
A Times Editorial
Published December 4, 2005
Gov. Jeb Bush has called the Florida Legislature into special session this week to give final approval of a health care experiment with poor people, but there is time to do more. Lawmakers also should take care of some other unfinished business, including writing slot-machine rules for Broward County, requiring lobbyists to disclose their fees and compensating a man who spent 22 years in prison for a crime he didn't commit.
Whether lawmakers can accomplish any of these goals remains unclear. As they gather in special session on Monday, they do so without the types of broad agreements that generally are necessary to produce results. Bush seems to want more than just an experiment with Medicaid, while the Senate is appropriately cautious. House and Senate leaders have moved closer to agreement on slot-machine regulation, but they still differ over tax rates and the number of allowed machines. The fine print over the lobbying disclosure reforms is still being negotiated. Maybe Wilton Dedge, exonerated by DNA evidence that showed he did not commit rape, will be the cause on which they can all agree.
Changing Medicaid
Given his White House connection, Gov. Bush had little trouble convincing the U.S. Centers for Medicare and Medicaid Services to let him start turning Medicaid health care over to private health management companies. Lawmakers should not be quite so eager to roll over.
Medicaid costs are indeed soaring, and Bush deserves credit for seeking alternatives. But the current context, according to one new study, is that Medicaid spending per enrollee is expected to grow at a slower rate next year than overall health care spending nationally. The point is that the private markets, to which Bush proposes to turn, aren't doing any better themselves in controlling costs.
The two counties chosen for the pilot project, Broward and Duval, are well-positioned for the experiment. Both offer an extensive network of service providers, which is critical to controlling costs. Under the plan, the state would pay a set amount for each Medicaid enrollee, rather than for each medical procedure.
Lawmakers, though, will not want to let this privatization experiment expand without considerable evaluation and further approval. At best, the governor brings a checkered record of accomplishment with his private initiatives. Given the risk to personal health associated with the nation's most radical Medicaid experiment, lawmakers need to set clear measurements and boundaries. This should be a carefully controlled experiment, not a wide open door to a statewide expansion.
Slot machines
House Speaker Allan Bense has finally given ground on what was his chamber's most untenable claim: that a constitutional amendment approved by voters last year didn't really call for Las Vegas-style slot machines. Bense and Senate President Tom Lee also say they will resist any effort to ask voters to repeal the amendment. That's progress, but there is still disagreement over two central issues: 1) How much to tax the slots; and 2) How many machines to allow.
The constitutional amendment required the state to adopt a law by July 1, and lawmakers are engaging in their own high-stakes gambling by continuing to ignore it. For better or worse, parimutuel facilities in Broward have been empowered to install slot machines. If lawmakers don't act soon to write enabling laws, then they may write themselves out of the equation. They may also leave the public, which was promised tax revenue for schools, holding the bag.
The slot machines must be allowed, but they should be taxed heavily - one study recommends 74 percent. As of Friday, the House was calling for 55 percent and the Senate 45 percent. Neither is enough.
Lobbyist disclosure
The applause by lobbyists who cheered the collapse of Senate President Lee's effort last spring to spread some sunshine on who pays how much to change public policy turned out to be a positive development. It motivated House Speaker Bense to make a more determined effort to bring Florida out of the dark ages and join nearly 30 other states and Congress that require the disclosure of lobbying fees. As Lee and Bense take another run at it this week, they should not retreat from some general principles.
The reporting of lobbying fees has to be specific enough to be meaningful, whether it is reported by firm or by individual and by actual amount or by range. The reports must be filed and audited on a schedule that is timely and ensures accountability. If legislators can't live without gifts and free food, any new rules should allow nothing more than inexpensive trinkets. There should be a reasonable limit on the price of free meals and specific reporting on the cost and who paid for it.
Finally, the Legislature should slam shut a loophole exploited by four lawmakers - including Sen. Dennis Jones, R-Treasure Island, and Rep. Frank Farkas, R-St. Petersburg - to take a free trip to Canada that was paid for by a gambling company. Allowing the company to then report the cost as a campaign contribution to the state Republican Party without prior approval is dishonest.
Compensating Dedge
It looks as if Wilton Dedge and his parents will finally be compensated for his 22 years of wrongful imprisonment. The $2-million compromise works out to less than $100,000 a year, which can hardly be called excessive for so monstrous an injustice.
But it bears remembering that hundreds of other inmates are waiting to have their DNA evidence tested as his was. Some, perhaps many, may be just as innocent. The Legislature needs to repeal the deadline that would have tolled this year without an emergency extension from the Supreme Court. It also needs to put money into the volunteer program that screens the cases and finds lawyers for the prisoners. And it should enact permanent legislation, the splendid bill written by Sen. Dan Webster of Orlando, so that those who are proven innocent won't have to run the gantlet of the Legislature's capricious claims bill process for fair compensation.
In the longer range, there has to be a systematic review of the many known causes of wrongful conviction, which include mistaken eyewitness identification, false confessions and perjury by co-defendants and jailhouse informants. In the majority of wrongful convictions, especially for robbery, there is no DNA to expose the falsehoods and acquit the innocent. The scales of justice will remain unfairly weighted in Florida, as in most states, until we get serious about correcting the balance.
