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Bush's Medicaid overhaul gets House backing

Under his plan, Medicaid patients would be moved into privately run HMOs and managed care plans.

By STEVE BOUSQUET and CARRIE JOHNSON
Published December 8, 2005

TALLAHASSEE - The Florida House approved an overhaul of Medicaid Wednesday, all but assuring that Gov. Jeb Bush will get to launch his revolutionary experiment to contain health care costs through privatization.

The Senate debated a similar Medicaid bill, but delayed a vote until today. The legislation would give final authorization for Bush's Medicaid experiment in two Florida counties. Some senators want the legislation to require more input from lawmakers before the pilot program can be expanded.

Two other key issues of the special session remained unresolved: allowing slot machines at four gambling sites in Broward County and outlawing the practice of lobbyists and their clients giving meals, drinks and gifts to legislators.

Seeking to reduce the rate of growth in Medicaid costs, Bush wants to move many Medicaid patients into privately run health maintenance organizations, managed care plans and new networks of doctors and hospitals.

The new plan would assign patients to managed care groups to oversee their care, with more emphasis on checkups and preventive treatment, ending a system in which patients see a doctor only when they are sick. The state hopes to improve patients' health and reduce fraud at the same time.

The state would pay premiums to managed care groups based on the patient's health, with companies getting more for sicker patients.

Florida expects to spend nearly $16-billion this year on Medicaid, about a fourth of the state budget. More than 2.2-million Floridians received care under Medicaid, a federal-state health insurance program for the poor, mentally ill and children that was formed in 1965.

The largely party-line House vote of 83-36 followed four hours of debate, and came six weeks after the U.S. government endorsed the program in record speed and sent it back to the Legislature for final approval.

Supporters hailed the changes as long overdue, while critics warned that patients would have fewer health care choices.

"This is all about better care, managed care and improved access," said Rep. Frank Farkas, R-St. Petersburg.

"Medicaid reform is about gambling with the health care of our most vulnerable citizens," said Rep. Eleanor Sobel, D-Hollywood. "This is about a rush to judgment."

The overhaul starts in July with pilot programs in the Jacksonville and Fort Lauderdale areas. The House bill would allow statewide expansion without another vote by the Legislature, an approach Senate President Tom Lee rejected.

Four House Republicans, including Rep. Ed Homan of Tampa, joined the Democrats in a failed attempt to compel full legislative approval of a statewide expansion. But Homan voted for the final bill (House Bill 3B), as did every other Republican who voted.

Senators were generally receptive to the Medicaid bill, although some Democrats expressed concern about a lack of supervision.

"Privatization that's happened in this state before has been a miserable failure," said Sen. Les Miller, D-Tampa. "This privatization might be a miserable failure, but in this case, the miserable failure's going to hurt somebody."

Lawmakers also moved closer to a deal to bring Las Vegas-style slot machines to Broward County parimutuels Wednesday, after the Senate Ways and Means Committee erased language that would have reduced the tax rate on the machines.

The committee restored the Senate bill to its original form, which calls for a tax rate of 45 percent. The vote wiped out a proposal by the Senate's Regulated Industries Committee to cut the rate, which angered House members who want a 55 percent tax.

The Senate also moved closer to the House on the number of machines allowed at each of the four parimutuels, from 2,000 to 1,500. The House wants to limit the number to 1,000.

"We've been operating in good faith, they've been operating in good faith," said Sen. Dennis Jones, R-Treasure Island, the sponsor of the Senate's bill. "We hope that we can come to a final agreement so we can put this issue behind us so we don't have to leave it until regular session."

The Senate and House remain at odds over a proposal to prohibit all lobbyist-paid gifts to legislators. Some fear the ban would be ineffective without expressly forbidding the use of political parties as a conduit for gifts such as meals and event tickets.

[Last modified December 8, 2005, 00:49:13]