Medical issues including a patient's right to sue HMOs will be key during the legislative session.
By JO BECKER
© St. Petersburg Times, published March 6, 2000
TALLAHASSEE -- With elections fast approaching, Republicans who control state government are suddenly paying much closer attention to an issue that affects every Floridian: health care.
While tax cuts have lost some of their political potency in these relatively prosperous times, polls show that health care remains a top worry. So it's not surprising that access to affordable, quality health care is emerging as one of the hot topics the Republican-controlled Legislature will debate during the 60-day session that opens Tuesday.
Mirroring a national trend, the managed care industry will find itself on the hot seat.
There is growing bipartisan support to allow patients to sue HMOs that improperly deny care, an idea the Republican leadership opposed last year. Sensing a good campaign issue, Democrats intend to push the issue hard, and some Republicans are already signing on.
In other efforts to reign in the managed care industry, lawmakers will debate forcing HMOs to offer various benefits, such as infertility treatments. Some legislators also want to punish HMOs that do not promptly pay hospitals and doctors, and mandate that HMO medical directors sign off on decisions to deny care.
Senate Majority Leader Jack Latvala, who intends to sponsor one GOP version of the right-to-sue law, had a friend who died this month of throat cancer after unsuccessfully wrangling with an HMO to see a specialist.
"I think what the HMOs are doing to health care is unconscionable," Latvala said.
Gov. Jeb Bush and House Speaker John Thrasher have been decidedly cool to the idea, but they may be unable to hold their party in line as term limits force many lawmakers to compete for new offices. A spokeswoman for Senate President Toni Jennings, who is running for insurance commissioner, said she is open to talking about the issue.
Lawmakers of both parties have also signaled support for a $55-million plan to help senior citizens afford prescription drugs, something that promises to play well in a state where nearly one of every six residents is elderly.
Meanwhile, Bush wants to continue to expand a program begun by his Democratic predecessor that provides state-subsidized health insurance to the children of the working poor.
Democrats had hoped to have the health care issue to themselves this year: Last year, their sweeping HMO "Patients Bill of Rights" went nowhere while Republicans concentrated on cutting taxes, limiting the legal liability of businesses and giving students at failing public schools state-funded vouchers to attend private schools.
"We see health care as being right up there with education as the two biggest issues to distinguish Democrats from Republicans," said Senate Democratic Leader Buddy Dyer. But Republicans are unwilling to cede the health care territory. It was, after all, a Democratic governor who vetoed a 1996 bill that would have given people the right to sue HMOs.
"To say that Democrats have had all the heart on the health care issues is just not true," said Sen. Ginny Brown-Waite, a Brooksville Republican who is also sponsoring a bill to allow patients to sue HMOs.
As the two parties vie for the hearts of health care consumers, they must also confront a series of potential health crises that may not play as well with the public.
Nursing homes top the list. With legal liability insurers that have covered nursing homes now fleeing the state, there is a renewed push for a law to limit the multimillion-dollar patient abuse judgments that have plagued the industry in recent years.
Meanwhile, almost 20 percent of the state's nursing home beds are operating under Chapter 11 bankruptcy protection. Five nursing home companies filed for bankruptcy in the last year alone.
Patient advocates say the lawsuits are a symptom of the bad care nursing homes deliver, but the industry blames a state law that makes such lawsuits particularly lucrative for lawyers.
Raising the specter of mass closings that could leave elderly Floridians with no place else to go, the nursing home industry hopes to limit lawyers fees and raise the standard of proof for medical abuse cases.
"I'm not saying that the lawsuits are the sole cause, but they are part of the problem," said Ed Towey, an industry spokesman. Hospitals are also seeking relief. Rep. Mike Fasano, R-New Port Richey, is one of the sponsors of a measure to reduce the tax that hospitals pay to support the Medicaid program. Clinical laboratories, diagnostic imaging centers and outpatient surgical centers would no longer have to pay the tax at all.
Rather than absorb the hit to the state -- estimated at $85-million -- by cutting the Medicaid program, the cost would be shifted to the tax-paying public at large.
Hospitals argue that the measure is needed: Managed care cost squeezing, a slowdown in federal Medicare and Medicaid spending, and the cost of treating those without health insurance have left them in financially bad shape.
According to the Florida Hospital Association, 49 hospitals closed between 1990 and 1999. Today, according to the association, one-third of all Florida hospitals are operating in the red.
As lawmakers seek to reshape health care policy, they do so against the backdrop of this stark reality: Health care premiums continue to rise, and current policies have done nothing to make a dent in the number of people who are uninsured.
In 1998, 2.5-million Floridians went without health insurance.
Opponents of some of the measures to crack down on HMOs suggest the state needs to pay more attention to those numbers. The Florida Legislature has forced insurers to cover more specific health benefits than any other state except Maryland, a recent study found. Now, some lawmakers want to study what -- if any -- impact that has had on premium costs. Allowing patients to sue HMOs, elected officials like Thrasher and Bush argue, may only raise rates further.
"We are under siege -- it's death by anecdote," said HMO lobbyist Scott Keller. "There's this perception that we are out there doing bad things that isn't true."
Currently, consumers who are unhappy with HMO decisions can appeal to the state. Associated Industries of Florida, a powerful interest group that represents big businesses with an interest in keeping premium costs down, has proposed strengthing that process in an effort to head off a right-to-sue law.
Meanwhile, insurers are pushing to strip the insurance commissioner of some of his power to deny premium rate increases.
Two potentially contentious efforts to reduce health care costs are aimed at the brand-name pharmaceutical industry.
Facing ever-escalating Medicaid prescription costs, Gov. Bush wants to place limits on the number of expensive, brand-name drugs that can be prescribed by doctors for Medicaid patients. Doctors would be encouraged to prescribe cheaper alternatives from a list a state panel would develop. Bush estimates his plan would save the state $88.6-million next year.
Another effort would make the generic equivalents of certain drugs more readily available to consumers. Unlike many states, Florida maintains a list of drugs it considers too dangerous to allow pharmacists to offer consumers cheaper, generic alternatives.