Proposals would leave no state money for poor people to get eyeglasses, hearing aids and dentures, among other cuts.
By DIANE RADO
© St. Petersburg Times, published April 17, 2001
TALLAHASSEE -- In a wheelchair since a car accident 15 years ago, Dee Hudson of Miami is not ready to let the Legislature cut programs for Florida's poor, elderly and disabled.
"We're here to put a face on the human issues we have," said Hudson, who joined about 100 social services advocates on a 101/2 hour bus trip from Miami-Dade to lobby lawmakers in the state Capitol earlier this month.
To Hudson, it makes no sense for the Legislature to push tax breaks while cutting programs for the state's neediest citizens. Lawmakers just don't understand the suffering of ordinary people, she said. "It hasn't hit close to home."
Indeed, lawmakers face a public relations nightmare as they struggle through a $1-billion shortfall in the Medicaid program and the tightest budget year in a decade.
If all of their proposals go through, there would be no state money for poor people to get eyeglasses, hearing aids and dentures. The fees paid to thousands of doctors who take care of Medicaid patients would be lowered. Poor patients would face more restrictions on getting brand name prescription drugs.
These are among an estimated $840-million in health and human services cuts up for consideration as House and Senate negotiators head into the final, frenzied weeks of the legislative session and iron out a state budget for Florida.
At the same time, the state House has proposed $355-million in tax breaks, mostly for people who pay the intangibles tax on stocks, bonds and other investments.
House lawmakers have also set aside some $300-million for their local projects. The Senate has some $400-million in community projects -- often called pork barrel projects or "turkeys" -- according to the governor's office.
This is the stuff of a negative campaign ad -- tax breaks to the rich and cuts in services to the poor -- and it has made some lawmakers nervous.
"How can I go home and say that I cut taxes on the backs of women and children?" said state Sen. Ken Pruitt, R-Port St. Lucie, one of a half-dozen or so Republican senators who don't support tax breaks.
Senate President John McKay also is against tax breaks -- putting him at odds with the House and Gov. Jeb Bush, who favors a cut in the intangibles tax as well as a tax-free holiday for back-to-school shoppers.
But some of McKay's colleagues say a compromise may be necessary for the Legislature to finish the budget and get out of town. "It's going to take some give and take," Senate Majority Leader Jim King said last week.
Lawmakers argue that overall, the Medicaid budget will increase by more than $1-billion next fiscal year. That is because lawmakers plan to cover deficits from prior years, an unexpected spike in eligible Medicaid clients, and the rising cost of prescription drugs.
Little mentioned is that the House and Senate have proposed cuts in specific Medicaid programs to free up money for other priorities. The proposals have created a stir among social service advocates, physicians, pharmaceutical companies, nursing homes and others connected to Medicaid.
Some of the cuts affect poor people directly: To save $37-million, the state House has proposed cutting dental, visual and hearing benefits to an estimated 190,000 adults on Medicaid; the state Senate tightened income requirements to make make 1,828 poor, elderly and disabled people ineligible for broad benefits under the Medicaid program.
Other cuts are more subtle, but advocates say they would limit access to health care by the poor.
The Senate, for example, wants to cut the monthly fee that more than 4,000 doctors get for seeing certain Medicaid patients, from $3 to $2. That would save the state about $8-million.
Bob Sharpe, who oversees Medicaid programs for the state, said there have been problems because some doctors aren't seeing patients as often as they should though they continue getting the fee.
The fear is that fewer doctors will be willing to take poor patients if the fee is cut. As it stands now, the Medicaid program doesn't reimburse doctors the full cost of providing health care.
"I've been amazed at the doctors continuing to take patients," said Sandra Mortham of the Florida Medical Association. "It costs a certain amount every time you open your doors. At some point, as a small business person, you're going to say, is this something I can continue to do?"
Also under consideration are cost-cutting measures that would shift more Medicaid patients into cheaper health plans, require "prior authorization" for Medicaid patients to get admitted to hospitals for certain conditions and require competitive bidding for a variety of programs affecting Medicaid patients, including nursing home services.
If Medicaid doesn't reimburse the full cost of those services now, why would someone bid a cheaper price, asks Karen Woodall, who represents the National Association of Social Workers. She believes competitive bidding could lead to lower quality of care for poor patients.
"We're not buying cars here," said Woodall.
A paper written last year by Janet Barber, an Agency for Health Care Administration official, argued against competitive bidding for nursing home services. Among other reasons, the move could force some nursing homes out of business, the paper said.
Despite the report, Sharpe, the Medicaid official at AHCA, said his agency favors competitive bidding, because competition for Medicaid services could weed out bad nursing homes.
Both the House and Senate also recommend savings in prescription drug costs for Medicaid patients. Under consideration is a program that would further restrict Medicaid patients from brand name drugs without getting prior approval.
Drug companies, which stand to lose money under the proposal, are fighting the plan.
"Our fundamental concern is . . . they will restrict access for the patient and the physician for the drugs they need," said Tad Fisher, lobbyist for the Pharmaceutical Research and Manufacturers of America.
But Sharpe said drug costs have skyrocketed, causing Medicaid costs to soar.
"We've got to have controls," he said.