The HMO industry prevailed; their doctors will decide services covered.
By JO BECKER
© St. Petersburg Times, published May 7, 2000
TALLAHASSEE -- With health care concerns promising to play a role in November's elections, the legislative session began with much talk from high-ranking Republicans about reforming the HMO industry.
But the only health maintenance organizations reforms to pass were those the industry signed off on.
The Legislature sent a bill to Gov. Jeb Bush on Friday that ensures that HMO employees who decide whether medical services should be covered will be doctors.
But it does not allow Floridians to sue an HMO for damages when it improperly denies medical care, something that was much debated this session. A bipartisan group of lawmakers in the Senate supported that idea, while the Republican-controlled House and Bush opposed it.
After much verbal wrestling, Senate President Toni Jennings, who is running for the statewide office of insurance commissioner, capitulated.
Democrats are promising to make the failure to pass a right-to-sue law a major issue in November's election. According to the Democratic Party, Republicans have taken in nearly $648,000 over the past nine months from HMOs and insurance companies. "Money in, votes out -- that's the Republican mantra," said Florida Democratic Chairman Bob Poe.
Republicans say their plan will help medical consumers without driving premium rates up through lawsuits and increasing the rolls of the uninsured. "Our polls show that people wanted three things: affordable health care, doctors to make choices and access to group health plans. Our plan fulfills those goals," said Republican Party Chairman Al Cardenas. "(Democrats) wanted to raise costs and allow courts to make decisions."
The series of health care reform bills on their way to the governor closely mirror a House plan drawn up by Associated Industries of Florida, the state's most powerful business lobby and an opponent of most proposals to crack down on the managed care industry.
Lawmakers okayed changes to practices that only some HMOs use. For instance, HMO patients who are hospitalized could continue to have their care handled by their doctor, rather than having their care taken over by unknown physicians hired by HMOs to manage hospital stays.
A study would look at the alarming rate of medical mistakes, but lawmakers did not endorse a proposal that would make reports of those mistakes more readily available to the public.
The legislation is also aimed at encouraging HMO consumers to rely on rights they already have. A state panel to which consumers can appeal when care is denied would have to take action more quickly. Doctors and hospitals would be required to post the state's three toll-free numbers for consumer complaints.
Late last month, Senate Majority Leader Jack Latvala said the House plan was "written by the industry, and that's wrong." On Friday, Latvala said the Senate dropped its insistence on the right to sue HMOs as part of a deal it struck with the House over the state's $51-billion budget. In return, he said, the Senate got more money for education and other priorities.
"We got into a situation where we thought that we had a budget that was best for the state of Florida," Latvala said.
Many of the reform plan's provisions had little to do with patients. Hospitals and doctors lobbied successfully for legislation that would force HMOs to pay them promptly, and hospitals got a huge tax break.
The insurance industry made out, too.
Insurers who provide small-group insurance to employers with up to 50 workers will be able to raise rates based on the health and claims history of the insured.
The industry did not, however, win its bid to take away the ability of the insurance commissioner to deny rate increases that are not "viable" to consumers.
Nor did doctors get everything they wanted: A bill that would have made it more difficult to sue a doctor under the state's medical malpractice laws died, as did a measure pushed by the nursing home industry to make it more difficult to sue nursing homes for poor care.
Next, lawmakers may deal with nursing homes: The governor and other legislative leaders have said the industry's financial woes may force them to hold a special session.