Florida Republicans want to be rewarded as if they expanded Medicaid

March 13--Some Florida Republicans want to transform the state's health care system by cutting out insurance companies that act as a middleman between patients and doctors and upending how the Medicaid system serves the poor.

The proposal to change Florida health care, pushed by House Republicans, would offer the same model to those on Medicaid that would be used by those in the private market. The plan has three parts: a subscription-type service for patients to see primary care doctors; a health savings account for patients to pay cash for the majority of their needs; and insurance that will cover catastrophic illnesses that can cover a broad range of health issues from appendicitis to brain cancer.

Florida House Republicans see an opportunity to influence federal policy regarding the Medicaid program, which eats up $25.8 billion of the state's $80 billion-plus budget every year. They argue that will help them overhaul an unsustainable health care system in Florida and ultimately curb costs. Democrats question whether Republicans can even come up with a plan given the federal climate, and they accuse the GOP of not being committed to helping the poor.

Congressional Republicans offered their alternative vision to the Affordable Care Act last week, laying out what some Republican critics are calling "Obamacare light." In that bill, states that chose to expand the government health program's central tenet -- Medicaid -- would receive extra federal funding until 2020. So the 19 states that didn't expand Medicaid would get proportionately less money than those that did.

On Thursday the Florida House passed legislation that requested the federal government give a lump sum of Medicaid funding in a single, block grant to the state. The legislative request also asks the feds "to eliminate funding disparities between states" -- meaning it would not penalize Florida and the 18 other states for rejecting Medicaid expansion.

"States that expanded necessarily shouldn't be favored over the ones that aren't," House Speaker Richard Corcoran, R-Land O'Lakes, said at a news conference Friday, echoing both Gov. Rick Scott, R-Naples, and the leader of the Florida Senate.

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Corcoran's chamber is taking the lead on health care issues.

Florida Senate President Joe Negron's office said it will consider the legislation. While there's no guarantee it will pass the Senate, Negron, R-Stuart, is in favor of block grants.

Two years ago Negron tried to lead on health care by calling for what conservative critics said was the expansion of Medicaid under the Affordable Care Act. Florida House leaders at the time, including Corcoran, felt blindsided by the move and quit session three days early, blocking expansion to an estimated 800,000 Floridians.

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Corcoran compared the House proposal to transform Florida health care to the creation of apps for Apple's system platform, arguing that the piecemeal approach would create many cheaper marketplaces for buying care than insurance plans currently provide.

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"If we build it, they will come," Corcoran has said repeatedly about the House health care approach.

Even though the House plan has gone nowhere in the past several years, Negron said the Senate would be willing to revisit some areas of disagreement if Florida gets a block grant.

"When we were negotiating with the House, there was no flexibility of Washington from co-pays, to deductibles, to charging a modest premium," Negron said. "We should work on empowering people to make choices. I think there's an opportunity to re-open those discussions in the context of a block grant."

Some House Republicans, including Rep. Cary Pigman -- chair of the House's health care policy committee and an emergency care doctor from rural Avon Park -- want to use the potential extra block grant money to help cover many uninsured able-bodied working poor. But Corcoran has shot that idea down.

Senate Democrat Kevin Rader, of Delray Beach, who sits on the Senate's health care appropriations committee, said he was worried the federal government wouldn't come to a decision on Medicaid in time to make a budget this year, and that if it did choose to do block grants, poor patients would suffer.

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Rader is in line with several House Democrats who, before the block-grant bill passed for the second time off the floor last week, questioned the long-term value of block grants, how many patients they would ultimately serve and what Florida would do with the fixed pot of money if it comes across a health crisis.

Furthermore, Rader said his chamber had yet to determine any direction on health care so far this session, saying, "The cards haven't been exposed yet on the Senate side on how they want to deal with the health care issue."

Three senators have filed bills perceived as complementary to House bills that would upend some of the current system, including repealing regulatory rules governing how many hospitals, nursing homes, hospices and trauma centers can be in the state, as well as a direct primary care bill. But these bills either haven't been heard or face several committees, indicating they could be harder to pass.

"My bill was given four committees because it's been perceived to be a priority of the House speaker. It's just the way the mop flops," said Sen. Tom Lee, R-Brandon, who filed the direct primary care bill. "The legislative process works off leverage all too often."

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