Health care plan could reshape insurance for Floridians

March 22--As the state Senate strategically slows down this week, one health care plan that could drastically reshape insurance for millions of Floridians is on the move.

A bill, SB 240, passed out of its third Senate committee on Tuesday that would allow patients -- private and Medicaid -- to pay their doctors directly for care in a subscription-type model.

The legislation, a priority for the Florida House, incorporates two of three pillars of the lower chamber's several-years-in-the-making plan to overhaul the way Florida's health care is delivered.

"That particular health care proposal seems to have the most traction," said Sen. Rob Bradley, R-Fleming Island.

State lawmakers appear more divided than ever this early in the 60-day lawmaking session; there's a growing belief that they won't finish on time and will need to return later to Tallahassee to pass a budget in a special session.

And yet, in a state where the Republican leaders are at odds, health care appears an unlikely point of intersection.

Gov. Rick Scott, a Naples Republican, has begun shaming Corcoran through a series of campaign advertisements and press conferences for attempting to dismantle his business incentives program known as Enterprise Florida.

Over the weekend, Corcoran said he expected to go into a special session over his Enterprise Florida fight with Scott.

And yet all three Republican state leaders agree that the federal government should give Florida its share of the state-federal program funding for the poor known as Medicaid through a lump sum payment or a "block grant."

Corcoran and Scott favor deregulating the hospital industry, which they claim interferes with the free market and increases costs. That bill -- opposed by the powerful hospital lobby -- has yet to be heard in the Senate.

The direct primary care legislation, on the other hand, is supported by one other major health care trade group -- doctors. And at the same time, the health insurance lobby is quiet.

Managed care companies are third-party groups that negotiate health insurance contracts on behalf of Medicaid patients.

The trade organization that represents these companies has not publicly opposed the bill but in an interview said the otherwise good policy wasn't appropriate for Medicaid patients.

"The concept does not work within the Medicaid managed care model, and carving out primary care services would undermine the goal of the (Statewide Medicaid Managed Care) program in providing access to coordinated, comprehensive health care services," said Audrey Brown, president and chief executive officer of Florida Association of Health Plans, which represents managed care companies.

Sen. Tom Lee, the bill's sponsor, said he hadn't heard from insurance companies yet but thought direct primary care could still work for Medicaid patients.

"I realize that a direct primary care agreement might end up operating outside the scope of the insurance contract that the managed care companies are currently administering, but if that's a more efficient way to deliver care, I don't know why anyone would object," Lee said in response to Brown's comment.

He acknowledged his bill would require changing the current Medicaid agreement between Florida's health agency and the federal Medicaid agency, which allows states to implement variations of the state-federal program that eats $25.9 billion of the state's $80 billion-plus budget and provides health insurance for over 4 million Floridians, about 21 percent of the population.

The House version of the bill does not have Medicaid as a provision for direct primary care, but the House's chairman of health appropriations, Rep. Jason Brodeur, said it was already available to Medicaid patients under employer-sponsored benefits.

"Now if we had a completely flexible Medicaid block grant, we may be having a completely different conversation," said Brodeur, R-Sanford.

Lee is known to be close to Corcoran and said he wasn't carrying the House priority on behalf of the speaker but, rather, filed the legislation because it is good policy.

"I think it could have a big impact on the way health care is delivered," said Lee, R-Brandon.

Lee added that circumventing insurance companies could save doctors a lot of money because they wouldn't have to deal with claims, a sentiment the doctor lobby supports.

Future House Speaker Rep. Jose Oliva has taken health care on for the House and said he thought the legislation would become law this year.

"I think they'll both pass, and the governor should happily sign it," said Oliva, R-Hialeah, about the pieces of legislation in both chambers.

So far in the Senate, the bill has had zero opposition in three of four of its committees. Two of the committees it passed through are chaired by one of the Senate president's close allies, Sen. Anitere Flores.

"I think it's not terrible public policy," said Flores, R-Miami.

The legislation's final stop in the Senate's budget committee, however, could become more political.

Health care could prove an effective bargaining chip for Senate leadership, none of whom seem to have health care as a priority but do care about many other policies.

Lee said he hadn't discussed the legislation yet with Sen. Jack Latvala, who chairs appropriations, but that it was not "lost" on him that most of his bills -- at least some of which are supported by Corcoran -- have to go through Latvala's committee.

Latvala wouldn't say whether the direct primary care legislation was going to get on his committee's agenda because he hasn't reviewed it yet.

"There are some bills of mine in Tom's committee that he hasn't heard. I don't know how these things will play out," said Latvala, R-Clearwater.

The Senate has had conspicuously few meetings this week, a move Latvala said was strategic.

"We are slowing the budget down to meet the House in Week 6," Latvala said.

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