With a $5 billion health-care budget breach between the House and Senate halfway through the legislative session, Senate President Andy Gardiner dispatched two of his lieutenants to Washington this week to meet with federal officials about key health issues involving care for poor and uninsured Floridians.
Senate Health and Human Services Appropriations Chairman Rene Garcia, R-Hialeah, and Senate President Pro Tempore Garrett Richter, R-Naples, spent part of Monday and Tuesday meeting with U.S. Health and Human Services officials, according to Katie Betta, a Gardiner spokeswoman.
The senators' listening tour focused on the two major budget issues that divide the House and Senate. The Senate's plan includes $2.2 billion for a possible extension of the Low Income Pool, or LIP, program, which funnels additional money to hospitals and other health providers that serve large numbers of poor and uninsured patients. That program, which the House left out of its spending plan, is scheduled to expire July 1 unless state and federal officials, now in negotiations, can reach an agreement.
"With billions of dollars in hospital funding hanging in the balance, President Gardiner asked Chair Garcia and Senator Richter to travel to Washington, not to negotiate, but to listen to HHS' views on the health care challenges facing Florida, so the Senate can have an idea of the federal government's view on where Florida stands as the senators prepare to vote on the budget and head toward a conference with the House," Betta said in an e-mail.
Garcia and Richter also went to Washington with Senate leadership's backing of a $2.8 billion proposal to use Medicaid expansion funds from the federal Affordable Health Care Act, better known as Obamacare, to help lower-income Floridians purchase private insurance. The House has steadfastly refused to consider that option.
State Agency for Health Care Administration officials have negotiated in recent weeks with the federal government about extending the LIP program. Agency Secretary Liz Dudek on Tuesday told the Senate Health Policy Committee that she had presented the Senate's LIP plan to federal officials, but Dudek was unaware that senators were also speaking with the feds.
"We're always in discussion with the House and the Senate about what we're doing. And as I mentioned, we did take the Senate proposal with us last week and talk to them about it. But beyond that, we haven't had other discussions. So I don'?t know what other individuals might be doing," Dudek said.
Dudek said federal officials viewed certain elements of the Senate plan favorably. But Dudek said her agency's talks with the Obama administration have not included an expansion of coverage under the Affordable Care Act, as the Senate proposes. She also added she is unconcerned about philosophical differences between the House and Senate about how to treat the issue.
"I don't think there's a breach on the issue of LIP. I think everybody's in agreement that we need that money for the state of Florida. It's a totally different issue from expansion. We're not at all discussing expansion in our negotiations with the federal government," Dudek said.
The House and Senate on Wednesday are scheduled to take up their dueling budget proposals for the fiscal year that starts July 1. In all, the Senate plan totals $80.4 billion, while the House plan weighs in at $76.2 billion. By far, the biggest difference between the chambers is in the $5 billion that the Senate has included for LIP and the health-coverage expansion.
While the House wants to continue the LIP program, leaders have said it would be premature to include the money in the chamber's proposed budget. If a LIP agreement is reached with the federal government later in the legislative session, the money could be added to the final budget during negotiations between the House and Senate.
Senate Appropriations Chairman Tom Lee, R-Brandon, said he has participated in talks with federal officials, though he did not go to Washington this week. Federal health officials said they were open-minded about how to resolve the LIP issue, Lee said.
"They said they are going to deal in good faith with anyone who has any models that they would like to be considered but that they are very interested in longer-term, more sustainable solutions than this annual or biannual renegotiation of this antiquated LIP model to try to kick the can down the road for another couple of years. That's code for something that addresses this low-income population out there," Lee, a former Senate president, said.
Lee said he has also taken part in conference calls with representatives from the House, the Senate, Gov. Rick Scott's administration, and hospitals after hearing different reports about the talks with federal officials
"And it's like they all went to a different movie. One hangs up and says, 'Hey, it's going great. They're about to approve the Senate's model.' The other one hangs up and says, 'There's no way we're getting it,'" Lee said. "So, instead of filtering this through what others who are dreaming in Technicolor would like to see, I want to hear it myself."
Federal officials told him the state's LIP model "is dysfunctional and not good public policy as currently designed" and is unsustainable, Lee said.
"And while it gets down into the weeds and it's complicated, it is the problem du jour right now," he said.