The Florida House passed two Medicaid reform bills -- HB 7107 and HB 7109 -- on Thursday after a debate of more than two hours. The measures passed on votes that mirrored party lines.
The measures -- which ranked as one of the House leaderships top priorities for the 2011 session after similar measures stalled in 2010 -- send most Medicaid recipients in the state into managed-care plans, including HMOs. Supporters of the measures pointed to the growing number of Medicaid recipients and warned that these numbers would only increase if nothing is done. The measures also include a liability provision -- limiting potential damages to $300,000, a reduction of $200,000 from the current system, when medical personnel are found liable for injuries to patients on Medicaid.
While the reform measures failed last year, the 2011 versions passed through a number of House committees during the first weeks of the session.
The House agreed on a special format for the debate, with floor managers guiding speakers in blocks during the debate which lasted for more than two hours. Rep. Rob Schenck, R-Spring Hill, the chairman of the Health and Human Services Committee and the sponsor of the measure, led the Republicans, while Rep. Jim Waldman, D-Coconut Creek, served as floor manager for the Democrats.
While Republicans filed technical amendments that sailed through the House, an amendment by Rep. Richard Steinberg, D-Miami Beach, to ensure that Medicaid recipients provide driver's licenses and voter cards to ensure that they are citizens went down on a party lines vote. Schenck argued that the state did not have the constitutional authority to require proof of citizenship.
Rep. Gayle Harrell, R-Port St. Lucie, opened the debate by saying this reform effort resulted from years of grappling with the problem.
We all know the system is broken, insisted Harrell, who argued Medicaid was broken in terms of access, finances, quality and accountability. Patients wind up traveling long distances to receive care.
Rep. Mia Jones, D-Jacksonville, fired the first shot on the Democratic side, arguing that the Medicaid reform hurt the medically needy and put the states financial concerns over patient care.Our focus is on the dollar, not the patient, insisted Jones.
Just as they had on Tuesday when Schenck took questions on the bills, Democrats attempted to score points by arguing that Solantic, the medical company that Gov. Rick Scott helped set up before his term in office, would be eligible to receive more Medicaid funds if the reform measures were passed.
This is a massive shift to for-profit, capitated care that will reduce the scope, amount and duration of care,said Rep. Mark Pafford, D-West Palm Beach. We have a governor who transferred Solantic to his wife, the first lady of the state, and apparently the media have found a connection to this bill
Speaker Dean Cannon, R-Winter Park, jumped in, ruling that Pafford was moving away from the legislation at hand.
There are tremendous conflicts of interest in this bill, continued Pafford, who maintained there would be no accountability or transparency under the measures.This is a giveaway of $20 billion a year to for-profit, private managed-care companies outside the Sunshine.
Republicans responded by insisting the reform measures were needed to control spiraling costs. In the 1999/2000 fiscal year, Medicaid costs came to $7.42 billion, almost 18 percent of the state budget. By the 2009/2010 fiscal year, the costs totaled $18.81 billion, more than 28 percent of the budget. Estimates hold that by the 2014/2015 fiscal year, Medicaid will cost $28 billion, more than 33 percent of the states budget.
The current system threatens to break the economy, insisted freshman Rep. George Moraitis, R-Fort Lauderdale, who fired back that free-market solutions would lead to better access and services.
We cannot continue to sustain the states current Medicaid program as the costs continue to accelerate each year, said Rep. Doc Renuart, R-Jacksonville, who voted for the bill despite insisting that smaller regions would be more efficient. This is a far improvement from the current system.
Republicans and Democrats took to the House floor as the debate continued,focusing on defending or attacking specific parts of the reform package. With Democrats controlling only 39 of the 120 House seats, as Rep. Luis Garcia of Miami admitted in his remarks on the floor, they had no chance of stopping the measures and offered warnings about the consequences of the bills.
Rep. Elaine Schwartz, D-Hollywood, closed the debate for the Democratic side.
If the free market could have made a profit off Medicaid, they would have, insisted Schwartz. Were handing $20 billion on a silver platter.
Insisting that the reforms would help recipients, Schenck ended the debate by running through the numbers, arguing that the bills were necessary. All of us can see that not only is this not sustainable, but this will cripple Floridas government, said Schenck. We simply cannot continue down this road.
I commend Chair Schenck for his diligent work to reform our states Medicaid program, as well as my fellow House members for passing this landmark legislation today, said Cannon after the votes.
Medicaid in its current form is an out-of-control entitlement program which has become the single largest cost-driver in our states budget, continued Cannon. The meaningful, comprehensive Medicaid reform adopted by the House today is the first step toward fixing a broken program that both lacks the ability to provide quality care to patients, and drains our states financial resources at the expense of other vital services and programs.
I thank my colleagues for passing this critical legislation to reform our states Medicaid program today, said Schenck. For the past several years, Medicaid has plagued our budget, and this year alone it has consumed one-third of general revenue.The Medicaid reform plan approved by the House today restores sanity to this broken program and will deliver relief to the taxpayers of Florida by establishing a Medicaid program that can control costs and offer long-term viability, while improving access to coordinated, quality care for patients.
The Senate version of the Medicaid reform bills moved through the Health Regulation Committee despite some opposition from Democrats and Sen. Mike Fasano, R-New Port Richey. If the measure passes the Senate, the chambers will be forced to conference on a number of key issues. While the House version breaks the state down into eight regions, the Senate version would set up 19 regions. The House version also has a longer time line for implementation. Gov. Rick Scott has expected support for the reforms.
Reach Kevin Derby at kderby@sunshinestatenews.com or at (850) 727-0859.
