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House Tackles Medicaid Reform

April 13, 2010 - 6:00pm

When the Florida House convenes, Medicaid reform will be at the top of the agenda. There are more than 2.7 million Floridians currently participating in the program, and that number as if it will rise -- along with the price tag.

Medicaid is not functioning and, from a fiscal standpoint, is not sustainable, said Rep. Denise Grimsley, R-Lake Placid.

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.

A major portion of the Florida economy goes through the program, said Rep. Keith Fitzgerald, D-Sarasota.

House Republicans convened Wednesday to push their Medicaid reform plan that emerged from the House Select Policy Council on Strategic & Economic Planning on a 16-1 vote earlier in the week. The bill is being sponsored by Rep. Dean Cannon, R-Winter Park, the chairman of the council and the incoming House speaker.

Cannons proposal establishes a statewide managed-care program, dividing the state into six regions. In each region, Medicaid participants will be able to choose from up to 10 different plans.

Republicans said that the system was too complex and inconsistent with too many exceptions. They maintained that their reforms will improve the programs quality by focusing on the patients and by increasing accountability and transparency.

Cannon and Grimsely faced questions from members of their own caucus Wednesday about how they would lure specialists into participating in the program, especially with many questions about access.

I live in a rural area, said Grimsley, who is a nurse. There are no specialists.

Rep. Ed Homan, R-Tampa, who is an orthopedic surgeon, expressed reservations about the reforms, even comparing it to the recent federal health-care legislation signed into law by President Barack Obama. This led Grimsley to state there was no free market in health care.

Despite incoming House Minority Leader Ron Saunders, D-Key West, already calling the measure CannonCare, Cannon and Grimsley can expect little opposition from House Democrats. Only Perry Thurston of Plantation voted against the measure when it was in committee.

Weve had significant bipartisan participation, said Grimsley.

At a media event Wednesday, House Democrats expressed some concerns, but most of them seemed open to backing the reforms.

We are still at the table, said Thurston.

Cannon and Grimsley may have more problems with members of their own caucus than with the Democrats.

The James Madison Institute, a conservative-leaning nonprofit think tank, recently released a report that held, "Medicaid is growing at a long-term, unsustainable rate and threatens both state and federal budgets."

The state should expand a program allowing residents to waive their Medicaid claims in favor of risk-adjusted credit for prepaid plans from private insurers, the report suggests. The program, started in 2005, is now active in Broward, Baker, Clay, Nassau and Duval counties. The Institute recommends implementing it statewide.

With the state slated to pay $19 billion in Medicaid this year, the state-federal partnership has become a leviathan swallowing the state budget, said Bob McClure, president and CEO of the Institute.

McClure said the proposed House Medicaid overhaul is in line with the Institutes recommendations.

You would get these costs under control very quickly, he said.

Giving residents a choice between Medicaid and private insurers lessens the burden on the state, McClure said. It also encourages competition between insurers and promotes better medical care for residents.

McClure said reform will also allow companies to expand coverage, leaving less likelihood that a client will be denied plans.

Before the reform program was implemented in 2005, Medicaid contracted with 12 managed-,care programs in Broward County, according to the Institute report. Since the reform, the managed-care programs have risen to 15, with two more plans pending.

In the Senate, a trio of powerful Republicans have proposed an overhaul of Medicaid that allows residents with higher incomes to pay deductibles or supplement Medicaid with private insurance, and allows the Legislature to change eligibility requirements for certain optional programs. The proposal was introduced with the budget by Sen. Joe Negron, R-Palm City, Sen. Don Gaetz, R-Destin, and incoming Senate President Mike Haridopolos, R-Merritt Island.

Reporter Alex Tiegen contributed to this story.

Contact Kevin Derby at, or at (904) 521-3722.

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