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Nancy Smith

Foolish, Foolish Hospitals, You Awoke a Sleeping Giant

May 4, 2015 - 6:00pm

Calling Rick Scott a lame duck is like calling Betty White a retired actress.

Until last week, we were hearing the "lame duck" line a lot. The media loved it. But now, except for a growing rumble in the beanstalk, it's gone eerily quiet.


Lobbyist Bruce Rueben and Sen. Tom Lee -- probably more than any others -- are responsible for waking the sleeping giant.

They did it by shoving this fight on LIP funding and Medicaid expansion down the throats of the House and the governor. Bad idea.Scott is up, alert, fully engaged on health care and the budget, and God help those who want to see this Medicaid expansion through.

Certainly it didn't help that a Senate panel refused to confirm Scott-favorite John Armstrong, the state surgeon general, after Armstrong wouldn't answer questions on Medicaid expansion. That came a day after the governor said he could no longer support expanding Medicaid because of doubts about the federal government's promise to pay for it.

Whatever side of the issue you're on, if you're responsible for a hospital operating in Florida, you know Florida Hospital Association President Rueben, tone deaf and arrogant, overplayed his hand and incurred the giant's wrath.

Scott showed it to us Tuesday, as he prepared for a trip toWashington to meet with Sylvia Burwell, secretary of the U.S. Department of Health and Human Services. When a reporter asked him what he would tell federal officials about the Senate plan to extend private insurance coverage to hundreds of thousands of low-income Floridians, Scott was uncharacteristically direct. "It's not going to happen," he said.

He wasn't ducking the question. He wasn't smiling. Frankly, he looked comfortable and never sounded less like he was working off a script. "There's no support in the House," he said. "I'm not going to support it. It's not a program that's worked."

In other words, auf wiedersehen, Medicaid expansion.Consider the issue going nowhere. If you heard the governor for yourself, you've already figured out the federal handout is curtains in Florida.

But, thanks to Rueben's blown counsel and bull-in-a-china-shop strategy, Scott's interest now goes beyond LIP or Medicaid expansion. Watch the governor, with Rep. Richard Corcoran's help in the House, take a chunk out of the hospital industry's hide through amulti-year commitment to changing the health care system.

For starters:

  • "Certificates of need" -- considered a clunky, free-market-unfriendly regulatory scheme meant to cap medical facilities and services -- are like mother's milk to Florida hospitals. Scott wants them gone, and so doesSanford Republican Rep. Jason Brodeur, who will make it a priority in 2016.
  • The governor and House leaders -- including Jose Oliva of Miami Lakes, who will be speaker after Corcoran -- want more ambulatory surgical centers. Which the hospital industry very much opposes because of their potential to cut into profits.
  • They want to limit the number of mandated coverages in health insurance policies. Mandates drive up policy costs, but they make sure hospitals get paid.

The Florida Hospital Association certainly didn't expect or want a list of hospitals and their profits released -- but the governor prepared and shipped it out anyway. (Click here or see the attachment below.) Hospitals argue people are going without care, and their facilities have to treat whoever shows up on their doorsteps; no, no, says the House and governor -- have a look -- hospitals are receiving government welfare to boost profits.

The Commission on Healthcare and Hospital Funding, just created by the governor, will bring on the pains in Hospital Land, mark my words. This isn't going to be some evenly selected, namby-pamby, lip-service panel. Check out Section 2 of his executive order (in the attachment below or here) which pretty much says, I'll choose whomever I want on the commission and kick them off if I want, for any reason I want.

Make no mistake, the health care commission is brought to you by a shrewd, deliberate governor who already has the answers and just wants a vehicle to show you how and why hospitals can do more than line their pockets to replace LIP and care for more lower-income patients.

Tallahassee players in particular have been underestimating Rick Scott for five years. He found a way to beat them every time. At their own game. So, what do you think he's going to do now, when he's got opponents who arrogantly think they can win playing his game, in his yard?

In the Game of Hospitals, Rick Scott reallyisa giant. He's American Pharoah, Tom Brady and Superman rolled into one. You want to tug on Superman's cape? Really, Bruce Rueben?

Scott wrote the book on hospital financing. It's in hisDNA. Which is something Rueben should have known, and coached his side accordingly. It's going to take quite a while for the Florida hospital industry to recover from this one. Rueben should be held accountable.

Reach Nancy Smith at or at 228-282-2423. Twitter: @NancyLBSmth

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