Democratic U.S. Sen. Bill Nelson urged Florida Gov. Rick Scott to veto legislation his fellow Republicans advanced that suspends for two years the state’s authority to set health insurance rates.

Nelson, a former state insurance commissioner, said in a Wednesday letter to Scott that allowing the bill (SB 1842) to become law would put consumers at risk of sky-high rate hikes.

“To eliminate the Florida insurance commissioner’s authority to turn down rate increases is unbelievable and unconscionable.”  Nelson wrote.

Nelson’s criticism echoes that raised during the session by legislative Democrats who said the legislation appeared designed to shield state regulators from any fallout stemming from the Affordable Care Act. Among them would be Chief Financial Officer Jeff Atwater, a Republican and former Senate president from North Palm Beach, whose office oversees the Office of Insurance Regulation.

Proponents of the legislation, however, said it is merely aimed at helping the state comply with evolving regulatory requirements under the federal health care overhaul.

Group or individual health plans in place in 2010 will still be subject to rate review by state regulators, under SB 1842. But the host of new coverage options expected to be created when the Affordable Care Act takes effect in January will have rates controlled by federal agencies, although Atwater’s office will still review the proposals.

When the proposal was advanced in the Legislature, Republicans insisted they were not trying to shift blame for any problems that could rise from the influx of coverage plans and new companies.

They said that since the federal government has been imposing so many new regulations on the state, it made sense that federal officials do the rate-setting.

“This is not changing the consumer tradition of this state,” Rep. John Wood, R-Winter Haven, said at a House hearing last month. “But it is giving us
flexibility to understand a changing landscape.”

Democrats have been angered by the Republican-ruled Legislature’s long reluctance to enact provisions of the Affordable Care Act. They also said the new measure will give consumers the runaround in dealing with any issue with health insurance rates.

“We can do better for consumers,” said Rep. Jose Rodriquez, D-Miami, said during the April hearing.

Supporters of the Affordable Care Act continue to criticize the Legislature’s move.

“Senate Bill 1842 brings bad news for Florida consumers in at least two distinct ways: it deregulates health insurance at the state level, putting consumers at risk; and, it sets up ACA to be blamed for Florida’s irresponsibility,” said the Jupiter-based health advocacy group, FloridaCHAIN.

Scott has until June 5 to act on the legislation.

Gov. Rick Scott has been catching heat for failing to lobby hard on behalf of his call for a Medicaid expansion.

But on the second-to-last day of session, Scott went hand-to-hand with lawmakers, schmoozing his way across the House floor. The rare visit looked mostly genial — and likely included a few thank-yous to House members for approving a version of his manufacturers’ tax break late Wednesday.

Still, Scott said he was not abandoning hope that some version of a health care expansion was still possible in the session’s waning hours.

“As you know, there’s still time left in session,” Scott said earlier Thursday. “A lot of things happen the last week in session. We’ve got a little over a day left in session. So we’ll see what happens. As you know I’ve said making sure we take care of the uninsured and the legislature said no.”

From the House, Scott headed across the hall to the Senate.

The Florida House lurched into Day 2 of a slowdown Wednesday, initiated by Democrats angry over Republican leadership’s rejection of a plan to draw federal Medicaid dollars to provide health insurance to more than 1 million Floridians.

House Speaker Will Weatherford, R-Wesley Chapel, advanced the session’s scheduled 9 a.m. start by an hour. And an auto-reader continued to be used to read the full text of bills before the House.

House Democratic Leader Perry Thurston of Fort Lauderdale made the rarely used procedural move Tuesday — demanding the full readings to underscore the party’s frustration. A new tactic emerged Wednesday, when Democrats began using floor debate on virtually every bill to highlight the health care expansion.

Environmental bills, water management legislation and even a measure involving the mapping and monitoring of agricultural lands seemed to remind Democrats in debate about the failed health coverage.

Rep. Lori Berman, D-Lantana, was among those speaking. She grabbed her microphone to debate on an otherwise routine bill involving a state organ and tissue registry.

“Unfortunately, we’re not going to allow some people to take advantage of the organ and tissue registry because we’re not going to allow them to receive health insurance coverage,” Berman said.

The House approved its state-financed plan Friday to extend health insurance to more than 100,000 Floridians, shunning billions of dollars available from the federal government for a more ambitious effort backed by Gov. Rick Scott and the state Senate.

The House 71-45 vote broke along party lines, with Democrats opposing the measure (CS/HB 7169) as unworkable and driven by ideological opposition to President Obama’s federal health care overhaul.

The House debated the measure for six hours over two days, with many Republicans ridiculing the promise of federal dollars as unreliable. But Democrats said the House plan was useless.

“This bill is wrapped in a beautiful box,” said Rep. Mia Jones, D-Jacksonville. “But when you open the box…it’s filled with empty promises.”

Still, Republicans said those criticizing the legislation were missing their best chance to help low-income Floridians. With the Legislature entering its final seven days, the House and Senate have deadlocked over relying on federal Medicaid dollars to cover uninsured.

“If you vote no on this bill, you are voting to deny Floridians the opportunity to buy health insurance,” said Rep. John Wood, R-Winter Haven.

The House proposal would extend health coverage to 115,000 parents, children and disabled Floridians living below the federal poverty line and cost state taxpayers $237 million annually.

Called Health Choices Plus, the House plan would cost low-income Floridians $300 a year, letting them choose from a variety of insurance options supplemented by $2,000 annually in taxpayer contributions.

A family of three earning less than $19,530 would qualify for coverage. But critics say out-of-pocket costs would prohibit many poor from taking part.

Unlike the Senate proposal, Health Choices Plus wouldn’t cover childless adults.

The Senate’s Healthy Florida would cover families with income up to 138 percent of the poverty level, or $26,300 for a family of three, along with single adults earning as much as $15,586. Like the House plan, it also would require those in the program to pay modest monthly fees and co-payments.

The Senate proposal positions Florida to receive $51 billion in federal aid over the next decade, while costing state taxpayers $3.5 billion. The House plan would cost Florida taxpayers more than $2 billion in the same period, while covering one-tenth of those without coverage.

Florida has almost 4 million uninsured residents, one of the largest populations in the nation.

The Senate plan has been praised by supporters for helping cover many low-income workers in the state’s tourism, health care and service industries who currently have no health insurance.

Scott this week began hinting to lawmakers that he may wield his veto pen heavily — killed coveted spending priorities, if they fail to embrace his legislative agenda.  Scott’s salesmanship on the health insurance plan, however, has been low-key.

But Rep. Jim Waldman, D-Coconut Creek, said the Republican governor should retaliate if he is sent the House health insurance proposal.

“Gov. Scott, this Legislature has failed you,” Waldman said Friday. “This House of Representatives has failed you.”

Waldman said, “You need to veto this budget and send us back here to do our job.”

A Senate budget panel Wednesday approved Sen. Joe Negron’s plan to draw billions of dollars in federal money to expand health coverage to 1.1 million low-income Floridians.

But Negron also offered an olive branch to fellow Republicans in the House — who so far have shunned the federal dollars. Negron, R-Stuart, said he wants lawmakers to not only approve his sweeping Healthy Florida plan, but also the scaled-back approach favored by Rep. Richard Corcoran, R-Land O’ Lakes.

“I think there may be a way we could move forward with something that accomplishes both of our goals,” Negron told the House Health and Human Services budget subcommittee.

The panel OK’d Negron’s legislation (SB 1816) 13-0, with lawmakers from both parties praising the bill — and the dealmaking strategy with a scheduled less than three weeks remaining in the legislative session.

Negron said he envisions lawmakers approving both his proposal and the dramatically smaller House Health Choices Plus plan that covers 115,000 parents, children and disabled Floridians — but not childless adults. As Negron pitched it to the Senate committee, Floridians would have a choice to take his plan or the House program.

A Senate plan by Sen. Aaron Bean, R-Fernandina Beach, which incorporates much of the House approach, also was approved by the committee on a narrower, 6-4 vote. Senate Republicans said it was important to have all options available as the session hurtles toward the finish line.

Sen. Bill Montford, D-Tallahassee, questioned that stance.

“It’s like trying to take two dates to the prom,” Montford said. “You don’t do that where I’m from.”

Montford also cautioned that twin plans — big and little — would give House members the impression the Senate was willing to settle for less.

The House didn’t immediately react. But senators from both parties Wednesday did their best to sell Negron’s plan.

“It’s not about politics. It’s not about Democrats or Republicans,” said Sen. Rene Garcia, R-Miami. “It’s about the health care of Floridians.”

Negron’s Healthy Florida plan would build on Healthy Kids, a program created under late-Democratic Gov. Lawton Chiles that serves 250,000 children, aged 5-18.

Parents pay $15-$20 monthly for health coverage for their children and can choose from at least a couple of private health plans available in each of Florida’s 67 counties.

Negron would reposition Healthy Kids to also allow the adults who could be eligible under the health care law option that provides more money to states expanding Medicaid to families with income up to 138 percent of the poverty level. That would add about 1.1 million adults and children in Florida.

Florida stands to draw $51 billion in federal funding over the next 10 years through an expansion, while state taxpayers would pay $3.5 billion.  The federal government would fully finance the first three years, if Negron’s plan wins approval from the Obama administration.

By contrast, the House proposal would cost Florida taxpayers $237 million annually. But since it doesn’t draw any federal dollars, it could be enacted without review by Washington — although Negron’s deal might change even that.

The House plan would cost low-income Floridians $25-a-month, letting them choose from a variety of insurance options supplemented by $2,000 annually in taxpayer contributions. Negron, however, indicated that financing was likely not enough — and that maybe federal dollars could be added to the program.

With the House and Senate divided over whether to accept federal dollars to expand health insurance for poor Floridians, Senate budget chief Joe Negron said Tuesday that he is open to finding a middle ground.

Negron, R-Stuart, is scheduled to shepherd a proposal through a Senate budget subcommittee Wednesday that relies on federal money to reposition the Florida Healthy Kids program to accept $51 billion in federal aid over the next decade.

Negron wants to create a Healthy Florida program to cover the potential 1 million uninsured adults and children who could be eligible for coverage under the Medicaid expansion allowed states by the federal Affordable Care Act.

The House and Senate have both rejected the Medicaid expansion earlier sought by Gov. Rick Scott, but the governor, Senate leaders, and most health care advocates have since signed onto the Negron proposal.

The House, however, is rejecting the federal money. House Speaker Will Weatherford, R-Wesley Chapel, and his likely successor, Rep. Richard Corcoran, R-Land O’ Lakes, say the promise of a steady stream of federal dollars is unreliable.

Instead, House leaders are advancing a proposal that would cover only 115,000 low-income parents, children and disabled at a cost to state taxpayers of $237 million-a-year.

A similar Senate proposal by Sen. Aaron Bean, R-Fernandina Beach, also is expected to be reviewed by the Senate budget panel Wednesday.

“My goal is for people to have health insurance, with them paying part of these premiums,” Negron said. “I would prefer a premium assistance program along the lines of the Senate plan. But this process requires people of good will to enter into principled agreements with the other side.”

Negron said that some sort of “hybrid” proposal — incorporating portions of his plan and the House proposal — is the only approach that will fly this session.

“I think for any plan to succeed this session, it would have to have elements of the House and Senate plans in it,” Negron said.

Although federal Health and Human Services Secretary Kathleen Sebelius told states last December not to expect full federal funding with a partial expansion of Medicaid coverage, Negron said he felt federal officials will be ready to deal.

“I would think that the federal government would want the citizens of Florida to have private health insurance rather than show up at emergency rooms when it’s too late, frequently,” Negron said.

While the House plan would cover 115,000 and Negron’s approach would bring 1 million Floridians insurance coverage, the senator said it was still unknown how many the “hybrid” will insure.

Almost 4 million Floridians currently have no health insurance. Where will the hybrid land?

“Somewhere in between. It depends on where you draw the line,” Negron said.

The Florida House approved its $74.4 billion state budget Friday, setting the stage for end-of-session negotiations with the Senate over a final spending plan for 2013-14.

The House vote was 99-17, with about one-third of the Democratic caucus opposing the proposal.

Unlike recent sessions, the House and Senate budgets are relatively close, helped along by a $1 billion budget surplus which follows six years of spending reductions.

“We prioritize people, while maintaining reserves,” said Rep. Matt Hudson, R-Naples, who helped craft health and human services spending.

The House increases public school spending by $1 billion, or an average $395-per-student. College and university tuition would jump by 6 percent under the House plan, which also sets aside $2.6 billion in reserves.

The Senate approved its $74.3 billion proposal earlier this week on a 40-0 vote. Much of the session’s remaining three weeks will be devoted to reaching a consensus  plan for the year beginning July 1.

House Democratic Leader Perry Thurston of Fort Lauderdale criticized the House proposal for failing to embrace a Medicaid expansion that could draw $51 billion to Florida over the next decade, while costing state taxpayers no more than $3.5 billion. Another 1 million Floridians could get health insurance under the approach.

Instead, House Speaker Will Weatherford, R-Wesley Chapel, and other ruling Republicans unveiled a health insurance proposal Thursday that would cover only about 115,000 Floridians while costing state taxpayers $237 million a year. No federal dollars would be used in the modest expansion.

Thurston said the difference means a “big elephant stands in the way,” of his supporting the House budget proposal.

“We stand with a once in a lifetime opportunity to not only do something good, but to do great things,” Thurston said.

Weeks after Republican legislative leaders defied Gov. Rick Scott and refused to expand Medicaid, the House rolled out a health insurance plan Thursday that parallels a longshot proposal already introduced in the Senate.

The House would build on Florida Health Choices, a five-year-old insurance marketplace designed for individuals and small businesses.

Sen. Aaron Bean, R-Fernandina Beach, has advanced a similar approach in the Senate, where it has drawn little support compared with a more ambitious proposal from Senate budget chairman Joe Negron, R-Stuart.

With just over three weeks remaining before the Legislature’s May 3 adjournment, the battle lines are clear. While Scott and Negron have expressed support for drawing billions of federal dollars to finance health coverage for an additional 1 million Floridians, the House proposal shuns federal money.

“The Florida House has developed a plan that will fit the needs of Florida, not the requirements of Washington,” said House Speaker Will Weatherford, R-Wesley Chapel.  “Our plan increases our commitment to a strong safety net and ensures Floridians are not on the hook for billions that we currently do not have.”

The House’s Florida Health Choices Plus would cover an additional 115,000 uninsured Floridians at a cost of $237 million annually to state taxpayers. Florida has close to 4 million residents without health coverage, contributing to hospitals losing $2.8 billion in charity care last year.

Democrats, hospitals and health-care organizations have joined advocates for low-income Floridians in pressing Republican leaders to embrace the Medicaid expansion allowed states under the Affordable Care Act.

Florida stands to draw $51 billion in federal aid at a cost to taxpayers of $3.5 billion over the next decade — with the first three years of the expansion fully paid for by the federal government.

Negron’s proposal in the Senate, if approved by the full Legislature and signed into law by Scott, is seen as likely winning approval from the Obama administration. That would clear the way for it to be financed as an alternative to the Medicaid expansion.

Following the plan’s release, House Democrats and Scott found rare symmetry.

Both sides gave a nod to the effort by House Republicans — but said it fell short.

House Democratic Leader Perry Thurston of Fort Lauderdale called it “bare-bones health coverage.”

“Though personally, at a glance, I am not enthralled by the proposal, I recognize that it is at least a minimal attempt toward achieving a legislative compromise on the important topic of health coverage for Floridians,” Thurston said.

Scott weighed-in supporting the Senate plan.

“The House’s plan will cost Florida taxpayers on top of what they are already taxed under the president’s new health care law,” Scott said. “This would be a double-hit to state taxpayers.”

He added, “The Senate’s plan will provide health care services to thousands of uninsured Floridians while the program is 100 percent federally funded. As it stands today, the Senate’s plan is in line with what I said I would support because it protects both state taxpayers and the uninsured in our state.”

Much of the proposal released Thursday by the House was devoted to making a case against expanding Medicaid. The Health Choices Plus plan would cost low-income Floridians $25-a-month, letting them choose from a variety of insurance options supplemented by $2,000 annually in taxpayer contributions.

Those taking part in the program would be expected to be employed, unless they could not work because of a disability.

Health care advocates earlier questioned the similar Bean proposal in the Senate — saying it’s lack of significant financing would blunt the kind of coverage Floridians could obtain.

Gov. Rick Scott’s task to get his push for Medicaid expansion through the Legislature got a bit tougher Tuesday — with House Speaker Will Weatherford openly deriding the plan and accusing the Obama administration of trying to “buy off” states.

“I am opposed to Medicaid expansion because I believe it crosses the line of the proper role of government,” Weatherford told the House in an address on the session’s opening day.

“I believe it forces Florida to expand a broken system that we have been battling Washington to fix, and I believe it will ultimately drive up the cost of health care,” he added.

Weatherford said the Obama administration is trying to “buy off” states with Medicaid cash, that for Florida would amount to $26 billion over the next decade. Florida would have to put up $3 billion for the aid, which is seen as helping extend health coverage
to about 1 million of the state’s 4 million uninsured.

Scott, however, has said that expanding Medicaid for at least the next three years – when the federal government promises to fully finance it – makes sense for Florida.

On the eve of the start of the 2013 Legislature, Gov. Rick Scott was dealt a blow Monday when a House committee killed his push for Medicaid expansion.

In a party-line vote, 10 Republicans on the House’s committee on the Affordable Care Act, voted against expansion; five Democrats sided with the Republican governor, who recently dropped his longtime opposition to the measure, which is expected to make 1 million lower-income Floridians eligibile for Medicaid.

“What you saw today was theater of the absurd,” said Rep. Mark Pafford, D-West Palm Beach, following the vote.

House Republicans took turns at the microphone to question expansion, saying it put the state at risk for future costs and relied on funding from a federal government which is weathering a host of fiscal challenges. Rep. Richard Corcoran, R-Land O’ Lakes, at one point likened the state relying on federal assurances of fully paying costs for the first three years of expansion as similar to tthose offered investors in Bernie Madoff’s Wall Street schemes.

“You cannot rely on someone giving us money when they are borrowing 50-cents on the dollars,” Corcoran said.

The House action came only hours after a Senate committee postponed its scheduled hearing where there was the possibility of a vote on expansion. But committee chairman Joe Negron, R-Stuart,  raised hopes among many health care advocates by speaking generally about how Florida should make every effort to assure that Florida’s 4 million uninsured become eligible for some kind of health coverage.

The House vote likely sets the stage for a session-long fight over expansion. The politics have been complicated, with Scott getting clear support from Democrats long accustomed to opposing his policies, while Republicans are divided, at best.

Defying conservatives in his own party, Scott said he wants the Legislature to approve expanding Medicaid to 138 percent of the poverty level, a move which would make eligible almost 1 million Floridians.

Medicaid already serves 3.2 million people and absorbs almost one-third of the state’s $70 billion budget. But saying no to expansion just means Florida tax dollars will be spent in other states, supporters have said.

Under the expansion, the federal government would pay for 100 percent of the expansion until 2016, when states would start paying a 5 percent share that would gradually increase to a maximum of 10 percent of new costs by 2020.

Estimates vary, but analysts have said Medicaid expansion could bring Florida $26 billion in federal dollars over the next decade. Florida taxpayers are expected to pay $3 billion during that period, according to the state’s Agency for Health Care Administration.

Beach cleanup volunteers throughout Palm Beach County say they see the evidence every time they walk the sands.

“Cigarette butts are the number one item we pick up,” said Todd Remmel, county chapter chairman for Surfrider Foundation, an environmental activist organization. “Beaches are supposed to be a playground. But people use them as ashtrays.”

State Rep. Bill Hager, R-Boca Raton, wants to change that.

Hager is pushing legislation (HB 439) this spring that would give cities and counties power to enact anti-smoking measures on publicly-owned property that are tougher than those in place at the state level.

State law, which has barred local controls since first enacted in 1985, is aimed chiefly at barring smoking indoors.

The legislation, which so far has been ignored by the influential cigarette industry in Tallahassee, is drawing some pushback from cigar enthusiasts.  A Senate version (SB 258) is scheduled to get its first hearing Thursday in the Senate Regulated Industries Committee.

Full story here: http://bit.ly/Zjjguz

Gov. Rick Scott kept his distance Tuesday from allegations that his former hospital chain is being investigated by federal officials over billing for unnecessary medical treatments, mostly at its Florida hospitals.

Scott’s role as chief executive of Columbia/HCA  Corp., haunted his race for governor, with the Republican repeatedly forced to defend his leadership that ended in 1997, three years before the chain paid $1.7 billion to settled federal claims of overbilling Medicare and Medicaid.

Scott was never charged and has said he left the company before it engaged in the practices that led to the federal penalties.

The New York Times reported Tuesday that the U.S. Attorney’s Office in Miami is looking into an internal HCA review prompted by whistleblower charges that doctors at its Florida hospitals had performed unnecessary cardiocatheter work on patients at hospitals in Fort Pierce, Miami and in the Tampa Bay-area between 2002 and 2010.

The U.S. Justice Department is looking into practices at 10 hospitals, mostly in Florida, according to HCA.

“I’m sure that the federal agencies are going to look into anything like that,” Scott said Tuesday. “But you know I haven’t been involved in that company in 15 years.”

HCA owns 160 hospitals — including JFK Medical Center in Atlantis and Palms West Medical Center near Wellington — and 110 surgery centers.

Florida’s tough economy has proved even more challenging for those living on the state’s financial fringes, with poverty, infant mortality and an unmet need for mental health care on the rise, a new report shows.

A study called The Well Being of Florida’s Children — Is Our Future at Risk? shows the poverty rate among Florida’s children has climbed 35 percent between 2006 and 2010, resulting in 1.8 million kids living in low-income households. The state’s rate of low birth-weight infants also is worse than the national average, with 10 percent of Florida children having developmental or behavorial problems.

The number of homeless students in Florida has almost doubled since 2006 and the rate of food insecurity among Florida’s children is worse than the national average, the study found.

The report was put together by Voices for Florida and the Minority Issues Action Council, a pair of advocacy organizations, and financed by the W.K. Kellogg Foundation.

 ”It is not new that disparities exist,” said Linda Alexionok, co-director of Voices for Florida.  “What is new is that disparities are more prevalent today than ever before, and growing.  This report dispels the myth that a level playing field exists for all children.”

 In the report, project researcher John Hall also found that Florida’s Temporary Assistance for Needy Families program (TANF) has declining caseloads and expenditures at a time when the poverty rate has increased.

“It warrants a closer look,” Hall said.  “There are considerable needs among Florida’s children that are unmet or addressed minimally due to inadequate funding.”

The Florida Department of Health released a four-page outline Friday of steps it plans to take leading to the January 1 closing of the state’s last tuberculosis treatment center, Lantana’s A.G. Holley Hospital.

But the document, ordered by the Florida Legislature, basically is a logical how-to when it comes to shuttering the 62-year-old facility. The practical difficulties of relocating 37 severely ill patients and what the state plans to do with Holley’s 144-acre campus are reduced mostly to aspirational goals.

Eleven of the patients at Holley have been hospitalized there under court-order, DOH acknowledges.

DOH, however, states in the transition plan that there are “ongoing discussions with several licensed hospitals” for accepting Holley patients who need continued in-patient care. “The anticipated contracts for hospitalization remain in a stage of active negotiation,” DOH said.

“Our Department of Health continues to demonstrate our commitment to meeting the needs of Floridians with tuberculosis as we work to reduce the risk of tuberculosis across our state,” said State Surgeon General Dr. John Armstrong. “We remain focused as well on facilitating the transition of our AG Holley employees to new opportunities.”

The town of Lantana has long talked about acquiring the hospital site and using it to lure industry to the area.

The state has talked about closing Holley for years but has been stymied by a host of problems related to the facility’s population of patients difficult to treat.

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Palm Beach County — for now — is staying out of a lawsuit filed Thursday by 47 Florida counties over the Legislature’s attempt to recover unpaid and disputed Medicaid bills.

Florida’s 67 counties expect to lose $70.5 million in health care dollars this year. Palm Beach County, alone, could lose almost $8 million. While County Commissioners earlier this month approved resolution supporting the lawsuit, they’re not part of the case filed in Leon County Circuit Court.

“We have a unique situation in Palm Beach with our health care taxing district,” said Todd Bonlarron, the county’s lobbyist. ”The county effectively says ‘you’re responsible…for health care. Our board supports the lawsuit. And they might take another look at it, but not now.”

The Florida Association of Counties also is involved in the challenge, which casts the Legislature’s action as an “unfunded mandate.”  The constitution doesn’t prohibit the state from increasing costs for local governments. But to do so, measures must be approved by two-thirds of the House and Senate, which the Medicaid bill (HB 5301) didn’t get. 

  Lawmakers said local governments owe the state $325 million, and the legislation reduces local revenue sharing for several years.

But the amount of debt is disputed, with counties accusing the state of double-billing or demanding payments from them for treating Medicaid patients who turn out not to be county residents.

“This bill represents the worst kind of body blow to taxpayers,” said Martin County Commissioner Doug Smith, president of the Florida Association of Counties, when Gov. Rick Scott signed the bill last month.  ”Rather than correcting Tallahassee’s error-ridden Medicaid billing system, HB 5301 codifies it and leaves local taxpayers with the bill.”

State lawmakers concede billings are frequently inaccurate, especially since Florida changed its system in 2008. In signing the measure, Scott added a letter in which he said the state’s Agency for Health Care Administration will work with counties on specific billing problems.

Florida’s last tuberculosis sanatorium, Lantana’s A.G. Holley Hospital, would close in January under legislation approved 86-28 Friday by the state House.

Holley’s shuttering has been proposed for most of the past decade. But House Health Care budget chief Matt Hudson, R-Naples, said it was time to move forward with closing a facility he said costs $10 million annually to operate and typically serves no more than 30 patients.

“It’s time we dust off those plans and go to work,” Hudson said about the proposals for shutting down Holley.

Under the bill (CS/HB 1263), the state’s Department of Health would be charged with drafting a transition plan by May for steering patients from Holley to community hospitals.

Earlier versions of that approach date to at least 2008, when the Legislature directed DOH to find a new way to treat tuberculosis patients, while also outsourcing their management to a private vendor, records show. When no qualified vendors came forward, the Legislature in 2010 ordered DOH to develop a plan to find community hospitals willing to isolate and care for patients.

Lantana town officials also are eager to obtain the 144-acre site, which they hope will prove attractive to a company looking to relocate to the area.

The proposal still must clear the Senate, which so far has shown little interest in the wide-ranging bill. Along with closing Holley, the measure revamps the duties of the state surgeon general and repeals a statewide septic-tank inspection program approved by lawmakers only two years ago.

Critics say the bill also limits the department’s focus on disease-prevention and education programs. 

But Holley, the last of the state’s four TB hospitals opened between 1938 and 1952, has drawn much of the focus. The legislation in the House advanced over opposition from several health advocates, who said closing Lantana hospital would threaten care for a few dozen seriously ill patients who also pose a public health risk.

In a committee hearing earlier this week, Dr. Paul Arons, former director of the state’s HIV-AIDs program, called Holley a “unique institution.”

 ”It treats the hardest of the hard patients,” he said.

Arons said 40 percent of Holley’s tuberculosis patients also have HIV, making them particularly frail and complicated to treat. He labeled the House proposal “puzzling and troubling.”

Gov. Rick Scott said Tuesday he has little interest in a fellow Republican’s plan that guts the state’s Department of Health, while also closing Lantana’s A.G. Holley Hospital.

Even before he was sworn-in, Scott’s transition advisers gave him a blistering review of the DOH, dismissing it as a wasteful bureaucratic agency ripe for change. Legislation by Rep. Matt Hudson, R-Naples, would decentralize most of the department’s services, and give county commissions authority to run county health departments.

So far, though, the proposal looks like a no-sale with Scott.

“I’m trying to figure out what it does,” Scott said.  “Does it improve quality? Does it reduce costs? Does it improve service? If if it doesn’t do something that makes the lives of Florida’s citizens better, why would we think about doing that?

“I haven’t seen anything — the way it’s been explained to me — in the bill that does any of those things,” Scott concluded.

Several public health advocates blasted Hudson’s proposal Monday when it cleared a House subcommittee.

The measure would largely get the state out of the business of running county health departments, turning them over to county commissions to operate. State and federal dollars would be steered in block grants to county governments, based on population, which would gain more control over how the dollars are spent.

About 12,000 state Health Department jobs would be slashed, although supporters of the move said many would convert to county positions. A.G. Holley’s closure, seen as another cost-saving move, would shutter Florida’s last remaining tuberculosis hospital, most likely by January.

The House’s push to meet Gov. Rick Scott’s demand for $1 billion more in school spending came into sharper focus Tuesday, as a budget panel unveiled about $300 million in health and humans services cuts aimed at freeing-up dollars for classrooms.

Emergency room visits would be limited to a dozen per-year for adults in the state’s Medicaid program, while chiropractic and podiatry services for some 34,000 mostly low-income and elderly Floridians would be eliminated under the House’s approach, which cleared the Health Care budget subcommittee on a 10-4 vote, with Democrats opposed.

Chairman Matt Hudson, R-Naples, said House Speaker Dean Cannon, R-Winter Park, had hinted that cuts in many programs would be needed to meet a goal of pumping more money into public schools this election year — blunting a $1.3 billion cut schools weathered last year.

“He certainly is going to make sure we spend money on people over things,” Hudson said. “And students are certainly a priority for the speaker.

“ I would anticipate that when the other budgets roll out, you’ll see they’re a collective package in that we will be very aggressive in making sure that not only are we meeting the health care needs, but we are meeting the education needs.”

Democrats, however, urged that Republican leaders find more deft ways to make budget reductions. Eliminating some routine health coverage completely for some of the frailest Floridians can result in the state absorbing costs elsewhere.

Several college students who said they received $1,200-a-month from the state as part of the Department of Children & Families’ ‘road-to-independence’ program for youngsters who have been in foster care, argued against another House plan to cut the program’s maximum eligibility age to 21 — down from the current age 23.

The change would save about $10 million, but eliminate 657 people from the program.

Those who testified Tuesday before the committee recalled childhoods spent cycling through foster homes and schools before setting themselves on a path to college and a professional future only with the help of mentoring and the program’s cash.

“It’d be absolutely devastating to end these services at age 21, just when people are getting their feet under them,” said Andrea Cowart, 22, of Dunedin, who attends St. Petersburg College.

Cowart said she was in foster care for almost seven years and attended 10 to 15 schools. She had dropped out of high school her freshman year and had a child at age 17. Motherhood, she said, changed her course — but only with the financial help from the state program.

“It made what was impossible, possible to me,” she said.

Florida Insurance Commissioner Kevin McCarty’s approval Monday of a sharp increase in worker’s compensation insurance rates paid by businesses is rekindling a fight between potent power bases of the ruling Florida Republican Party.

McCarty’s 8.9 percent rate hike drew scorn immediately from the business lobby, Associated Industries of Florida, which blamed higher health care costs on doctors pocketing extra money from repackaging prescription drugs they give worker’s comp patients.

“Almost one third of this rate increase is due to the ever-expanding practice of physicians dispensing repackaged drugs at prices exponentially higher than the statute allows pharmacies to charge for the same drugs,” said Jose Gonzalez, an AIF vice-president.

 ”Associated Industries of Florida will diligently seek the Legislature’s intervention to close this loophole during the 2012 session and allow Florida employers to use those millions of dollars to create new jobs rather than line the pockets of those who unfairly manipulate the system for their own gain,” Gonzalez said.

Over the past two years, Florida business groups have been scuffling with the Florida Medical Association, Florida Orthopedic Society and the American Federation of State, County & Municipal Employees (AFSCME), a Democratic power base, over the prescription repackaging issue.

Last year, lawmakers approved a measure backed by then-Chief Financial Officer Alex Sink that would have imposed new restrictions on doctors’ repackaging, lowering costs to the state and private companies. Sink, who lost to Republican Rick Scott in last fall’s governor’s race, was among those saying the change would have saved private companies $34 million in worker’s comp costs.

But then-Gov. Charlie Crist vetoed the measure.

Among those supporting Crist’s veto in June 2010 was Automated Healthcare Solutions, a Miramar company headed by a pair of doctors, Paul Zimmerman and Gerald Glass, who later that summer gave more than $1 million to political spending committees headed by the Legislature’s then-incoming leaders, Senate President Mike Haridopolos and House Speaker Dean Cannon.

The company provides software that helps doctors dispense and manage patient prescriptions, a profitable sidelight for many doctors. Because the legislation vetoed by Crist would have imposed new restrictions on doctors’ repackaging,  it also threatened Automated Healthcare’s services.

Zimmerman, the company’s CEO, says in a statement on the company’s website that its services are designed to “enhance revenue production by allowing physicians to retain profits.”

Haridopolos and Cannon last year used the money funneled from the doctors primarily to help then-Attorney General Bill McCollum in his losing Republican primary fight with Scott.

But with McCollum out of the picture, the doctors quickly pivoted following the campaign – pouring $735,000 into the Florida Republican Party and another $145,000 to Scott’s spending committee – in an attempt to make nice with the new GOP nominee, who is now a resident of the Governor’s Mansion.

And the doctors are still giving. While the business groups looking to cut worker’s comp costs aren’t shy about giving to the ruling state GOP, Automated Healthcare Solutions also has donated $203,500 to the party so far this year, records show, as it becomes more apparent another effort to rein-in repackaging is coming. 

 

Without waiting for President Obama’s administration to appeal lower court rulings, Florida Attorney General Pam Bondi and 25 other states are asking the U.S. Supreme Court to decide whether the federal health care law is unconstitutional.

Florida led the challenge against the Obama administration, arguing that its requirement that most Americans purchase health insurance – also known as the “individual mandate” – is unconstitutional.

Last month, the 11th Circuit Court of Appeals in Atlanta ruled that the individual mandate is unconstitutional but upheld the remainder of the sweeping health care law, including a dramatic expansion of Medicaid.

But even Obama’s attorneys believe that much of the law relies on the requirement that individuals purchase health insurance.

Although several other cases are working their way through the courts, attorneys on both sides believe that a U.S. Supreme Court decision in Florida’s multi-state case will ultimately decide the matter.

Bondi’s lawyers argued that the Patient Protection and Affordable Care Act forces individuals to engage in commerce and is an imposition on states because of increased Medicaid costs which they cannot avoid.

“Both features of the Act raise constitutional issues that go to the heart of our system of limited government and the Constitution‘s division of authority between the federal government and the States. Of the various challenges working their way through the federal courts, only this case allows the Court to address both of these fundamental questions,” lawyers representing Bondi and the National Federal of Independent Businesses, wrote in the appeal filed today.

Bondi is holding a noon press conference on the filing today in the Capitol.