April 27, 2010

April 27, 2010
Overhaul Medicaid Over for Session

Welcome to another day in my life. Today is Tuesday and I hope you are having a safe and great week so far. Dab the AIDS Bear is in Washington, DC for AIDS Watch2010 attending meetings, having pictures taken and meeting with our elected officials. So stay tuned for picture soon.

I do have some news for people in Florida. Sponsors of a massive House plan to overhaul Florida's Medicaid system today declared it dead for this year but said they will try again in 2011.

The House legislation would have expanded a five county experiment in privatized managed care to all 67 Florida counties over five years. The plan had been one of several sticking points in budget negotiations between the House and Senate that continued through the weekend although it would have relatively little effect on spending in the next fiscal year, which starts July 1.

The Senate proposed a more modest expansion of the pilot to 19 counties but wanted to do it quicker. Leaders of both Republican controlled chambers see managed care as a way to cut costs and fraud in the $19 billion state federal health care program that covers more than 2.7 million low income and disabled Floridians.

Representative Dean Cannon, a Winter Park Republican slated to become House speaker next year, said he did not believe lawmakers could resolve their differences during the final week of the 60 day legislative session that is scheduled to end Friday.

"It looks like major reform is not going to happen this year," Cannon said before a budget meeting. "Hopefully some components of either the House or Senate plan can be worked out as groundwork to take it up again next year."

Cannon, who chairs a committee that filed the bill, and Representative Denise Grimsley, a Lake Placid Republican who drafted it, said those components would not include adding more counties to the five already in the experiment: Broward in South Florida and Duval, Baker, Clay and Nassau in the Jacksonville area.

Grimsley said one step that is needed this year regardless of what happens is to apply for an extension of a federal waiver that Florida received for the pilot program. It is due to expire June 30, 2011.

"That keeps us in play," Grimsley said.

The managed care concept championed by then Gov. Jeb Bush when it began in 2006 has strong support among Republican lawmakers, but is opposed by many Democrats. Also, doctor and patient advocates say the experiment has not gone well.

Physician groups say some doctors have dropped Medicaid patients because health maintenance organizations have refused to pay for tests and medications they have prescribed. Patient advocates say some Medicaid recipients have unknowingly chosen managed care plans that do not cover drugs or doctor visits they need. It also has not saved as much money as expected.

Senate Ways and Means Committee Chairman JD Alexander, a Lake Wales Republican who has been in budget negotiations with the House's appropriations chief, Representative David Rivera, R-Miami, said members of Gov. Charlie Crist's staff had expressed reservations about the House plan.

Cannon, though, said the possibility of a veto did not affect the decision to pull back. He said the House and Senate plans were just so different the two sides were unable to come together.

"We have not even discussed it at all in the Senate," said Senator Durrell Peaden, a Crestview Republican who chairs an appropriations committee that oversees health care spending.

He said he was not surprised the House sponsors decided to drop it this year because lawmakers are focused on several other complex issues including the budget with just five more days left in the legislative session.

Although the House began holding hearings Medicaid in October, a bill was not filed until the session was half over.

Budget negotiators, meanwhile, are continuing talks aimed at getting the spending plan settled by Tuesday. That is the deadline to avoid extending the session past its scheduled Friday finish due to a 72 hour waiting period before a vote can be taken on a budget that is expected to total more than $67 billion.

Another major unresolved budget issue is a House proposal to cut state workers' pay by 3 percent. The Senate wants to avoid a pay cut.

Alexander said it may be "bumped" to House Speaker Larry Cretul, R-Ocala, and Senate President Jeff Atwater, R-North Palm Beach.

"Sen. Atwater has strong feelings and, of course, in the Senate we have a pretty collegial working relationship and (Democratic) Leader (Al) Lawson has some strong feelings," Alexander said.

Lawson's Tallahassee district includes thousands of state employees.

Until we meet again; here's wishing you health,hope, happiness and just enough.

big bear hug,

Daddy Dab