At midpoint, a health care chasm

/

TALLAHASSEE — Lawmakers hit the midpoint of their 60-day session on Wednesday in one of the most contentious sessions in recent history.

Although Gov. Rick Scott and Republican leaders who control the House and Senate are in general agreement on the major issues, they face some fundamental differences as they try to navigate the final month of the annual session.

Foremost is a sharp disagreement over health care funding, with the threat of the end of a $2.2 billion hospital funding program complicating the budget negotiations. The federal program, if not renewed, will end on June 30.

“The 900-pound elephant in the middle of the room is this: What do you do to fund the balance of health care if (the federal government) doesn’t do its thing?” said Ron Book, a veteran lobbyist who represents Jackson Memorial Hospital in Miami. “That’s driving the contentiousness.”

Florida Gov. Rick Scott addresses a joint session of the Florida Legislature on March 3. Even at the start of session, Legislative leaders were talking about possibly calling a special session to complete the budget, a rare topic to come up so early. (AP ARCHIVE)

Florida Gov. Rick Scott addresses a joint session of the Florida Legislature on March 3. Even at the start of session, Legislative leaders were talking about possibly calling a special session to complete the budget, a rare topic to come up so early. (AP ARCHIVE)

The budget problems threaten Scott’s ambitious efforts to cut more taxes while also boosting public school funding. The Senate is still trying to advance a $2.8 billion plan to expand Medicaid, while House leaders remain firmly opposed to any expansion effort.

The health care standoff has its roots in Florida’s refusal to expand Medicaid, the federal-state health care program for the poor and disabled, under the federal Affordable Care Act. The Senate plan, which offers a modified version of Medicaid expansion, would offer health care coverage to some 800,000 low-income Floridians.

It also could bring a more favorable response from the Obama administration on continuing the hospital funding program, although Scott and House leaders see that as a separate issue.

Lawmakers and environmental lobbyists are also divided over how to handle the new Amendment 1, which directs some $741 million be spent on environmental programs.

Senate Majority Leader Bill Galvano, R-Bradenton, does not see the session as particularly contentious as much as the $4 billion budget divide between the House and Senate reflects fundamentally different approaches to the health care issues.

Galvano said continuing some form of the hospital funding program, which reimburses hospitals that have large numbers of poor and uninsured patients, as well as Senate plan to expand Medicaid are the “cornerstone” of the Senate’s $80.4 billion budget.

“We’re being very cautious as we craft our budget in terms of projects and other funding issues until that gets resolved,” Galvano said.

Until it does, the Senate budget does not contain any of Scott’s $673 million in tax cuts nor does the public school funding reach the historic level that the governor is also advocating.

Read more: Big issues at the halfway mark

Meanwhile, the House has a $76.2 billion budget that has no expansion of Medicaid — an issue House leaders have firmly opposed — nor does it have a hospital funding program, although House leaders say they expect federal officials to eventually approve a modified version of the current program.

“There’s a huge chasm right now between the chambers,” House Appropriations Chairman Richard Corcoran, R-Trinity, told House Democrats who criticized the health-care gaps in the budget. “I’m sure that as we move forward some of the items that you have rightfully raised, we’ll see some resolution there.”

In search of a solution

The House budget does contain $690 million in tax cuts, including Scott’s plan to reduce the tax that Floridians pay on their cell phones and cable television services.

The Senate budget has no tax cuts, but the Senate is holding about $800 million in tax-cutting bills, pending the outcome of the health-care debate, said Senate Appropriations Chairman Tom Lee, R-Brandon.

Like Galvano, Lee said the Senate is committed to finding a solution to the hospital funding issue, noting that hospitals like Tampa General in his home county of Hillsborough could lose as much as $120 million if the program ends.

“There isn’t a legislator in a major urban area in this state that can go home with this budget,” Lee said.

“Our budget is higher. But as I said you can’t solve the problem and spend less money,” Lee said. “You’ve got to name your poison, and we’ve chosen to solve the problem.”

Rep. Matt Hudson, R-Naples, who oversees health care spending in the House, said House leaders expect a similar scenario to last year when the federal hospital funding program was again in doubt but was eventually renewed.

“They are in the midst of negotiating a yet-to-be-named replacement,” Hudson said.

Other issues have added to the session tension including a new constitutional amendment, approved by 75 percent of the voters, that requires lawmakers spend some $741 million on environmental initiatives.

Environmental groups expect a sizable portion of that funding to be spent on land-acquisition programs like Florida Forever. The Senate budget contains $2 million for the program, which once had a $300 million a year budget, while the House is at $10 million.

“We don’t need to be known as the hoarding-land state,” said Sen. Alan Hays, R-Umatilla, reflecting the sentiment among many top lawmakers that the state does not need an aggressive environmental land-buying program.

But other senators say funding for the environmental initiatives will likely rise in the final budget once the major issue of health care funding is resolved.

“We’re probably going to have to go up substantially in that number,” Lee said. “I would encourage people to stay calm and give us a chance to work through it.”

Book said the divides between the House and Senate leaders, who are all conservative Republicans, is not unusual in the legislative process. He said historically regardless of the political makeup, the House and Senate have always served as a “checks and balances” system on public policy.

But Book said the scope of the health care funding issue had led to the unusual declaration by legislative leaders in the first weeks of the annual session that an extended or special session may be needed this year.

“It’s rare where they were talking about it in week one and it was coming from the leadership,” Book said.

The timing of the session’s conclusion is largely dependent on when lawmakers receive an answer from the federal government on the fate of the hospital funding program.

Galvano, who leads the 26-member Senate GOP majority, said he remains optimistic that lawmakers will be able to resolve their differences by their scheduled May 1 deadline.

“I think it comes together,” he said, noting the Legislature’s annual obligation to pass a balanced budget.

“It’s not like we can’t do it. We have to do it. So that’s when people get serious and things come together.”

avatar

Lloyd Dunkelberger

Lloyd Dunkelberger is the Htpolitics.com Capital Bureau Chief. He can be reached by email or call 850 556-3542. ""More Dunkelberger" Make sure to "Like" HT Politics on Facebook for all your breaking political news.
Last modified: March 29, 2015
All rights reserved. This copyrighted material may not be published without permissions. Links are encouraged.