RN takes charge of health spending

By Christine Jordan Sexton 
8/26/2009 © Health News Florida

A registered nurse who cares for indigent and uninsured patients was suddenly thrust this week into one of the top positions in the Florida House when it comes to health care spending. 

House Speaker Larry Cretul placed Rep. Denise Grimsley in charge of the House panel that oversees Florida’s mammoth $17-billion Medicaid program. Grimsley, a Republican from Lake Placid, works part-time at Florida Hospital in Sebring. 

Cretul, R-Ocala, dramatically altered the structure of the House, especially on oversight of health-care issues. Many of those in leadership positions during the 2009 session were appointed by Rep. Ray Sansom, who was ousted as House Speaker amid a criminal investigation into his handling of the state budget. 

As chair of the House Health Care Appropriations Committee, Grimsley said, her priorities will be protecting funding for people with disabilities and restructuring the Department of Children and Families. 

With budget forecasters predicting a $555-million deficit or more in Medicaid this year -- $165.8 million of which comes from state general revenue, the rest a federal match -- Grimsley said she also is willing to take a “hard look” at the Medicaid program. 

“When somebody comes to the triage door, has an I-phone, and hands me a Medicaid card, yeah, there is a problem,” said Grimsley. She said she sees that scenario “all the time.” 

“The disabled depend on it (Medicaid) and need it,” she said, adding that the Legislature needs to “look at those who also are able to obtain Medicaid that maybe could get insurance in other places or maybe could work, but don’t.” 

Grimsley’s appointment was just one of a number of moves that resulted in sweeping changes on the House panels that regulate health care policy and spending decisions for the state. 

Cretul said he was reassigning members and restructuring committees to improve efficiency. But the moves also unravel many of the decisions made by Sansom, who was indicted by a Leon County grand jury on corruption charges. Cretul did not become House Speaker until the first day of the 2009 session. 

Cretul took power away from several lawmakers who pushed significant health care bills during the 2009 session. He also abolished two health care spending panels -- Healthy Seniors Appropriations Committee and the Human Services Appropriations Committee -- altogether, giving their responsibilities to others.

Ed Homan, an orthopedic surgeon from Tampa, was one of two lawmakers who chaired a health care panel in 2009 who retained his position. The other was Rep. Tom Anderson, who carries over as chairman of the House Elder and Family Services Policy Committee. 

Homan, first elected to the House in 2002 along with Cretul, said he was “surprised’’ to see that he kept his post.

Homan pushed a “medical home” bill last year as a potential alternative to the ongoing Medicaid reform program. He also has championed mental health “parity,” to require insurance companies to treat mental health disorders the same way they do physical disorders. 

One key change: Rep. Kevin Ambler, R-Tampa, was removed from all health care committees. Ambler had been chairman of the budget panel in charge of Medicaid and vice chairman of the Health Care Regulation Policy Committee. Ambler is running for the state Senate. 

Ambler, who was named chairman of the Public Safety and Domestic Security Policy Committee, did not return phone calls.

Rep. Marcelo Llorente, prime sponsor of a bill authorizing creation of a prescription drug database, was removed from his powerful post as one of the two budget chiefs in the House. Llorente, R-Miami, will chair the House Policy Council, a post that Sansom had held.

Cretul’s move consolidated control of the budget – which had been divided between education and health care – under Rep. David Rivera, R-Miami. Rivera, who has aided the fledgling medical school at Florida International University, tried this past year to place a clause in the budget that prevented spending of state money on embryonic stem cell research.

The two lawmakers who lost their posts atop health care committees were Rep. Juan Zapata, who had been chairman of the Human Services Appropriations Committee, and Rep. Carl Domino, who led the Healthy Seniors Appropriations Committee. Zapata opposed efforts to expand Medicaid Reform into Miami Dade County and also opposed efforts to privatize the Northeast Florida State Hospital in Baker County.

Unlike Ambler, Zapata remains on health care panels but isn’t heading any of them up.

Cretul’s changes didn’t stop with appropriations committees. The speaker also made changes to the substantive committees, which make broad policy decisions.

Rep. Nick Thompson, R-Fort Myers, was named chairman of the Health Care Regulation committee, which doubled in size from 7 to 14 members. Thompson is an attorney with Morgan & Morgan. Thompson replaces Rep. Jimmy Patronis, a Republican from Panama City, who sponsored a bill on behalf of HCA to change the membership of the Low Income Pool council. Patronis served on four councils and committees in 2009 but won’t serve on any under the new committee structure.

Although the Health Care Regulation Committee is now twice its former size, there are very few carryovers. Indeed, in addition to Thompson, only Rep. Ari Porth, D-Coral Springs, and Rep. Charles Van Zant, R-Keystone Heights, have been reappointed.

Surgeon Paige Kreegel, R-Punta Gorda, was appointed chairman of the Health Care Services Policy Committee. He replaces Rep. Gary Aubuchon, R-Cape Coral, who is still a member of the committee. This panel doubled from 7 to 14 members and has just three carry-overs.