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Sen. Pres. ‘aggressive’ on Medicaid

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 By Jim Saunders
 8/3/2010 © Health News Florida

Incoming Senate President Mike Haridopolos leaves little doubt about his views on major health-care issues. He calls Medicaid "broken.'' And, to him, the new federal health-care law is "Obamacare.''

But as Haridopolos sets off Wednesday on a whirlwind "Health Care Solutions Tour" from Miami to Tallahassee, he is preparing for a tough debate next year about how --- or even whether --- to overhaul Medicaid.

The Merritt Island Republican will travel during the three-day tour to places such as clinics, hospitals and an HMO to gather information and to focus attention on Medicaid. He, along with many other Republican leaders, argue the roughly $20 billion program needs to be revamped because of escalating costs.

"I'm going to be very aggressive on this,'' Haridopolos said during a phone interview Monday.

But Crestview Republican Durell Peaden and incoming Senate Democratic Leader Nan Rich -- both longtime leaders on health and human-services issues -- said it will take more than a three-day tour to study the Medicaid issue. Rich, D-Weston, said she thinks Haridopolos' tour is "very political.''

"Is this going to be a preaching tour or a listening tour?'' asked Peaden, who chairs the Senate Health and Human Services Appropriations Committee and will leave office this fall because of term limits.

Haridopolos, 40, a lecturer at the Bob Graham Center for Public Service at the University of Florida, was chosen by fellow Republicans to succeed outgoing Senate President Jeff Atwater after the November elections. Republicans far outnumber Democrats in the Senate, which allows them to select the president.

Since getting elected to the House in 2000 and moving to the Senate in 2003, Haridopolos has been an outspoken conservative on many issues such as taxes. He has repeatedly indicated he wants to shift the Senate --- which during the past decade has generally been less conservative than the House --- further to the political right.

"This is a new Senate,'' Haridopolos said. "It's a more conservative Senate.''

That approach is reflected in his stances on issues such as Medicaid, the federal health-care law and his support for placing more limits on medical-malpractice lawsuits. Haridopolos, however, also has a personal connection to many of the health-care issues, as his wife, Stephanie, is a family-practice physician. She will join him on the tour. 

Changing Medicaid is politically --- and technically --- difficult, with lobbyists for powerful groups such as doctors, HMOs and hospitals trying to influence the outcome. Also, any major changes ultimately would have to be approved by the federal government, which during Haridopolos' term will have Democratic leadership.

"You've got to do what you think is right,'' said Sen. John Thrasher, a St. Augustine Republican who also is chairman of the Florida Republican Party. "And I think that is where Mike is coming from.''

Lawmakers spent this spring's legislative session debating possible changes to Medicaid.  The House approved a bill that called for eventually requiring Medicaid recipients statewide to enter managed-care plans, while the Senate approved a more modest proposal to expand a five-county managed-care pilot to an additional 19 counties. The House and Senate did not agree so neither plan passed.

Incoming House Speaker Dean Cannon, a Winter Park Republican who helped spearhead the House bill, will join Haridopolos for part of the tour this week. Haridopolos described the House bill as a "thoughtful plan" and said Senate staff members are studying it.

But he said he also wants to look at an even more far-reaching idea to give vouchers to Medicaid recipients, who would then be able to buy private insurance. That idea, first proposed this spring by Sen. Joe Negron, a Haridopolos ally, also could help limit costs. Haridopolos said Florida should have flexibility in running the Medicaid program.

Rich said she thinks Haridopolos' focus is to move people from the traditional fee-for-service system, in which doctors and other health professionals are paid based on the services they provide, to an expanded managed-care system. She said that could include an "overlay" of the vouchers proposal.

"It's another way of getting at the expansion of managed care,'' she said.

But it's also questionable whether the federal government would approve such a voucher plan. Thrasher said former Gov. Jeb Bush had a difficult time getting federal approval for the current Medicaid managed-care pilot.

"At the end of the day, you've still got to take those ideas to the federal government, and they've got to approve them,'' Thrasher said. The federal government pays more than half the cost of Florida's program.

Haridopolos said, however, that lawmakers need to revamp Medicaid because the growing costs will drain money away from other programs such as education. He acknowledged that "we're not going to solve all the problems in a three-day bus tour,'' but he said he wants to focus attention on the issue.

"Whatever we want to do in other areas of the budget, we have to focus on Medicaid because that's where the money is,'' Haridopolos said. 

When Peaden, a retired physician, was asked what he thinks will happen with the Medicaid issue next year, he gave a two-word answer: "More confusion." Whatever changes are made, Peaden said, the health-care system will need additional funding as the state goes through tight budget times.

"He (Haridopolos) has learned a lot, as far as what the problems are,'' Peaden said. "They're still going to need more money.''

The tour itinerary is: 

--Wednesday: 9:30 a.m. at the Borinquen Health Care Center in Miami; 1:30 p.m. at the Hendry County Health Department in Clewiston.

--Thursday: 9 a.m. Orlando PCAN (Primary Care Access Network) Clinic in Orlando; 1 p.m. at Amerigroup in Tampa; 2:30 p.m. at Brandon Regional Hospital in Brandon; 4 p.m. at the University of South Florida College of Medicine in Tampa.

--Friday: 9 a.m. at Shands Hospital in Gainesville; 1 p.m. at Florida State University Medical School in Tallahassee; 2:45 p.m. press conference at the Florida Press Center in Tallahassee. 

More information on the tour is at Haridopolos' website.

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.