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Legislature won’t take up volatile drug dispensing issue

By Jim Saunders
11/16/2010 © Health News Florida

Trying to avoid "food fights" during a special legislative session today, House and Senate leaders backed away from overriding Gov. Charlie Crist's veto of a politically charged bill that dealt with doctors who dispense drugs.

The bill, which would have restricted the cost of drugs that doctors supply on-site to workers' compensation patients, stirred a political struggle that pitted physicians and a major Republican donor against the influential business group Associated Industries of Florida.

Lawmakers gathered in the Capitol this morning for a largely ceremonial session that included swearing in members and formally selecting Rep. Dean Cannon of Winter Park as House Speaker and Sen. Mike Haridopolos of Merritt Island, as Senate president. Both are Republicans.

After an election dominated by the GOP, Haridopolos immediately vowed to prevent tax increases and to cut spending to balance the state's cash-strapped budget. Also, he reiterated his call for Washington to give the state more flexibility in running Medicaid.

"Their (federal officials') heavy-handed ways are not serving our state well,'' Haridopolos said after being sworn in as president.

Cannon and Haridopolos tacked on a brief special session this afternoon to override several Crist vetoes and to pass a resolution calling for Medicaid changes. But they announced Monday they would pull the drug-dispensing issue off the agenda.

Chief Financial Officer Alex Sink, who had pushed for adoption of the measure to save on workers' compensation costs, blasted the decision.

"This gives the appearance that the Florida Legislature and Governor-elect Rick Scott are getting square with the special interests who funded their campaigns,” said Sink, a Democrat who lost the governor's race this month to Scott. She will be out of office by the time the next session is held.

She added: "This was a perfect opportunity to save taxpayers millions of dollars and reduce workers’ compensation costs for Florida businesses. Once again, Tallahassee business-as-usual prevailed."

Workers' comp blogger Joseph Paduda was, if anything, even more caustic, noting that a company that makes millions on the status quo contributed heavily to recent political campaigns. Joe Paduda wrote the decision "will keep employers' costs up while enriching politicians and physician dispensers."

But legislative leaders said the decision was simply about trying to avoid what Haridopolos termed "food fights" during the one-day session. Cannon said he expects the dispensing issue to come up again during next spring's regular session.

Almost certain to pass today, however, is an override of Crist's veto of $9.7 million for the Shands teaching hospital in Gainesville. Also, the Republican-dominated Legislature likely will pass a non-binding resolution expressing its intent to make major changes in the Medicaid program.

Though they don't formally take office until Tuesday, Cannon and Haridopolos are busy making changes in the House and Senate. Both announced key committee chairmanships Monday, including the leaders of health-and human services committees.

Cannon offered somewhat of a surprise when he named Rep. Robert Schenck, a Spring Hill Republican who has not played a major role in health issues, as chairman of the House's main health-policy committee.

A former teacher who has a real-estate broker's license, Schenck said he hopes to "hit the ground running and do a lot of learning.'' He said he expects the Health & Human Services Committee to tackle major issues, such as overhauling Medicaid and limiting medical-malpractice lawsuits against doctors.

"We're going to do as much as we can in the next two years,'' he said.

While Schenck does not have a lot of experience on health issues, he is a conservative whose views appear to mesh with the smaller-government approach Cannon and Haridopolos want to take with health care.

"To improve access to health care, we need more choices and freedom, not mandates and government intrusion,'' Schenck's campaign website says. "The last thing we need is a bureaucrat getting between us and our doctors.''

Haridopolos, meanwhile, appointed Sen. Joe Negron, R-Stuart, as chairman of the Senate Health and Human Services Appropriations Subcommittee. The move had long been speculated and puts Negron in charge of a panel that will have the daunting task of drawing up the health-care budget.

Negron, like Haridopolos and Cannon, favors major changes in Medicaid. For example, he has supported pursuing the possibility of giving vouchers to Medicaid beneficiaries and allowing them to buy private insurance --- an idea that is not currently allowed by federal law.

Also appointed Monday was freshman Sen. Rene Garcia, R-Hialeah, as chairman of the Senate Health Regulation Committee. While a newcomer to the Senate, Garcia was heavily involved in health-care issues while serving earlier in the House.

Haridopolos and Cannon decided to hold the special session primarily to override vetoes by Crist, who became a pariah to many Republicans when he left the party to run unsuccessfully for the U.S. Senate. Lawmakers always hold a ceremonial session after the election to take care of business such as swearing in members.

The new leaders, however, added the Medicaid resolution to the special-session agenda because they want to send a message about revamping the $20-billion health program. They argue, in large part, that changes are needed to hold down soaring costs in the program.

The resolution calls for controversial ideas such as gradually moving to a statewide managed-care system for almost all Medicaid beneficiaries, including seniors who need long-term care. Also, it calls for the federal government to give states greater latitude to run the Medicaid program as they see fit --- likening the idea to welfare reform in the 1990s.

But incoming Senate Minority Leader Nan Rich, D-Weston, said she doesn't think lawmakers should take up such a resolution before holding committee meetings and taking testimony about the often-complicated Medicaid issues. She described the resolution as "putting the cart before the horse,'' because lawmakers need to pass bills during the spring legislative session to make changes.

"We just need to make sure that we bring all the stakeholders together and have a meaningful dialogue about the direction we need to go,'' said Rich, who has been a longtime leader on health and human-services issues.

In announcing the special session, Cannon and Haridopolos said they would stay away from controversial issues such as trying to override Crist's veto of a bill that would have required women to have ultrasounds before undergoing abortions.

But the bill dealing with drug dispensing touched off a political fight, with groups such as the Florida Medical Association supporting Crist's veto of the measure.

The bill would have have affected doctors who dispense medications in their offices instead of sending patients to pharmacies to fill prescriptions. Medical groups argue dispensing is a convenience to injured patients and also helps increase compliance with getting medications.

"Physician dispensing in Florida has expanded at a significant rate in recent years for a myriad of reasons including patient convenience, patient compliance and patient safety,'' the FMA and the Florida Orthopedic Society wrote in a letter Monday to the legislative leaders.

But dispensing also provides another revenue source for doctors' offices --- and, business groups argue, drives up workers-compensation costs. A House analysis released last week said restricting the drug costs could save $34 million a year for businesses.

Adding to the political difficulty of the issue, major Republican supporters lined up on both sides of the issue. Along with Associated Industries and the FMA, those GOP players included Automated HealthCare Solutions, a Miramar-based company that sells technology used in physician dispensing.

In all, Automated HealthCare and related companies contributed at least $2.8 million to parties, candidates and political committees during the 2009-10 election cycle, according to state records. That included $852,000 to the Republican Party of Florida; $615,000 to a committee linked to Haridopolos; $600,000 to a committee linked to Cannon; and $295,000 to a committee linked to Scott.

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