Scott Steps Into Health Care Funding Battle
Gov. Rick Scott stepped into the legislative fray over health care funding Tuesday, proposing an idea for moving forward on the state budget that was quickly dismissed by the Senate.
Scott's attempt to break the impasse, which comes with less than two weeks left in the legislative session, followed separate meetings among the full Senate and House Republicans in which both sides seemed to dig in further for a protracted battle over funding for providers of medical care and a potential alternative to Medicaid expansion.
Lawmakers on both sides have conceded that an extension of the regular session or a special session centered on the budget is now inevitable, meaning the Legislature will not finish its one constitutionally mandated responsibility by the scheduled May 1 conclusion of the regular session.
At the center of the dispute are two related Senate plans: one that would seek to extend a $2.2 billion federally-backed program for hospitals and other health care providers, and another that would use $2.8 billion in Medicaid expansion funds to help low-income Floridians purchase private insurance. Scott and House Republicans oppose the Medicaid proposal.
In his statement Tuesday, Scott called on the two chambers to develop budget plans with large reserve funds and deal with the $2.2 billion pot of money --- known as the Low Income Pool, or LIP, program --- later, after hearing back from the federal government about whether the program will continue beyond June 30. The governor said lawmakers could hammer out a spending plan with a record level of per-student funding for public education and "a significant tax cut."
"If the House and Senate fail to agree on allocations and begin a budget process that can be completed in an extended session, then I will call the House and Senate into a special session to pass a budget that continues current year funding levels for critical services like education, law enforcement, children services, and transportation," Scott said. "The continuation budget should be silent on any LIP funds as we wait on the federal government's answer to our request that they continue assisting low income Floridians."
Scott said he would also convene a Commission on Healthcare and Hospital Funding to examine facilities' finances, if the regular session doesn't produce results.
Senate leaders brushed the ideas aside, with Senate Appropriations Chairman Tom Lee, R-Brandon, saying the term "continuation budget" is "a made-up word."
Lee said he has considered a similar idea, but that he and House Appropriations Chairman Richard Corcoran, R-Land O' Lakes, have decided that it wouldn't be necessary unless lawmakers don't have some plan in place by late June. The new fiscal year begins July 1.
Senate President Andy Gardiner, R-Orlando, suggested that the Legislature might at least technically remain in session --- though lawmakers could take a break --- a maneuver that would prevent Scott from calling a special session before the fiscal year runs out.
"We have until June 30 (to craft a budget)," Gardiner told reporters. "If we want to stay until June 30 in an extension to talk about that, then we certainly will."
Gardiner also rejected the idea of setting LIP aside, noting that both the House and Senate have said the issue is crucial to finishing a budget.
"Then, to all of a sudden say, 'Let's do a never-mind and put that back in the corner, and let's not talk about it,' I'm not sure that that gets you a legitimate budget people can be proud of," he said.
House Speaker Steve Crisafulli, R-Merritt Island, issued a statement that once again called on the Senate to drop its linkage between LIP and the Medicaid-funded expansion plan.
"The House remains willing to have a conversation on the Low Income Pool and is willing to work with the Senate to create a plan for appropriate contingencies should the federal government fail to fund LIP," Crisafulli said. "The discussion on LIP should be separate from Medicaid expansion. ... We can continue to debate the reasons why Medicaid expansion is wrong for Florida; however, for the sake of our state, we should fulfill our constitutional duty to pass a balanced budget."
But the federal Centers for Medicare & Medicaid Services suggested last week it will consider whether the state plans to expand Medicaid when deciding on Florida's LIP application.
Supporters of linking the two ideas note that increasing the number of Floridians with health insurance could decrease the need for LIP, which is largely used to cover the expenses of uninsured, low-income Floridians who show up at hospitals needing treatment.
Scott's announcement Tuesday came after meetings in both chambers to update members on the health-care issues. With all members invited to a Senate Appropriations Committee meeting, the upper chamber emphasized the horrors that would be visited on the state if LIP funding goes away.
Over the next five years, the state would lose almost $612 million in tax revenues and almost 20,000 jobs, according to Amy Baker, the Legislature's chief economist. Baker said employment in the hospital and nursing sectors would drop by almost 4.2 percent.
"This is a big enough change to the economy that we can see it, we will feel it, we will know it," she said.
Russell Armistead, chief executive officer of UF Health Jacksonville, said his hospital would lose $95 million if LIP expires.
"If I lose it, I'll close in a few months," he said.
Gardiner has his own connections to the health-care industry, serving as a vice president of Orlando Health, a hospital system based in Central Florida.
Gardiner said he understood that his ties to the hospital might be raised as an issue as he pursues a coverage expansion favored by health-care providers, but he pushed back on potential criticism.
"I think it almost is more irresponsible if I say, 'Yeah, I see that problem over there, but I'm not going to touch it because I work in health care,' " he said. "I think that's kind of irresponsible. At the end of the day, the members will decide how this thing all shakes out."
Meanwhile, Crisafulli convened a closed-to-the-public caucus meeting to give GOP representatives what he called "a history lesson" on Medicaid and LIP.
Reporters, including one with his ear pressed against the door, huddled outside the House Majority Office during the hour-long meeting before questioning Crisafulli about whether the gathering violated the state's open-government laws.
Crisafulli's overheard remarks indicated that the speaker may have been trying to shore up support for the House's rejection of Medicaid expansion, which is supported by influential business lobbying groups and the health care industry.
Crisafulli urged the Republicans to "stand like a rock" and pleaded with his GOP members to "please trust us." But because the caucus did not discuss pending legislation, open access was not required, Crisafulli told reporters.
"We didn't get into any details on any issues at all. We did give them a background, however, on LIP and Medicaid expansion and what's going on in the Senate and what we have done in the past here in the House and what we anticipate we'll see in the future," he said. "Strictly a history lesson for our members, and it was important for us to do it."
Asked whether the House meeting, which was called after the Senate announced its plans for the Appropriations Committee, was a direct response to the Senate's moves, Lee said he wouldn't speculate.
But he used the opportunity to take a shot at the House.
"All I can say is we're not lobbying our members to support the president," he said. "Our members are coming to us creating these policy positions and the president's supporting that. This isn't a top-down driven mandate from the Senate president that we prioritize health-care funding. So we don't need to convene meetings to leverage or lobby or convince our members that they're on the right path."
News Service of Florida senior writer Dara Kam contributed to this report.