Jim Saunders

As the Florida House and Senate transform the $20 billion Medicaid system, they will create winners and losers.

One winner is easy to predict. The House and Senate both want to put almost all Medicaid beneficiaries into managed-care plans, giving HMOs a flood of new customers.

But numerous other groups will have to wait for the outcome of House and Senate negotiations to find out how they fare. With those talks expected to accelerate after the Passover-Easter break, here are some groups that have a lot at stake:

With lawmakers getting "lobbied to death" on the issue, a House committee Thursday expanded a bill that would help doctors and hospitals fight medical-malpractice lawsuits.

The House Judiciary Committee voted 15-3 to approve HB 479, after making a controversial change that would give defense attorneys a new tool in gathering information about patients in medical-malpractice cases.

Also, the committee added legal protections for doctors who volunteer to work with high-school athletics teams.

With negotiations looming with the House, the Senate Budget Committee approved a massive Medicaid overhaul Thursday that would try to slam the brakes on health-care spending.

The bill includes a controversial proposal that would cap the amount of money the state spends each year on Medicaid and force mid-year cuts if costs go up. The proposal could be a key issue as lawmakers try to reach agreement in the coming weeks on a final Medicaid plan.

With time running short, a proposed merger of Florida health and human-services agencies appears dead this year --- and lawmakers also likely will not approve a major overhaul of the Department of Health.

Gov. Rick Scott's transition team proposed merging the Department of Health, the Agency for Health Care Administration and two other agencies. Also, the Department of Health spent months putting together a proposed reorganization plan at the request of the Legislature.

A Senate committee Tuesday narrowly approved a bill that would help prevent costly lawsuits against nursing homes, despite arguments from trial lawyers and the senior-advocacy group AARP.

The Senate Health Regulation Committee voted 7-5 to approve SB 1396, which is a top priority of the nursing home industry. The bill stalled in the committee last month, but supporters made changes before Tuesday's vote.

After years of the Florida Medical Association thwarting the idea, Sen. Mike Bennett got creative Tuesday in his effort to boost drug-prescribing powers for optometrists.

Bennett attached the idea to a bill that, otherwise, would be near and dear to the FMA --- a bill that would help shield doctors from medical-malpractice lawsuits.

But trying to box in the doctors' lobby didn't work, as the Senate Health Regulation Committee deadlocked 6-6 on the bill. Tie votes kill bills in Tallahassee.

In a major reversal, a powerful House committee today went along with using a prescription-drug database to help combat widespread abuse of painkillers.

The House Appropriations Committee approved an 86-page rewrite of an earlier bill designed to close unscrupulous pill mills that have popped up in recent years. House leaders had earlier wanted to scrap the database because of patient-privacy concerns.

Less than a year after former Gov. Charlie Crist vetoed a similar proposal, the Florida Senate has approved a bill that would limit how much doctors can charge for dispensing drugs to workers-compensation patients.

Though somewhat arcane, the drug issue pits powerful special interests. The business group Associated Industries of Florida has pushed for the price limits, while opponents have included the Florida Medical Association and a major corporate political donor.

A House panel today approved a controversial medical-malpractice bill that would place new restrictions on out-of-state expert witnesses who testify against Florida doctors.

The Health Care Appropriations Subcommittee voted 11-3 to approve the bill, which is a top priority of the Florida Medical Association and also is backed by hospitals, dentists and other doctor groups.

Just past the halfway point of the 2011 session, the Florida House and Senate approved competing budget plans Thursday that rely heavily on cutting health- and human-services programs.

That is only the start, however, of a four-week rush to deal with major health-related issues. The top priorities will be negotiating a final budget and working out differences on mammoth plans to overhaul the Medicaid system.

The Florida Senate today approved a proposed 2011-12 budget that would slash hundreds of millions of dollars for hospitals, mental-health services and the Medically Needy program.

Senators voted 33-6 to approve the spending plan. The House is expected to approve its version later today, setting up negotiations on a final budget in the coming weeks.

The Senate Health Regulation Committee replayed an abortion debate Monday and dealt with turf wars that led a senator to call doctors "greedy." But it couldn't find time to listen to a stroke patient.

Here is a round-up:

Abortion politics

The proposal is virtually the same as last year: Women would have to undergo ultrasounds before almost all abortions and watch them, unless they decline in writing.

Senate leaders have scrapped a proposal that rank-and-file state employees feared would force them to pay thousands of dollars a year more for family health insurance.

The Senate Budget Committee on Friday approved a bill that still could require employees to pay more for family coverage --- but far less than a potential $6,000-a-year increase included in the original version of the bill.

Five years after a controversial pilot program began in Broward and Duval counties, the Florida House on Thursday approved a statewide proposal to shift Medicaid beneficiaries into managed-care plans.

The Republican-dominated House voted 80-38 along almost straight party lines to approve a bill that details a five-year process for overhauling the Medicaid program. Another bill needed to carry out the changes passed 78-39.

Supporters said the plan would improve care for Medicaid beneficiaries, reduce widespread fraud and control costs in the $20 billion program.

Supporters say the plan would improve patient care and hold down costs. Opponents fear it could be a disaster for poor Floridians.

But when state House members approve two bills today, they will take the first major step toward transforming Medicaid into a managed-care system.

The bills have been a long time coming --- and still have a long way to go. The House and Senate will have to agree on a final plan in the coming weeks and, ultimately, get federal approval.

A new Senate proposal would force many state employees to pay thousands a dollars a year more for health insurance --- or choose skimpier coverage.

The bill, filed this week to help carry out the Senate's budget plan, would provide $500 a month to help cover each worker's health costs, whether the worker is single or has a spouse and children.

The House and Senate budget proposals include wide differences in health and human services.

Overall, the House would spend $29.2 billion in the six agencies included in the health- and human-services budget, about $800 million more than the Senate proposal.

Most of the money goes to the Agency for Health Care Administration to pay for the Medicaid program. The House's AHCA budget proposal totals $21.7 billion, while the Senate would spend about $21.2 billion.

The House and Senate budget proposals include wide differences in health and human services.

Overall, the House would spend $29.2 billion in the six agencies included in the health- and human-services budget, about $800 million more than the Senate proposal.

Most of the money goes to the Agency for Health Care Administration to pay for the Medicaid program. The House's AHCA budget proposal totals $21.7 billion, while the Senate would spend about $21.2 billion.

With the chief sponsor calling for "bold and transformative" changes, a Senate committee today approved a controversial proposal that would hand over most of the Medicaid program to managed-care plans.

The Senate Health Regulation Committee unanimously approved a bill that calls for shifting hundreds of thousands of women, children and seniors into HMOs and other types of managed-care organizations.

Moving toward a 2012 ballot fight, a House subcommittee on Tuesday approved a proposed constitutional amendment that might allow Floridians to opt out of a key part of the federal health overhaul signed into law a year ago.

The House Health & Human Services Quality Subcommittee voted 10-4 along party lines to approve House Joint Resolution 1. The full Senate has already passed its version of the measure.

Even as Gov. Rick Scott insists law enforcement can take care of Florida’s notorious pill mills, many lawmakers appear intent on ripping down regulations passed over the past two years.

A Senate committee Monday approved a bill that would undo some pain-clinic regulations that lawmakers passed in 2009 and 2010. A separate bill also is moving through the Senate --- while the House has taken a radically different position.

As lawmakers remain divided about how to fight pill mills, Gov. Rick Scott on Monday announced a statewide law-enforcement effort to stop what he described as the "Oxycontin express.''

Scott and Attorney General Pam Bondi said the Florida Department of Law Enforcement will work with other state agencies and local police to coordinate regional crackdowns on the illegal sales of painkillers.

"We're going to change the direction of this,'' Scott said during a news conference in the Capitol. "This is not going to continue.''

Gov. Rick Scott and two state agencies have been hit with a class-action lawsuit alleging Florida has failed to provide needed services to 19,000 disabled people who are stuck on a waiting list.

An advocacy group and five named plaintiffs --- who have developmental disabilities such as mental retardation and cerebral palsy --- filed the lawsuit last week in U.S. District Court in Tallahassee.

In rural Baker County, the Northeast Florida State Hospital is big business.

But after a long-running debate, a new Senate proposal would transform management of the mental hospital --- either turning it over to a private company or possibly to a non-profit firm created by hospital employees.

Florida lawmakers moved Thursday toward placing new limits on medical-malpractice lawsuits involving Medicaid patients, arguing the move could help draw more doctors into the program.

The House Appropriations Committee approved a Medicaid bill that would limit non-economic damages --- which are awarded for such things as pain and suffering --- to $300,000 in cases where doctors or other providers are at fault for injuries to Medicaid patients.

With supporters arguing it would make coverage more affordable, lawmakers began considering a bill Wednesday that would open Florida to stripped-down health insurance policies from other states.

The bill, which was approved by a House subcommittee, could undergo major changes in the coming weeks. But at a minimum, the proposal refueled a long-running debate about whether coverage requirements --- known as "mandates" --- drive up the cost of insurance in Florida.

When Sen. Joe Negron released a proposal Monday to cut at least $1 billion from health- and human-services programs, it was a first step in what likely will be a contentious budget process.

The proposal immediately drew criticism for deep cuts to hospital funding, mental-health services and the Medically Needy program. And Tuesday, Negron's House counterpart will release a budget proposal that will differ on key issues.

Sen. Joe Negron has warned for weeks that cuts are coming to health and human-services programs. Big cuts.

Today, the chairman of the Senate Health and Human Services Appropriations Subcommittee will release an initial budget proposal spelling out the details.

A House health committee overwhelmingly approved Thursday a plan that would shift hundreds of thousands of Medicaid beneficiaries into HMOs and other managed-care plans, as Republican leaders rush to rein in the roughly $20 billion program.

Part of the bill also changed the way the $1-billion-a-year Low Income Pool – which pays for the care of poor and uninsured patients –is divvied up among hospitals.

The Florida House and Senate agree that Medicaid should be revamped, but they have vastly different views of how it should be done.

Here are some of the key questions they need to answer:

--- Who should be included in managed care? Both the House and Senate would enroll the vast bulk of Medicaid beneficiaries, such as children and women, and seniors who need long-term care.