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.
But before the May 6 end of the 60-day session, lawmakers also will face unresolved issues ranging from cracking down on pill mills to limiting lawsuits against doctors and hospitals.
Some high-profile issues have barely even surfaced during the first half of the session, including a possible revamping of the Department of Health.
With Wednesday marking the halfway point, here is an update about what is to come:
Budget
With the state facing a $3.8 billion shortfall for the fiscal year that starts July 1, interest groups are lining up to try to save their programs from cuts.
That was evident Thursday, as safety-net hospitals and transplant recipients held a news conference to fight potential cuts in Medicaid hospital rates and in the Medically Needy program.
The Senate budget proposal would eliminate funding in April 2012 for hospital and drug expenses in the Medically Needy program, which serves people who don't qualify for Medicaid but have debilitating -- and expensive -- medical conditions. The state would restrict payment to doctor visits.
"Don't make these cuts,'' said Delray Beach resident Mary Ellen Ross, president of the Florida Transplant Survivors Coalition. "I don't want to die.''
But while people like Ross worry about how they would pay medical bills, hospitals also have a bottom-line interest in the issue: The industry fears it will get stuck providing more uncompensated care to Medically Needy patients if the state slashes funding.
Under the state constitution, the budget is the only piece of legislation that lawmakers are required to pass this spring. But health-related spending will play a critical role as House and Senate negotiators try to balance the budget.
Big picture, Senate and House Republican leaders say budget cuts are necessary to close the shortfall.
"We're going to make decisions we really don't want to make,'' Senate Budget Chairman JD Alexander, R-Lake Wales, said Wednesday.
But the chambers disagree about how to divvy up tax dollars. The Senate budget proposal calls for spending $28.4 billion on health- and human-services programs, about $800 million less than the House would spend.
That difference shows up in areas such as the Medically Needy program, which the House would not cut, and in deeper Senate reductions in hospital Medicaid rates. The Senate proposal would cut those rates 10 percent, while the House would cut them 7 percent.
Medicaid
For Republican leaders, Medicaid is the favorite whipping boy of this session. They blame its steadily-growing costs -- a result of enrollment spikes that came with the recession -- for many the state's budget problems. They have made a top priority of overhauling the program.
"This program has captured our budget,'' said Rep. John Wood, a Winter Haven Republican who is chairman of the House Health & Human Services Quality Subcommittee.
But revamping the $20 billion program is extraordinarily complicated and affects poor, elderly and disabled people throughout the state. While House and Senate leaders agree that the solution is to require Medicaid beneficiaries to enroll in managed-care plans, the chambers will need to negotiate numerous details in the coming weeks.
The House has approved two bills that make up its Medicaid proposal, while a Senate bill is still moving through committees.
As an example of the issues that will have to be negotiated, the House wants to divide the program into eight regions, while the Senate wants 19. The number and boundaries of the regions are important because managed-care plans will have to compete in each region for contracts.
Many Democrats, meanwhile, are fighting the idea of moving to a statewide managed-care system. They argue, in part, that a pilot program in five counties has not worked well.
The rest:
It is common for lawmakers to put off decisions on dozens of issues until the final weeks of each session. This year, that could translate into a number of volatile debates as bills pour out of committees and hit the House and Senate floors.
Both chambers are considering bills that call for new abortion restrictions, including a proposal to require women to undergo ultrasounds before they can have abortions. Former Gov. Charlie Crist vetoed the idea last year, but it has returned in the House and Senate.
Also, doctors, hospitals and nursing homes are pushing bills that would seek to limit their liability in medical-malpractice and other types of lawsuits. Those issues always spur political fights, as trial lawyers and malpractice victims try to short-circuit the bills.
The House and Senate, meanwhile, have taken vastly different positions about how to combat unscrupulous pain clinics that dish out painkillers to drug addicts and traffickers.
House leaders say the answer is to ban doctors from dispensing drugs in their offices. They also want to eliminate a series of regulations approved during the past two years, including a requirement that the state use a new database to better track prescriptions.
But Senate President Mike Haridopolos, R-Merritt Island, has vowed repeatedly to fight the House on the database issue.
One far-reaching issue that has received little discussion during the session is a possible reorganization of the Department of Health. Arguing that the department was unfocused, House leaders last year pushed through a bill that led agency leaders to recommend a sweeping reorganization plan.
But House and Senate committees have not considered proposals to carry out the recommendations, which included cutting programs and jobs. So far, both chambers have focused more on revamping state economic-development programs.
--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.