After rejecting a controversial expansion of health coverage for low-income Floridians, House Republicans took a far-different approach Wednesday to revamping the state's health-care system.
A GOP-led committee approved six bills largely aimed at stripping away regulations, offering new ways for patients to get care and nudging state employees to pick from a menu of health-insurance plans.
House leaders say they want to create more competition and choices for consumers, which they contend will hold down costs and provide more access to care.
As an example, one of the bills (HB 23A) would allow patients to stay at ambulatory-surgical centers for up to 24 hours, eliminating a regulation that currently prevents overnight stays. Also, the bill would allow the creation of "recovery care centers," where patients could stay for up to 72 hours after surgery.
"I think this is a step in our overall desire to be able to offer better health care to Floridians, offer more transparency in the delivery of services and make it a much more competitive, safe marketplace," said bill sponsor Heather Fitzenhagen, R-Fort Myers.
But while the House Health & Human Services Committee overwhelmingly approved the bills, Democratic lawmakers raised questions about how some of the proposed changes would affect hospitals and low-income patients.
One of the most heavily debated bills (HB 31A) would eliminate what is known as the hospital "certificate of need" process, which regulates construction and replacement of hospitals and the offering of certain complex, costly procedures. Democratic lawmakers and the Florida Hospital Association expressed concerns that the bill would lead to new hospitals siphoning off insured patients, leaving behind other hospitals to treat uninsured patients and to provide services such as burn units.
"There's a reason for a certificate of need,'' said Rep. Janet Cruz, D-Tampa. "It's not about free market. But it's about protecting the neonatal intensive care unit. It's about protecting the burn units and the ability for these hospitals to level out these services that are so incredibly costly with those that are private-pay patients."
The House is expected to approve the series of bills this week and send them to the Senate, where it's unclear whether any will pass. The two chambers battled bitterly in recent months about a Senate plan to use federal Medicaid money to offer health insurance to hundreds of thousands of low-income Floridians, with the House killing the idea last week.
Senate President Andy Gardiner, R-Orlando, said Wednesday the Senate has been focused on uninsured Floridians and questioned whether the House bills address that issue. He was non-committal about whether the Senate would pass the House proposals, though the Senate Health Policy Committee on Wednesday held a workshop to discuss subjects such as ambulatory-surgical centers and certificates of need.
"It's the chairs' decision what they want to do with those issues,'' Gardiner said, referring to Senate committee chairmen.
House leaders have injected the issues into a special legislative session that was called because lawmakers did not agree on a budget during this spring's regular session. But some of the issues have been around in the past.
Among those issues, the Health & Human Services Committee approved a measure (HB 27A) that would allow advanced-registered nurse practitioners and physician assistants to prescribe controlled substances. Nurse practitioners have lobbied unsuccessfully for years for such expanded powers but have faced fierce opposition from the Florida Medical Association and other groups of doctors.
Committee Chairman Jason Brodeur, R-Sanford, also has proposed a bill (HB 21A) that would make significant changes in the state-employee health insurance program, an issue he and other House leaders have floated the past couple of years. Those changes would lead to employees in 2018 choosing among insurance plans with four different benefit levels. Also, the bill (HB 21A) would offer financial incentives that could ultimately lead to employees shifting away from the richest plans.
"We've got to control these costs and give choices,'' said Rep. Travis Cummings, R-Orange Park.
But Democrats and union officials questioned whether the changes could put more of a burden on state workers, who have gone years without pay raises.
"We continue to ask them to do more with less,'' said Rep. Mia Jones, D-Jacksonville. "We continue to ask them to take on more responsibility, and then we tell them that now you need take on more responsibility for your insurance."
The other two bills approved by the committee included a proposal (HB 25A) that would make clear what are known as "direct primary care" agreements between patients and doctors are not regulated as insurance. The other bill (HB 29A) would require hospitals to notify physicians at least 120 days before closing obstetrical departments.
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