TALLAHASSEE Millions of Floridians have no health insurance. The state has nowhere near enough primary-care doctors. Highly trained nurses might be able to help, but they lack the authority. Hospitals are suing other hospitals, claiming their trauma centers don't even deserve to operate.
No one expected Medicaid expansion to get a hearing in a Legislature dominated by Republicans seeking re-election, most of whom oppose the federal Affordable Care Act.
Yet even health care issues that might have seemed assured of success went nowhere this year. Blame it on political squabbles and failed power plays that managed to sink much in their wake.
Case in point: Senate President Don Gaetz tried to entice the House into helping doctors get around insurer restrictions on the drugs they prescribe. So he added his controversial idea to an under-the-radar insurance bill slated for easy passage and torpedoed both.
Gaetz has no regrets. "It's never more than 10 months until the next session," he quipped in an interview this week.
That wasn't the only time a lawmaker derailed a bill by tying it to a less popular topic.
Many lawmakers wanted to make sure three HCA trauma centers in Pasco, Manatee and Marion counties will stay open, despite lawsuits from longer-established trauma centers. HCA even agreed to accept compromises its competitors wanted in order to protect the three centers, including Blake Medical Center in Bradenton.
But the plan failed when it morphed into a heavily freighted "train'' of unrelated health bills.
Mark Delegal, a lobbyist for nonprofit safety net hospitals such as Tampa General that had sued HCA, says he now finds himself in the unusual position of defending the for-profit hospital chain.
"At the end of the day, the group that tried to do it the old-fashioned way of working its issue and getting votes ended up being the victim of a cobbled-together health care package that had so much on it it ended up not making it," Delegal said.
Gaetz said desperation created these trains, even though the danger was obvious.
"It was very difficult to get a clean health care bill out of either house," Gaetz, R-Niceville, said. "Because the special interests, as well as individual legislators, would sense that a bill might move so they all wanted to climb on. And as they climbed on they slowed the train down, and then started it up running in different directions so it couldn't move."
Infighting between interest groups doomed some health bills.
The House wanted to tackle the doctor shortage by allowing nurse practitioners more leeway to work independently, and by allowing doctors to treat Florida patients over the phone or Internet.
The Florida Medical Association, with Senate support, blocked those ideas.
The House also wanted to let outpatient surgery centers keep patients for up to three days after an operation, arguing it could save money. But the Senate sided with hospitals to kill that idea.
Bruce Rueben, president of the Florida Hospital Association, said he and his colleagues could not let up for a moment in the hunt for amendments unfriendly to their cause.
"We had to follow it and be active right until the last second of session," he said.
Most of the health care measures that fell apart this year likely will return.
Rep. Cary Pigman, R-Avon Park, a physician, has returned to his job working 12-hour shifts in the emergency room of a Highlands County hospital. He served as vice chairman of the House Select Committee on Health Care Workforce Innovation, which saw several of its priorities die late in the session.
"I was never delusional to think that we would get anything important in one year," Pigman said with a laugh. "That's just not the way it works."
Pigman said he will spend the next few months rethinking his arguments about independence for nurse practitioners and telemedicine now that he had a chance this year to hear from the opposition.
"I hope that now this session is over, the (Florida Medical Association) will be a little more reasonable and interactive so we can talk about these issues," he said.
Gaetz, who can serve for two more years under term limit rules, expressed similar optimism. He pointed to approval of legalizing a strain of medical marijuana as proof that some issues just need more patience than others.
"Even two years ago, could you have imagined one of the most conservative members of the Florida Legislature, Rep. Matt Gaetz, being the prime sponsor of legislation that would employ cannabis for medical purposes?" Gaetz said. "I couldn't, and I'm his father."