In crafting amendments to the Senate's centerpiece legislation that provides health care coverage to more than 800,000 low-income and uninsured Floridians, the upper chamber addressed key House roadblocks to passage.
The billions in federal money connected to Medicaid expansion remain available, presenting the state with a long-term solution to uncompensated medical costs now hammering hospitals and other heath care providers.
With a special session set to begin Monday, the Legislature's sole mission is approval of a state budget.
Health care costs loom as the biggest hurdle with the Senate and House still at loggerheads, but this important issue could well be sidelined without a compromise.
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Last week's Senate revisions to the chamber's Florida Health Insurance Affordability Exchange, which strengthens the central provisions on consumer choice and personal responsibility, should compel House acceptance.
Senate Majority Leader Bill Galvano, R-Bradenton, expressed optimism last week in a Herald interview.
The chief budget writer in the House, Rep. Richard Corcoran, R-Land O'Lakes, called the new Senate plan "exciting," but with a caveat -- the Senate consider a number of unrelated House bills on other health issues. One would require hospitals to publish prices lists, a major benefit for consumers.
Members of the lower chamber have been insisting for years that the Medicaid system is broken and unworthy of state participation. But the revised Senate plan wipes out any mention of Medicaid since the bill is a uniquely Florida program with a privately operated managed care system.
Avoids Medicaid enrollment
The measure no longer requires enrollment in Medicaid for six months as a first step toward securing private coverage via the federal exchange as well as the new state marketplace created by the Senate bill. Expansion money would be spent in the open market, not on a federal program.
That negates the cornerstone House refusal to accepting federal dollars purely through Medicaid enrollment.
In addition, a key provision voids the plan should the federal government fail to keep funding promises, invalidating the House argument that the state would be stuck with exorbitant costs should that occur.
Plus, Senate amendments reaffirm state sovereignty and maintain the Legislature's authority to reject any federal waiver that varies substantially from the legislation.
State plans that veer away from Medicaid require federal government approval. The stronger work requirements in the amended Senate could be a sticking point, but Galvano noted lawmakers are willing to work with federal officials on the issue.
The job requirements solve another House issue as some chamber Republicans portray subsidized health care as a handout to the unemployed and under-employed who could improve their income with a better job.
One provision seeks to improve future job opportunities for low-income Floridians by furthering their education. The revised Senate proposal also requires Floridians looking for work to register with CareerSource Florida, the agency that attempts to connect job-seekers with employers.
These Senate amendments solve House concerns. The overall legislative goal should be steering the uninsured and underinsured away from expensive hospital emergency rooms and into cheaper preventative medicine through basic primary care. Without a health care solution, 20,000 jobs would be lost statewide, hospitals will lose even more money in uncompensated care and some would close, Galvano said. There would be "draconian effects" on Manatee Memorial Hospital, the county's safety-net hospital that treats the vast majority of poor patients.
"We're not doing right by Floridians" should the Legislature fail to adopt a comprehensive, long-term solution on health care, he stated.
The most sensible and pragmatic strategy for Florida is accepting Medicaid expansion money -- but not the Medicaid program -- under the Senate's bipartisan proposal.
The revisions resolve House Republican objections. We urge Reps. Jim Boyd and Greg Steube to embrace this approach.
The revised legislation is a win-win for lawmakers, the health care and business communities and Floridians.