Delegates say health care issues to dominate session

Lawmakers returning Tuesday for their 60-day session are expected to deal with nursing home reform, Medicaid reimbursements and prescription drug fraud. Also on tap are insurance fixes for children and small businesses.

Constitutional issues also loom. Proposals to derail the bullet train and require that parents be notified before their school-aged daughters seek an abortion are expected to come up early. Meanwhile, many lawmakers want to make it more difficult to amend the state's most fundamental document.

But after spending most of last summer in a series of often-rancorous special sessions, legislative leaders say there will be a big push to finish on time so members can begin their fall re-election campaigns. To do so, delegates say that a handful of controversial topics ranging from medical malpractice to class-size reduction will be shelved until next year.

"My sense is that this being an election year, I'm hopeful we'll be able to get through the major issues, especially the budget issues, early," said Rep. Dudley Goodlette, R-Naples, and chairman of the House Policy Committee. "Ideally, we'll get our business done without the need for an extended session."

Topping their early "To-Do" list, lawmakers are expected within the first weeks to expand the state's system of subsidized health care to cover nearly 100,000 children who now await service.

Launched in the late 1990s, Florida's Kid Care now covers about 1.6 million children under a handful of programs targeting the families of Florida's working poor.

With $132 million in additional federal money freed up earlier this year, leaders from both political parties agree that a major expansion of the program is eminent. What isn't agreed upon, however, is how to pay for the program and who will be eligible.

Democrats say that's enough money to pay for the current waiting list plus the 2,000 children whose parents apply every week for medical coverage.

Republican plans emerging in the past few weeks would restructure the program to eliminate the waiting list. In its place would be open enrollment periods similar to those in monthly managed care plans that would give eligible parents a window of time to enroll. They also want those families with access to employer-based health coverage to use it, if it doesn't take too much of a bite out of their monthly paychecks.

"Right now, 40 percent of the children in Florida have some form of health care subsidized by the government," said Rep. Carole Green, R-Fort Myers, and chairwoman of the House Appropriations Committee's heath-care panel. "With the bill as proposed, we'll be at 43 percent."

Also early on, House members are expected to pass a measure to bolster parental rights. The chamber is slated to approve a proposed constitutional amendment requiring that parents be notified when their teenage daughters seek abortion services. While widespread support in the House is expected, Senate passage is less assured.

The proposal, which must be ratified by voters, is intended to overcome repeated Florida Supreme Court opposition to previous measures that required notification. The court repeatedly has stated that Florida's constitutional right to privacy extends to teenagers seeking abortions.

Beyond abortion, lawmakers are expected to propose changes to the state constitutional amendment process. Angered over recent amendments protecting pregnant pigs and requiring a high-speed railroad network, lawmakers want to make it more difficult for groups to amend Florida's Constitution.

Health-related issues

Fresh from hearings on the state of the nursing home industry after major reforms two years ago, lawmakers are looking to bolster standards that already seem to have improved patient care and reduced the number of lawsuits filed on their behalf.

The $60 million question is whether lawmakers follow through on staffing requirements that were a critical part of the 2002 legislation. Nursing homes were supposed to ratchet up the number of hours a day that certified nursing assistants spend with patients.

A plan to require 2.9 hours a day was supposed to go into effect May 1 but has been put on hold because of budget constraints. Lawmakers would need to provide an additional $60 million to make the jump.

"If we can't find that $60 million, we are stagnant," said Goodlette, House chairman of a select committee on nursing home care. "Without it, we're dead in the water for this session."

Lawmakers also are expected to look at regulation surrounding continuing-care centers, which offer residents increasing levels of care as their health declines. Attracted to such medical centers by the prospect of fixed payments for future care, many residents are now being charged assessments in addition to previously agreed upon fees.

With Medicaid rates continuing to skyrocket, lawmakers have been meeting for months to determine how to trim costs and eliminate fraud, especially in the area of prescription drugs.

Prescription drug abuse accounts for nearly a third of all illegal drug activity. Whether it's doctor shopping for multiple prescriptions or Medicaid providers fraudulently selling painkillers and other high-demand drugs, the overprescribing of otherwise legal drugs is costing the state millions.

"Our Medicaid program now exceeds $12 billion, and it's growing by 10 to 12 percent a year," said Sen. Burt Saunders, R-Naples, who heads up a task force on Medicaid prescription fraud. "We can't sustain that. One aspect of that is the elimination of fraud."

Saunders' proposal calls for stiffer penalties for trafficking prescription drugs and a better system to monitor high-demand drug sales. The bill also creates swifter and more severe penalties for physicians who defraud the Medicaid program.

Lawmakers also will propose a scheme to increase payments to Florida's 20 trauma centers, including Lee Memorial's in Fort Myers, which have been increasingly strapped for cash. Plans call for funneling money from increased traffic fines to trauma centers — their representatives say they are collectively losing $126 million a year.

Lee Memorial's own deficit is around $10 million a year, which has prompted hospital officials to threaten to close the trauma center unless they can recoup some of those losses.

"A funding source has to be identified," Saunders said. "This seems to be one that is the most politically acceptable."

Other key issues

Approaching the third anniversary of 9-11, state lawmakers are poised to spend $100 million in federal money to bolster homeland defense. Of that, $80 million will be funneled to emergency responders and $20 million toward prevention. The money will be used to ramp up port security and better equip those who must react to a terrorist event.

"Floridians and visitors can be comforted to know that we're ahead of the curve in getting those federal dollars down to the front-line responders," said Goodlette, chairman of the House domestic security committee.

On the growth-management front, a successful pilot program with Collier County roots will be offered for statewide consideration. Sponsored by state Rep. Mike Davis, R-Naples, the bill would expand Collier's rural lands program to other counties. Under Collier's plan, developers are allowed to cluster development in exchange for keeping environmentally sensitive lands pristine.

"It's been a great solution in Collier County. We're hoping the other 66 counties in Florida might be able to take advantage of the program," Davis said.

Four years ago, lawmakers attempted to make it more affordable for small businesses to offer health insurance for their employees. To do so, they proposed a series of reforms to allow small business owners to pool their resources while reducing the number of mandated services that insurance policies must offer.

Last time around, business groups said reducing mandates would allow employers who don't currently offer coverage to do so. Critics, however, said this would allow employers to water down current health policies at workers' expense.

"We have in Florida more mandates than any other state in the nation except for one," Saunders said. "That makes the insurance better but more expensive. We need to give employers some flexibility."

Sen. Dave Aronberg, D-Greenacres, whose cross-state district includes south Lee County, has introduced a trio of bills to bolster consumer privacy.

Leading the list is a proposal to strengthen penalties for video voyeurism, a practice that has exploded with the expansion of the Internet. Aronberg's bill would heighten penalties for taking or transmitting sexually explicit videos of unsuspecting victims.

Other measures would further protect consumers from fraudulent solicitations or selling personal information under false pretenses.

"We need to update our laws to match the advances in technology," Aronberg said. "Florida has an explicit right to privacy but technology is limiting those rights."

Hands-off for now

With elections looming, lawmakers are expected to stay away from a handful of controversial issues that will instead wait until after the November elections.

"In general, we won't spend a lot of time revisiting things we've done recently," said Rep. David Rivera, R-Miami.

Topping the list of items not to be addressed in the next few months are proposals to repeal the class-size amendment approved by voters two years ago. Potentially lacking the support needed in the Senate to approve a repeal, delegates say they will wait until the cost of the program is more keenly felt.

The next installment of class-size reduction will cost an additional $500 million, bringing to $1 billion the additional revenue spent to reduce class sizes. School districts now calculate class size by averaging it on a districtwide level. The costs rise dramatically when districts are required to comply on a classroom-by-classroom basis.

"We've be able to pay for it so far, but it is going to become increasingly expensive," Saunders said. "By the time we get into the 2006 budget cycle, the real costs will be visible and that's the time to take the issue to voters."

Beyond class size, industry calls to insulate nursing homes from lawsuits will be put on the back burner, local lawmakers predict.

Nursing home owners have asked for the same protections from catastrophic lawsuits that physicians and insurance companies demanded last year for medical malpractice.

Instead, legislators say they are more likely to give the 2002 reforms another year to work before re-entering the controversial area of litigation reform.

Likewise, lawmakers are unlikely to return to the telecommunications arena. Last year, the Legislature passed sweeping changes to encourage competition in local telephone markets.

Florida Attorney General Charlie Crist has challenged their solution in court, contending the law unfairly shifts the costs of service from businesses to residential customers.