SESSION PREVIEW: HEALTH CARE, UNDER THE KNIFE AGAIN

By JIM SAUNDERS
THE NEWS SERVICE OF FLORIDA

THE CAPITAL, TALLAHASSEE.......By now, it's a familiar scene: As Florida lawmakers deal with a budget shortfall, hospitals, nursing homes and other health providers scramble to fend off --- or brace for --- funding cuts.

The 2012 legislative session will be no different.

Already, Gov. Rick Scott has proposed deep cuts in Medicaid payments to hospitals, as he tries to free up money to boost spending on public schools. And while it's too early to know whether lawmakers will go along with Scott's proposal, they are almost certain to make cuts in health and human-services programs.

Hospitals, nursing homes and numerous other programs say they have been hammered by cuts during the past few years. The debate during the session, which starts Tuesday, will focus on where further cuts will be made --- and by how much.

"Nursing homes have been hit with a tsunami of funding cuts to our Medicaid and Medicare reimbursements over the past six months,'' Emmett Reed, executive director of the Florida Health Care Association, said this week in a document outlining the nursing-home group's session priorities. "If we see more cuts this session, many facilities will have to make difficult decisions which could restrict further access to care; our state's seniors deserve better.''

The budget likely will be the biggest health and human-services issue during the 2012 session. But lawmakers and industry groups also are preparing for debates about other high-profile issues, such as revamping the personal-injury protection auto insurance system and shielding doctors from medical-malpractice lawsuits.

Lawmakers focused heavily last year on approving a plan to overhaul Medicaid and move to a statewide managed-care system. That plan is undergoing a lengthy federal review, so it appears unlikely to play a major role during the 2012 session.

Florida's budget has faced repeated shortfalls as the struggling economy has limited the amount of tax dollars flowing into the state. The shortfall for the 2012-13 fiscal year could be up to $2 billion, though estimates vary because of issues such as how much money lawmakers decide to put in reserves.

Republican leaders have long complained that growth in the Medicaid program is sucking up dollars that could be used for other priorities such as education. As a result, they have looked each year at ways to trim health and human-services spending, which is dominated by Medicaid.

Scott's budget proposal, released last month, would make dramatic changes in Medicaid funding for hospitals. The key part of the proposal would seek to end widely varying Medicaid payment rates for hospitals and would cut about $1.8 billion, part of which would be used to help increase school funding.

Senate President Mike Haridopolos, R-Merritt Island, has indicated support for the broad concept of reducing differences in the amounts hospitals get paid to care for Medicaid patients.

"I think everyone would agree, if people are doing similar work in similar circumstances, their reimbursement should be similar,'' Haridopolos said recently.

But the extent of the potential hospital cuts has raised concerns from lawmakers ranging from Senate Rules Chairman John Thrasher, R-St. Augustine, to Senate Minority Leader Nan Rich, D-Weston. Rich, in part, objected to what she described as "pitting education versus health care.''

Even if lawmakers don't go along with Scott's proposal, however, they likely will make cuts in health and human-services spending. During the 2011 session, for example, they chopped Medicaid rates for hospitals and nursing homes to help balance the budget.

Senate Health and Human Services Appropriations Chairman Joe Negron, R-Stuart, said he supports the idea of moving money from health programs to education. In the past, he has backed controversial ideas such as trimming money for adult substance-abuse and mental-health services and for the Medically Needy program, which provides care to people with debilitating illnesses who don't qualify for Medicaid.

While trying to fend off budget cuts, health-industry groups also will closely watch major regulatory and legal issues. For instance, proposals to try to reduce fraud in the so-called "PIP" auto-insurance system could affect a wide range of health providers, including doctors, hospitals and chiropractors.

Also, groups such as the Florida Medical Association and Florida Hospital Association are calling for new limits on medical-malpractice lawsuits.

Rep. Jimmy Patronis, R-Panama City, filed a bill (HB 1233) this week that likely would make far-reaching changes in the malpractice system. That bill would set up a completely new system for handling medical-injury claims, somewhat akin to the way workers-compensation claims are handled.

Meanwhile, House and Senate members have filed bills that would help shield emergency-room doctors and workers from costly malpractice lawsuits. Those bills would extend a legal protection known as sovereign immunity, which typically is reserved for government agencies, to emergency providers.

If the medical-malpractice bills move forward, they are almost guaranteed to run into fierce opposition from lawyers who represent injured patients. But in documents outlining their priorities for the session, both the Florida Medical Association and the Florida Hospital Association said they backed extending sovereign immunity.