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House medicaid vote shows differences; conflicts of interest

By Lynn Hatter

http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-961043.mp3

Tallahassee, FL – The legislature is one step closer to a massive Medicaid shift that would put more than three million Floridians into managed care. The House voted on a party line vote for the proposal, but as Lynn Hatter reports there was plenty of opposition to the plan and several issues remain unresolved.

"Have all members voted? Have all members voted? Clerk will unlock the machine and show the vote. 80-yeas, 38-nays, Mr. Speaker. So the bill passes."

The vote was down party-lines, with Democrats unanimously opposed to a medicaid overhaul bill that supporters say will save the state millions of dollars. The state currently spends a third of its money on Medicaid, and costs continue to rise as more and more people turn to the program as they lose their private insurance plans. During floor debate on the bill, Republican Representative Gaye Harrell said something has to be done.

"We cannot continue to have a system that's broken from an access perspective, from a quality perspective and from a cost perspective. We can do better members and this bill puts us on a march to doing better."

While lawmakers in the House tried to keep the debate civil, at one point it took a turn for the personal with Democrats singling out private companies who could benefit if the overhaul goes through. One of those companies is Solantic, a chain of urgent-care centers that Governor Rick Scott founded in 2001. A part of the Medicaid proposal lawmakers are looking at would also allow Medicaid patients to use their money to purchase private insurance plans and spend their money at private clinics like Solantic --something that doesn't sit well with Democratic Representative Mark Pafford of West Palm, who pointed out the potential conflict during floor debate.

"We have a governor who transferred Solantic to his wife, the first lady of this state. Apparently the media has found there are tremendous conflicts of interest--"

"--Representative Pafford, Representative Pafford, I ask that you keep your remarks to the policy of the bill please."

"Thank you, Mr. Speaker. There are tremendous conflicts of interests in this bill. And I think that this chamber needs to recognize those conflicts of interests."

Scott transferred his multi-million dollar stake in the company over to his wife back in January, and in responding to questions regarding his support for the Medicaid overhaul proposal and potential conflicts of interest, the governor brushed it off.

Reporter: "Governor, we're aware that you're wife now has the Solantic interest but given your families' stake in it do you think Solantic should opt out of the Medicaid thing and the drug testing?

Scott: "As you know, like I've said I have no involvement in any decisions in regard to that company."

Reporter: "But your family does."

Supporters of the medicaid managed care concept say the shift is necessary because Florida can't afford the system as it is now. Many doctors don't accept Medicaid, because the reimbursement rates are much lower than what they receive from private insurers or Medicare. And there is rampant abuse of the system, which is based on a fee-for-service model that allows unscrupulous physicians and companies to charge more for services not being performed. House bill Sponsor Representative Rob Schenck of Spring Hill.

"This bill requires everyone who gets a contract with the state to have an adequate network of specialists, primary care physicians and hospitals. So from now on, when you talk to a Medicaid recipient, they're going to be able to see those specialists, they're going to get the care they deserve instead of having to continually go to the emergency room. This bill does that, it guarantees it, and it does all of that while controlling our costs for the future so that it does not cripple this state."

A similar proposal is winding its way through the senate, and is heading to another committee before it gets to the floor in that Chamber. The Senate's sponsor is Republican Joe Negron. He says one way to ensure there are providers to treat patients is to up the reimbursement rates for care.

"Starting in 2013 we will pay primary care doctors 100-percent of the Medicare rate. Right now the average is between 54-56 percent. That will have a dramatic effect on improving access to care and making sure Medicaid patients can get in to see the doctors."

But before anything is set in stone, both the House and Senate have to iron out differences in their bills. For example: The Senate divides the state into 19 regions for managed care providers to operate, but the House regions are fewer, meaning people may have to travel further for care. The Senate also includes transportation for patients in its list of required services, which the House doesn't. And neither chamber can agree on the price tag. Negron says those differences pose a big challenge to a final Medicaid bill.

"I think the House and Senate have strong positions on issues that are important to them, that's a given. And I think we'll just have to work through those."

After all the voting is done, the state will still have to get federal approval to move forward. Negron says he's optimistic the Obama administration will be willing to work with them. And if not, he also says the state is prepared to strike out on its own.