The Florida House and Senate rolled out vastly different healthcare spending plans Thursday, putting the two chambers on a collision course over the state’s $77 billion budget.
The dueling healthcare proposals are $5 billion apart — more than the entire budget for the state of Vermont.
The Senate version includes $2.8 billion in federal money to pay for expanded healthcare coverage, something the House adamantly opposes. It also includes a $2.2 billion program known as the Low Income Pool that helps hospitals treat uninsured, under-insured and Medicaid patients.
Reaching consensus on the two issues will be difficult, and could require an extended or special legislative session. For now, leaders in both chambers are holding firm.
“Those are the Senate’s priorities,” Senate Health and Human Services Appropriations Subcommittee Chairman René García, R-Hialeah, said Thursday.
The stakes are high. The final budget could expand coverage to nearly one million poor Floridians — or result in dramatic cuts to safety-net hospitals across the state.
Building the healthcare budget is more complicated than usual this year because the LIP program is set to end on June 30. The federal government has said it may be willing to approve a replacement program, but no deal has been reached.
There’s also the issue of Medicaid expansion, a provision of the federal Affordable Care Act, also known as Obamacare.
For the past two years, House Republicans have rejected billions of federal dollars to extend healthcare coverage to the poor. The Senate is hoping to tap into the money this year, saying it would help hospitals pay for uncompensated care if LIP disappears.
The Senate’s proposed $35.2 billion healthcare budget includes $2.2 billion in LIP money. It also includes an LIP replacement program that would distribute the money to all hospitals based on the services they provide, rather than targeting a few select hospitals.
“The overall effect of the Senate plan is a new LIP that distributes funds more broadly, so more hospitals benefit, and does so in a manner our federal partners are much more likely to accept on an ongoing basis,” Senate President Andy Gardiner, R-Orlando, wrote in a Thursday memo.
García pointed out that safety-net hospitals like Jackson Health System, Broward Health and Tampa General Hospital would receive more money than other hospitals — and would not lose funding as a result of the new formula.
“You couldn’t have them take a hit or why would they continue to participate in the program?” García said, pointing out that many put up local dollars to draw down matching federal funds.
The proposed replacement would have to be approved by the U.S. Centers for Medicare and Medicaid Services, or CMS, a federal regulatory agency.
García said he had not yet discussed it with the state agency spearheading the negotiations.
The Senate proposal also includes $2.8 billion in federal Medicaid expansion money. The upper chamber wants to expand coverage by creating a state-run marketplace for private insurance (SB 7044). Beneficiaries would have to pay small monthly premiums and meet a work requirement.
Even if the LIP money were to come through, said García, expanding coverage would remain a Senate priority.
The House $30.2 billion healthcare spending proposal includes no mention of Medicaid expansion. House Speaker Steve Crisafulli, R-Merritt Island, has repeatedly said he is not interested in the Senate marketplace.
And while the House wants to see the LIP program extended, the lower chamber did not include the money in its recommended budget.
“We have not received any final approval from federal CMS as to how this program will be implemented or what funding levels will be approved,” House Health Care Appropriations Chairman Matt Hudson, R-Naples, said Wednesday. “As such it would be premature for us to speculate as to what parameters federal CMS might give us. Therefore, we have not budgeted LIP funding in this proposal.”
On Wednesday, Crisafulli acknowledged the chasm between the House and Senate budget proposals.
But he stressed that it was still early in the 60-day legislative session, which ends in early May.
“I don’t know that there’s ever been a time in history where both chambers passed out the exact same budget,” Crisafulli said. “We’re going to work through this process.”
Contact Kathleen McGrory at kmcgrory@MiamiHerald.com.