The top Republican in the Florida House renewed his call for forcing more competition among healthcare providers and again rejected Medicaid expansion Wednesday, setting the stage for what is expected to be his top battle ahead of this spring’s legislative session.
House Speaker José Oliva, R-Miami Lakes, told reporters during the “AP Day” press session that he believes the only way to curb runaway spending is to inject more free market policies in the healthcare space: “You have to fix the environment to allow for competition,” he said, calling hospitals government-funded monopolies. “If you are the only game in town you don’t have to negotiate.”
Oliva’s push for more competition meshes with his stated plan to consider repealing parts of the state’s certificate-of-need system, which currently requires state approval before hospitals, nursing homes and other healthcare providers can add more sites or services. The program is used to make sure there is enough demand in an area before new beds can be added, which supporters say ensures new facilities would not siphon away insured parents and leave existing facilities with an unsustainable base of underinsured or uninsured patients.
Deregulating the hospital industry by restricting or removing the certificate-of-need system has long been a priority for some Republican leaders in the Legislature.
Oliva suggested he might be swayed to exempt a small class of facilities, such as those that provide medically complicated care: “There’s a very acute care that, one could possibly make the argument, deserves some level of protection because of the expertise required,” he said. But “it is such a minute number of procedures compared to the massive amount of care that is being done in the hospital setting, that should be done outside of it.”
He suggested in particular he would crack down on standalone emergency rooms that “are conditioning people to use their ERs as urgent care. Sometimes people don’t know the business. They’ll know it when they get their bill.”
The Democrats’ top item on their healthcare wish list — Medicaid expansion — is virtually certain to be a nonstarter under Oliva’s leadership. The speaker harshly criticized Medicaid expansion as “the worst of all mandates.”
“We’re going to take a form of healthcare that most doctors don’t accept, that reduces the quality the more people you pile on it, and we’re going to find that as a solution to access to healthcare,” he said.
Advocates in the state are currently collecting signatures to try to put Medicaid expansion on the ballot in 2020, though Oliva told reporters he believed the Medicaid expansion debate was over, for good, in the Legislature.
“We don’t have to relive it,” he said. “We fought that battle twice.”
Oliva has talked often about the need to reduce healthcare spending, but how that would impact trimming the existing Medicaid program remains uncertain. Advocates have raised concerns about Mary Mayhew, Gov. Ron DeSantis’ pick to run the Agency for Health Care Administration, who restricted Medicaid eligibility standards when she was the chief health and human services officer in Maine.
Oliva sidestepped a question on whether he intends to cement a recent, one-time change shortening how long patients can retroactively qualify for Medicaid coverage. The Legislature last year shortened the period patients can retroactively have Medicaid cover their health expenses from 90 days to up to 30 days. The Agency for Health Care Administration estimated at the time the change might save up to $98 million.
Solutions to lowering healthcare costs should “center around cost access and quality,” he said. “If we’re not having a discussion in that context, we’re not really trying to solve a problem. We’re just trying for whatever reason to appease whatever group that would appease.”
Other solutions, he suggested, “will continue to give [healthcare providers] license to raise their prices ... If we’re serious about healthcare we have to reduce price.”
Oliva’s distinctly free-market approach to trimming the ballooning healthcare budget is likely to clash with Democrats and some Republicans .
House Democratic Leader Kionne McGhee, D-Miami, criticizing the “Republican trifecta” that has controlled state government for two decades, called out Republican opposition to Medicaid expansion as “an ideological tantrum” rather than a policy disagreement.
He also implied: “Some say we need a free market to correct it. Haven’t we tried these things for the last 20 years?”
Oliva and Senate President Bill Galvano, R-Bradenton, also don’t see eye-to-eye — if not on substance, at least in style. Asked about Oliva’s focus on hospital spending Wednesday, Galvano said House and Senate staffers had “exchanged some ideas up to this point, to get an idea of where we both are.”
Oliva “has raised concerns about the lack of free market within the system,” Galvano said. But healthcare is “a unique animal and doesn’t fit neatly into a free market value [system].”