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Senate Approves Health Plan 2.0

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TALLAHASSEE (CBSMiami/NSF) --The Senate on Wednesday voted to approve its plan to use federal Medicaid expansion money to help lower income Floridians buy private health insurance.

Despite the 33-3 vote in favor of the bill (SB 2-A), which would create the Florida Health Insurance Affordability Exchange, or FHIX, program, the odds of the measure becoming law still seem incredibly long. Gov. Rick Scott and House Republican leaders staunchly oppose the legislation, which helped grind budget negotiations to a halt earlier this year and spark a special session currently underway.

Senators tried to open an avenue for negotiations over FHIX, suggesting that some of the reforms House leaders have pushed could be added to the bill and approved by the Senate. The House is looking to revamp insurance coverage for state workers and overhaul some longstanding health-industry regulations.

"We have been very, very clear that we welcome the debate," said Senate President Andy Gardiner, an Orlando Republican who has spearheaded the push for FHIX. "We really do. ... I think from our standpoint, it's like, send them over and let's start having the debate and the discussion. But we're open to it."

But that will likely not be enough to sway most House Republicans, who blast the plan on a variety of grounds. In a sign of the weak support the plan has in the GOP caucus, the Senate proposal is expected to be presented to the House on Thursday by a Democrat, Rep. Mia Jones of Jacksonville. A vote could come Friday.

Perhaps with that in mind, supporters of the bill spent much of Wednesday's debate in the Senate countering the House's talking points.

In response to one of the House's chief reasons for resisting the Senate's plan --- that the federal government is an unreliable funding partner and might withdraw from its promise to bankroll at least 90 percent of any Medicaid expansion plan -- Sen. Don Gaetz noted that the House's budget proposal includes $16.4 billion in health-care funding and $24.4 billion overall from federal sources.

"Those who say that they don't want federal money or don't want to take federal money --- that train has left the station a long time ago," said Gaetz, R-Niceville. "They've lost their virginity on that issue."

Senate Minority Leader Arthenia Joyner, D-Tampa, was scalding in her rebuttal to the House.

"Unless there's something else afoot in their opposition, unless there's a more insidious motive driving their willingness to permanently keep 1 million Floridians uninsured and trapped in emergency expensive care, then they have the duty and the moral obligation to give this plan a chance," she said.

Some senators have also voiced concerns about the plan. Sen. Alan Hays, R-Umatilla, questioned how easy it would be for the hundreds of thousands of Floridians in the program to receive care if providers were not reimbursed at more-generous rates than in traditional Medicaid.

"Let's face reality," Hays said. "The No. 1 objection to Medicaid patients today by the health-care community is the reimbursement rates are so low. ... Not one wise businessman anywhere, no matter what business they're in, is going to go out and welcome more losing business."

"Sen. Hays, actually, hospitals do it every day," Gardiner, a hospital vice president, said in a rare response from the rostrum where he presides over Senate business.

As many as 800,000 Floridians would meet income limits for health care under the plan, though work requirements likely mean that only 400,000 to 500,000 people would actually be eligible. Under the legislation, FHIX would expire on July 1, 2018, unless it gets renewed by the Legislature.

Senators amended the proposal Wednesday to try to counter concerns from the Florida Agency for Health Care Administration that the Senate exchange could enter a "death spiral," caused when mostly sick patients sign up for a plan and cause premiums to rise. That could actually leave fewer Floridians with health insurance, according to state Medicaid director Justin Senior.

The changes came one day after Senior was excoriated by a Senate committee for voicing those concerns.

But in a statement after the Senate vote, AHCA Secretary Liz Dudek said the agency wasn't completely satisfied with the new bill.

"Although we have recommended changes to the FHIX plan that alleviate our concerns with the 'death spiral,' we still have many concerns with other areas of the bill, which would make it uncertain whether the FHIX plan will be able to provide more Floridians with health coverage," Dudek said.

An agency spokeswoman said AHCA, which answers to Scott, is officially neutral on the legislation.

Senators also added a provision to ensure that the families of some lower- and middle-income children who receive health care from the state won't see their premiums rise under FHIX.

Following the Senate vote, outside groups continued to apply pressure on the House. The Florida Democratic Party used the passage to once again hammer the GOP majority.

"It is unconscionable that wealthy Republican legislators pay just $30 a month for health care while hundreds of thousands of working Floridians --- and tens of thousands of veterans --- cannot afford quality care," party Chairwoman Allison Tant said in a statement. "Floridians deserve better than the House Republicans' Washington-style dysfunction and brinksmanship."

But Americans for Prosperity, a conservative group, called on the House to continue fighting the plan. It praised Hays, Sen. Jeff Brandes, R-St. Petersburg, and Sen. Travis Hutson, R-Elkton, for voting against the legislation.

"Unfortunately, the rest of the Senate chose the easy way out, voting for a massive expansion of the state's Medicaid program that may look good on paper and benefit some health care special interests, but will not solve our state's healthcare problems and will sock the state with a billion dollar price tag," said Chris Hudson, the organization's state director.

(The News Service of Florida's Brandon Larrabee contributed to this report.)

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