Advocates for the disabled, elderly, hospitals and other interests objected to some details and the timing of a massive Medicaid overhaul Monday, but the plan won near unanimous approval at its first -- and possibly last -- committee hearing in the Florida House.
The Select Policy Council on Strategic and Economic Planning agreed to formally file two bills with only one dissenting vote in each case.
The measures would carry out a plan to expand a five-county pilot program of managed care by private companies or other groups, including provider service networks made up of doctors and hospitals, to all of Florida's 67 counties over the next five years.
The state would be divided into six geographic sectors. Managed care providers would compete for a maximum of three to 10 contracts in area. Miami-Dade County, the state's largest, would be added in the first year and the others later.
Lawmakers see the plan as a way to rein in the growing cost of the fraud-plagued state-federal program that provides health care for 2.7 million low-income and disabled Floridians. The program is expected to consume $19 billion in the next fiscal year and account for more than a quarter of the state budget.
The panel's chairman, House Speaker-designate Dean Cannon, R-Winter Park, said there's enough anecdotal and preliminary evidence that managed care cuts costs and fraud while still providing quality care to go ahead with the plan. However, data from the existing experiment has yet to be fully analyzed.
"As policy makers we have an obligation to make transformational change even though it may make people uncomfortable if we believe it's carefully constructed and the right thing to do," Cannon said.
There was plenty of discomfort about the bills that are on a fast track after getting a late start. House leaders waited until last week to unveil the plan, and now just 18 days remain in the 60-day session.
The Senate already has passed its own Medicaid overhaul that would add only 19 counties to the experimental program launched by former Gov. Jeb Bush five years ago.
Alisa Snow of the Florida Community Health Action Information Network, which advocates for Medicaid patients, urged lawmakers to delay action for a year to get a complete analysis of the pilot program and assess how the new federal health care overhaul would affect it.
Rep. Gary Aubuchon, though, said there's no need to wait.
"There are pieces and parts that people are unhappy with, but I would submit to you if we studied this for the next 10 years and then brought a bill forward there would be pieces and parts that people were unhappy with," said the Cape Coral Republican.
Most state Medicaid programs use managed care in varying degrees, but Kingsley Ross of the Autism Society of Florida told the panel the House legislation would make Florida the first to turn to for-profit health maintenance organizations to provide programs for developmentally disabled people.
The panel also heard that the legislation might result in the loss of $100 million in federal money for specialty physicians mostly at teaching hospitals, make it harder to attract such specialists to Florida and present a dilemma for public hospitals by requiring them to serve areas that don't contribute tax dollars to their support.
Florida Association of Health Plans president Michael Garner complained the legislation would give an unfair advantage to provider service networks over the HMOs he represents.
Ralph Glatfelter, senior vice president of the Florida Hospital Association, said his organization supports many concepts in the legislation, including the preference for at least one provider service network in each area, but he still had some problems. It's unfair to let health maintenance plans drop hospitals but not let hospitals drop plans, he said.
Democratic lawmakers said they'd also like to see some changes including adding requirements for public comment periods and hearings before regional plans are approved, a uniform statewide grievance procedure, an electronic claims system and information provided to Medicaid recipients in the language of their choice.
However, Rep. Keith Fitzgerald, D-Sarasota, withdrew amendments, saying Democrats would seek those changes later.
"There are a lot of details that need to be worked out," Fitzgerald said. "We commit to doing that in constructive manner."