Private companies and networks of hospitals and other providers would deliver Medicaid health care services across Florida under Republican legislation that passed the state House on a largely party-line vote Thursday.
Gov. Rick Scott, a Republican who made millions as a health care CEO before his election, supports the managed care concept. The legislation goes to the GOP-controlled Senate.
Republican lawmakers argued that the measure would improve services, curtail fraud and hold down escalating costs. The $20 billion state-federal program covers 2.9 million low-income and disabled people including 27 percent of Florida's children. Those expenses, though, are expected to grow to $28 billion by the 2014-15 fiscal year.
"We have to do the surgery necessary to fix this system," said Rep. Jimmie Smith, R-Inverness. "If we don't fix this system now, the only answer we have is to amputate it, and we cannot go down that road. We need this system."
Democrats said an experimental managed care program already operating in Broward County and four counties in the Jacksonville area -- Duval, Baker, Clay and Nassau -- doesn't back up those claims.
"The pilot programs have failed miserably," said Rep. Lori Berman, D-Delray Beach. "There is no useful data about the quality and quantity of patient care from the program, nor have we even seen any evidence that the pilots are really saving the state money."
Instead, opponents said, the legislation simply would fatten the profits of health maintenance organizations and other private businesses at taxpayer expense. They also noted that it hinges on approval of a waiver by the federal government, which pays most of Florida's Medicaid costs.
The House's main managed care bill (HB 7107) passed 80-38. A second bill (HB 7109) passed 78-39.
House Speaker Dean Cannon, R-Winter Park, interrupted Rep. Mark Pafford and told him to stick to policy issues when he said the legislation would create a conflict of interest for Scott.
The governor founded Solantic, a chain of walk-in clinics, and gave his ownership interest to his wife after he was elected last year.
The company doesn't accept traditional pay-for-service Medicaid payments, but Democrats contend it could take part in a managed care system.
Pafford, D-West Palm Beach, continued his conflict-of-interest argument but without mentioning Scott or Solantic. He also noted that unlike government agencies, private companies aren't covered by the state's open records law.
"This is a giveaway of $20 billion to folks who work out of the sunshine," Pafford said.
Besides managed care, the legislation sponsored by Rep. Robert Schenck, R-Spring Hill, would attempt to cut costs as well by giving doctors, hospitals and other providers increased protection against lawsuits. The House would limit Medicaid patients' malpractice claims to $300,000 for pain and suffering or other non-economic damages.
Sponsors expect managed care to save the state about $1 billion a year, but those savings would not be immediate. The House plan would be phased in between July 2012 and October 2016. The Senate's phase-in schedule runs from the end of 2012 through March 2013.