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Legislative Link
A legislative update provided by the United Way of Florida
SPECIAL SESSION ISSUE 1                                                                  JUNE 5, 2015
old and new capitol 
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SpecialSessionWhySpecial Session - Why?
The 2015 Florida Legislature's 2015 Regular Session was defined - and destroyed - by two health care issues totaling about $5 billion:
  • The Legislature could not craft next year's budget because it did not know if the federal government would provide any or all of the $2.2 billion in Low Income Pool funding the state received last year to reimburse hospitals for indigent care they provide; and
  • The Senate included about $2.7 billion in federal funds to provide health care for 800,000 low income Floridians that the House refused to consider.
Because the constitution requires the Legislature to pass a state budget before the July 1 new fiscal year begins, Senate President Andy Gardiner and House Speaker Steve Crisafulli agreed to call the Legislature to Tallahassee from June 1 through June 20 to resolve their differences and pass a 2015-16 state budget.
Prior to the start of the special session, the House and Senate re-filed the proposed 2015-2016 budget bills they had each considered during the regular session.

A $4.3 billion gulf remains between the Senate's $80.42 billion proposal (SB 2500A) and the $76.15 House proposal (HB 1A).

While mitigated by other budget items, there is a $5 billion difference between the proposals in funding for the Agency for Health Care Administration (AHCA), the state agency that administers Medicaid. The Senate funds AHCA at $27.8 billion and the House at $22.8 billion. The higher Senate allocation includes $2.8 billion in health care expansion dollars and $2.3 billion in federal Low Income Pool (LIP) funds used to pay hospitals for care they provide to indigent patients. The House includes neither.

The Senate passed its proposed budget on Monday, and on Thursday the House took up the Senate bill, amended it with its own proposal, and agreed to the Senate request to meet in budget conference to iron out the differences. The stage is now set for conference committees to meet once allocations for each appropriations area (i.e., education, health, environment, etc.) are set by the leadership of the two chambers.

A multitude of funding issues will be addressed during the conference process. Besides health care, the other two major money issues to be resolved are tax cuts (Governor Scott wants $600 million, the House has proposed $436 million, and the Senate has not proposed any) and how $1 billion in funding will be spent to implement Amendment 1, the water and land-buying ballot initiative approved by 75 percent of voters last fall.
SpecialSessionRulesSpecial Session Rules
Special session rules allow for a dizzying pace that advocates scramble to keep tabs on. Here are some of the timeframes for providing notices and filing amendments during the special session:
  • Committee Meeting Notices - 2 hours before the committee meeting.
  • Committee Bill Amendments - 1 hour before the committee meeting.
  • Floor Amendments - 2 hours before the start of a floor session.
  • Conference Committee Meetings Notices - 1 hour before the committee meets.
You must learn from the mistakes of others.  You can't possibly live long enough to make them all yourself.
-- Sam Levenson
SenateHealthCarePropSenate Health Care Proposal
In an effort to address House objections to its regular session plan to use federal funds to expand health care to low income Floridians, the Senate released a revised plan two weeks ago.

On Wednesday, the Senate passed the plan (CS/CS/SB 2A), which creates the private sector, market-based Florida Health Insurance Affordability Exchange (FHIX) intended to provide health care access to the estimated 800,000 Floridians who fall into the gap between Medicaid and Affordable Care Act eligibility.

Among others, the plan:
  • requires those eligible for FHIX coverage to wait until January to enroll;
  • requires that the same plans found on the federal insurance exchange are options for the FHIX population;
  • provides vouchers to recipients to purchase insurance policies through the state-based insurance exchange (FHIX);
  • gives people the option of staying on the federal health insurance exchange, rather than going into FHIX;
  • tightens the requirement that those receiving vouchers either work, volunteer, or demonstrate they are seeking employment by registering with CareerSource Florida (the state's workforce development agency);
  • requires enrollees to pay monthly premiums ranging from $3 to $25;
  • adds new triggers that would end the program if federal funding falls below certain levels;
  • adds a sunset provision that would automatically end the program on July 1, 2018 unless renewed;
  • creates a nine-member Health Outcomes Review Commission, which would oversee regulation of FHIX; and
  • requires federal approval and, if the federal government rejects any piece of it or recommends changes, the plan would have to come back to the Legislature for final approval.

The House Health & Human Services Committee work-shopped the bill on Monday and the full House debated it on Thursday.  While the final vote on the bill had not been taken as this Legislative Link went to press, it appeared to be facing certain defeat in the House.

HouseFilesHealthCareBillHouse Files Health Care Bills
During the 2015 Regular Session, the Senate proposed health care legislation to address the budget impasse that ultimately jettisoned the session, while the House proposed nothing. Last week, the House proposed a series of health care cost containment measures intended to counter the Senate's proposal to expand health care access. The bills:
  • expand authority of advanced-registered nurse practitioners and physician assistants to prescribe drugs (HB 27A);
  • eliminate the Certificate of Need (CON) process which requires state approval for building high-cost medical facilities like hospitals (HB 31A);
  • allow consumers to pay physicians directly for primary care (HB 25A);
  • authorize ambulatory surgical centers to keep patients overnight (HB 23A); and
  • require state employees to choose among multiple health care plans, so some may choose lower cost plans (HB 21A).

All these bills are controversial and died during the regular session.

The only mystery in life is why the kamikaze pilots wore helmets.  -- Al McGuire
TaxCutPackageTax Cut Package Ready for House Vote
On Tuesday, the House Finance and Tax Committee passed its comprehensive tax cut bill (HB 33A), and as this Legislative Link went to press, the bill was on third reading poised to pass the full House. The plan cuts $436.5 million in taxes next year and $299.3 million annually thereafter, far less than the almost $700 million supported by both Governor Scott and the House during the regular session. Among others, the bill includes cuts in the amount of:
  • $197.5 million on cell phone and cable television taxes (amounting to a $10 annual tax break for someone paying $100 a month, rising to $20 the second year);
  • $44 million for a three-day back-to-school sales tax holiday from August 7 - 9;
  • $25 million for a tax holiday for the purchase of college textbooks on August 8, January 8, 2016, and May 13, 2016;
  • $73 million in sales taxes businesses pay on commercial leases; 
  • $40 million for a one-day tax holiday for small businesses selling less than $1,000 in goods on November 28; 
  • $41.3 million in property taxes for widows and disabled Floridians;
  • $200,000 in homestead property taxes for military members deployed outside the country; and
  • $300,000 in sales taxes on pear cider.
LIPlynchpinLIP Lynchpin
Coming to consensus on Low Income Pool (LIP) funding is arguably the lynchpin to whether the 2015 special session is successful. 

Total LIP funding this year is $2.16 billion. Last month, a letter from Vikki Wachino, director of the federal Centers for Medicare & Medicaid Services (CMS), provided details about the history of the Florida LIP program, identified the reasons for the LIP situation the Legislature now faces, and addressed the future of LIP. It also stated that CMS had "preliminarily concluded that 2015-16 funding should be at approximately $1 billion...", creating about a billion dollar shortfall in next year's program. Funding for LIP would then likely fall to about $600 million in later years, Wachino wrote.

The Senate's health care expansion plan (FHIX) would use Medicaid expansion funds to provide health care coverage to about 800,000 Floridians. In her letter, Director Wachino noted that one of the main reasons federal LIP funding would decline next year is because "Coverage rather than uncompensated care pools is the best way to secure affordable access to health care for low-income individuals, and uncompensated care pool funding should not pay for costs that would be covered in a Medicaid expansion."

Governor Scott has proposed using local government and hospital funds to draw down additional federal funds to cover the LIP shortfall. The plan, which could cost non-profit hospitals hundreds of millions of dollars, has not been incorporated into any House or Senate proposals at this time.

Bottom line: If the Senate FHIX plan is not approved by the House, the money to cover the LIP funding gap will have to be found somewhere else.
Isn't it a bit unnerving that doctors call what they do "practice"?  -- George Carlin
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