TALLAHASSEE — It may be the most overused buzzword in the halls of the Florida Capitol: reform.
But from classrooms and college campuses to unemployment lines and doctor’s offices, Florida’s annual financial woes have provided ammunition for Republican lawmakers who want to impose more ideological or market-based changes on Florida’s massive $21 billion Medicaid program, schools and its once-heralded growth-management laws.
The legislative session set to begin Jan. 10 looks like a new year, same song.
Facing another nearly $2 billion shortfall, Gov. Rick Scott and the Florida Legislature are advancing overhauls of everything from unemployment compensation to auto-insurance payouts, the juvenile-justice system and higher education. Just months after cutting benefits to laid-off workers, they want to rename Florida’s unemployment-benefits system the “Re-employment Assistance Program” and give job training to low-scoring applicants.
And a slew of efforts to weaken environmental permitting are again getting lift.
“The one positive that has come out of this horrible situation economically is you have to look at programs like this,” said Senate President Mike Haridopolos, R-Merritt Island.
Critics say Republican political leaders have been using the state’s fiscal woes as cover for a broad philosophical agenda of dismantling state government, reducing regulation on corporations and delivering political benefits to supporters.
“We’re at a moment when you can engage in all sorts of mischief under the banner of cutting government spending and helping the taxpayer,” said Eric Draper, executive director of Audubon of Florida.
He pointed to last year’s legislation making it harder for citizens to fight development, and bills advancing for the coming session that would streamline regulation and allow companies to treat “reclaimed” water like a product instead of a public resource.
Supporters of such overhaul efforts see a golden opportunity.
“Our human nature makes it very difficult to change unless we absolutely have to,” said Dominic Calabro, president of the business-financed Florida TaxWatch think-tank.
Republicans such as former Gov. Jeb Bush tried for years to make cost-cutting changes to the state’s Medicaid health-care program for the poor, sick and elderly.
In 2005, Bush declared the program would bankrupt the state if it kept growing faster than education, public safety, transportation and environmental spending. But Republican lawmakers also had a $3 billion budget surplus that year and ultimately settled for a “pilot project” in Broward and the Jacksonville area.
“There was lots of money around,” Haridopolos said. “It was just a different mind-set than it is today.”
Last spring, with a governor from the health-care sector, Republican supermajorities in the Legislature and a $4 billion budget shortfall, GOP lawmakers and Scott easily expanded the managed-care privatization to most of the state’s 2.9 million Medicaid patients.
But since then, the federal government has balked at approving the changes, so Scott this week proposed a different tactic: slashing $1.8 billion in Medicaid reimbursement rates to hospitals, a move he said would free up more money for public schools.
Scott, who founded the private health-care company HCA/Columbia, has publicly pushed for a panel to review whether public hospitals should be privatized.
This week, he proposed to flatten the methodologies that give hospitals in more expensive health-care markets higher rates.
Florida safety-net providers say the cuts aren’t fair, because Medicaid already doesn’t cover the cost of treating the poor, elderly and catastrophically sick — and the hospitals being hammered the most are those in South Florida with higher percentages of poor patients.
Jackson Memorial Hospital in Miami would take the biggest cut in the state, at $133 million, but Broward’s hospitals would also be rocked. The four hospitals in the Broward Health system would face $42.2 million in cuts. Memorial Regional, Memorial Pembroke, Memorial West and Memorial Miramar would get whacked to the tune of $58.4 million.
Meanwhile, by averaging out the rate reimbursement, safety-net hospitals currently paid less than higher-cost hospitals could see more money. Orlando Health, for example, would see a $20 increase in its outpatient rate, equaling $3.1 million more.
Senate Democratic Leader Nan Rich, D-Weston, said the proposal will “devastate our hospitals.”
Another change on the table will be ways to reduce costs at public colleges and universities.
“If they have a program that is kind of underserved, why don’t they just talk to other universities and see if they have the same kind of program?” said Haridopolos, a current University of Florida instructor who also taught at Brevard Community College.
The next two presiding officers, Sen. Don Gaetz, R-Niceville, and Rep. Will Weatherford, R-Wesley Chapel, are developing changes to cut costs and streamline degree programs — although it’s unclear whether those ideas may take a year or longer to ferment.
“Higher-education reforms are going to come,” Haridopolos said.
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