James Call
The Senate Appropriations Chairman is drawing a line in the sand. Sen. Tom Lee wants clarity on health care spending before moving forward on building a budget, and both Sen. Aaron Bean and Sen. Renee Garcia are looking for the money to help him produce a balanced spending plan.
The federal Low Income Pool program expires in June, and the more than $2 billion dollars that it funnels to safety-net hospitals evaporates. Lee said that’s an “untenable proposition” for the Senate, and he suggests the issue could force the Session into overtime or lawmakers into a special session.
Bean is working on a form of Medicaid expansion drawing down Affordable Care Act money to reimburse hospitals for care of the uninsured and balance the state budget. Garcia is talking to the Centers for Medicare and Medicaid Services about LIP modifications.
The House however does not share Lee’s angst.
“All of this is hysteria because one guy said LIP won’t exist,” Rep. Richard Corcoran, Lee’s counterpart in the House, said last week. “But he didn’t say the funding was going away.”
When asked about the plan the Senate was working on Speaker Steve Crisafulli told reporters: “They’re going to have conversations that we probably won’t be having over here.”
A gaggle of reporters surrounded Lee at the conclusion of the Senate’s session Wednesday. He said he expects the budget the Senate will produce will include money for a significant policy change, possibly what Bean is working on. Here’s five minutes from the conversation.
Q: That was priced at almost $3 billion dollars by the committee, (see page 37 of this analysis)
Lee: (In regard to LIP), Medicaid expansion or this program that Sen. Bean has put together are different pots of money, but they flow to the same institutions that are struggling to cover Medicaid patients and to cover unreimbursed care in our state. So, they are both relevant to the discussion and we intend to have them both in play as we move through the process with CMS.
Q: And would you have zero in their for LIP; anticipating at this point?
Lee: No. 1, Sen. Garcia is working hard on a LIP model. We don’t just want to sit by and let this problem fester. We want to produce a solution. The President (Gardiner) has been specific about that. Sen. Garcia is chair of the subcommittee, has worked hard on producing an alternative model that he is putting the finishing touches on. And, I think it will be very innovative, creative and responsive to some of the concerns that CMS has mentioned in the discussions over the telephone and hopefully it will help alleviate the problem.
Q: Are you holding back money from GR for a potential tax cut package
Lee: Well, the nature of the way the budget unfolds there are always pieces of the budget that are negotiated late and obviously a tax package, some levels of working capital (and) things like that are kind of addressed late in the process.
So, holding back isn’t the right term, but we certainly have available resources to move around if we don’t get resolution to this LIP. So there should be some motivation to deal with the alternative resources.
Q: Is your tax package going to match the governor and House’s proposals — looking at $500 million plus?
Lee: It’s too soon to tell. It just is. I have been very consistent about and the president has been very consistent about first things first. We want to make sure we get some visibility and clarity in the health care picture and the funding picture there, and the president and Sen. Garcia are working hard on that with CMS and hopefully we will get a resolution here shortly.
Q: When it comes to trying to convince the House that the proposal on a Medicaid/private plan is the way to go — you don’t have that many cards left to play. Is a tax cut going to be one of the cards?
Lee: We didn’t create this problem. We don’t get to deal the cards. We have to play the ones that are dealt. We have an LIP model that’s expired and we have been told by CMS they are not renewing it: That’s an untenable proposition for the Senate.
And we can’t go home with Tampa General Hospital losing $120 million, or Jackson Memorial — some of the safety-net hospitals that are part of our health care network in the state of Florida struggling to make ends meet when they are already struggling with the resources to address unreimbursed care and uninsured Floridians who present in the emergency room. This would just be draconian and irresponsible in my way of thinking to ignore the magnitude of this problem in our health care system.
So, budgets reflect priorities and it is our priority that we want to see this addressed. We are not pleased that we find ourselves here. We wish we could have a resolution and we hope there is one. That is why Sen. Garcia is working so hard on an alternative LIP bill. And if we can work this out, boy, it would be great news for everybody. If not, there are a lot of cards to play and we’ll just see how things work with the House Appropriations Committee over there.
Q: You would acknowledge that given the direction you are going, your budget would be demonstrably different in terms of the bottom line and the gap in spending between the House and Senate?
Lee: If we go the direction of including the Sen. Bean’s Medicaid proposal in our budget, and that is a work in progress right now. Then yes. It would be anyways I guess given the LIP authorization that we are working on.
Q: How pressing is it on you, if at all, to be able to bring everything in for landing on time for yourself and the president … and come back and do it right in a special session?
Lee: Well, I’m just one guy but my opinion would be, my advice would be, it is better to get it right than to get it fast. There’s no sense passing a fiction of LIP theory that is not embraced by CMS and have to come back here anyways because our budget is not balanced.
So, we have several weeks to work through this, and we’re planning for the worst and hoping for the best, and we’ll see how it goes in weeks 6 and 7.
