Ryan Ray
The Senate Health Policy committee narrowly approved pair of closely watched health care bills Monday afternoon, auguring much more debate still to come about the proposals.
Bills to weaken the state’s “certificates of need” regime for hospital licensing, and to shield patients from a medical collections practice known as “balance billing” passed by votes of 6-3 and 5-4, respectively.
Former Senate President Don Gaetz joked that his SB 1144 is simply a “another uncontroversial bill” after the panel passed a raft of relatively minor measures. His bill then saw half an hour of debate and testimony before passing with three negative votes.
The bill would create major exemptions in a state hospital review process that requires prospective medical facilities to obtain a “certificate of need” by demonstrating enough local demand for services to prevent hospitals from cherry-picking patients with insurance and saddling existing facilities with unpaid charity care.
Senate Democratic Leader Sen. Arthenia Joyner quizzed Gaetz on whether eliminating the certificates would exacerbate disparities in the quality of care available in wealthy zip codes versus poorer neighborhoods, by setting the scene for a proliferation of new facilities in more affluent areas.
Gaetz responded that the state Agency for Health Care Administration will enforce a requirement in his bill that would mandate that any new entry to an existing market must perform at least as much uncompensated care as the incumbents.
“The only remaining reason for CONs is to restrict competition, or to prevent cherry-picking,” said Gaetz, citing an academic article. “This bill exempts from CON requirements only those health care projects with ‘a significant, active, and continuing commitment to improved access to care for uninsured and low-income persons.'”
He called CONs “a regulatory burden that costs more than it’s worth. ” He described them as obsolete in an age of health care when negotiated rates have supplanted the actual cost of providing services as the basis for insurance reimbursement. He also quoted an Obama-appointed Federal Trade Commission member who echoed his sentiments.
It passed 6-3 and will next be taken up by the Senate Appropriations Subcommittee on Health and Human Services.
The last measure taken up by the committee, SB 1442 by Miami Republican Sen. Rene Garcia was also contentious.
Garcia’s bill would prevent patients from receiving sometimes-astronomical bills after a hospital stay because they unintentionally were treated by an out-of-network provider, which is called “balance billing.” The issue has been a heated one.
Garcia introduced a strike-all amendment that tweaked the bill to prohibit balance billing in certain cases but leaves intact the billing formula now used to reimburse those providers rather than replacing it.
Several ambulance groups came out against the bill, saying it would shift costs for uncompensated care onto EMTs, who are required to treat patients regardless of ability to pay.
A lobbyist representing Pensacola said the bill would leave Escambia County’s ambulance service in a six-figure hole.
The debate ended abruptly, after Sen. Oscar Braynon requested a time-certain vote at 3:29 p.m.
The bill passed by a 5-4 vote with Republicans Sen. Anitere Flores, Sen. Denise Grimsley, and Garcia joining Joyner and Braynon to pass the bill.
Gaetz, Sen. Bill Galvano, and committee chairman Sen. Aaron Bean voted against it along with Sen. Eleanor Sobel, who broke with her fellow Democrats on the panel in opposition.
