Work on health care attracts lobbyists' cash

Published: Monday, March 1, 2004 at 6:01 a.m.
Last Modified: Sunday, February 29, 2004 at 9:33 p.m.
Katherine Bourassa hasn't hired any lobbyists to promote her cause. She hasn't made any major campaign contributions.
But the 79-year-old retiree from Dade City has a lot riding on the 2004 Florida Legislature, which begins Tuesday. She needs a new hearing aid.
"I miss an awful lot of what my children say to me and I guess they get a little aggravated with me," said the retired nurse, who raised six children and now has 16 grandchildren and five great-grandchildren.
Bourassa, who gets by on a $530 monthly income, relies on Medicaid, the state-federal health care program for the poor, for her hearing aid. But facing tight budget times, lawmakers over the last two years have cut back Medicaid coverage for hearing aids, glasses and dentures for adults, impacting about 155,000 Floridians.
It would cost about $35 million in state and federal funds to restore the program, which some lawmakers have vowed to do.
Bourassa's hearing aid is just one facet of the health care debate that will engulf the annual 60-day legislative session. Lawmakers have promised to help 2.8 million Floridians who have no insurance, to reach 100,000 children seeking subsidized health care and to try to help thousands of others on various waiting lists for Medicaid services.
But as one of the major components of the state's $55 billion annual budget, health care issues are among the most heavily lobbied in Tallahassee.
That was a point acknowledged by Gov. Jeb Bush, when he unveiled his health care package for the session that seeks changes in both the public health care programs and the private market to expand coverage.
"There are a lot of oxen that feel like they may get gored whenever someone shows up around here in Tallahassee as it relates to health care insurance," Bush said.
Doling out the cash The influence of the health care interests is reflected in their campaign contributions to the Republican and Democratic parties.
Since Jan. 1, 2003, health care interests, including insurance companies, hospitals, doctors and drug companies, have contributed $1.8 million in soft money to the Florida Republican Party, state election records show. It represents roughly a quarter of the $8.7 million the party has raised in that period.
Among the largest contributors were $129,000 from companies affiliated with the Blue Cross/Blue Shield insurance concern and $113,000 from HCA, the hospital company.
Health care interests were less generous with the Democrats, who are the minority party in Tallahassee. Of the $2.5 million raised by the party since Jan. 1, 2003, at least $127,000 could be linked to health care interests. Blue Cross gave $35,000 to the Democrats and HCA gave $8,750, records show.
Some critics suggest that those contributions, combined with the throng of health care lobbyists who work the Capitol hallways and meeting rooms, give the larger health care players a greater role in the debate than ordinary citizens like Bourassa.
"When it comes time for public policy issues to be debated, the special interests have an unfair advantage," said Ben Wilcox of Common Cause of Florida, a nonprofit group that has been critical of the role of money in politics.
Others are troubled by the fact that while the governor and lawmakers have advocated changes and cutbacks for some health care services they have maintained free health insurance for themselves.
Of the 160 lawmakers - 40 senators and 120 House members - only two have opted out of the free health care coverage, according to the Senate's records. High-ranking state employees, like the governor who earns $125,000 a year, are also provided the premium-free coverage. Lawmakers and state officials do pay co-payments for services.
The subsidy amounts to $766 a month for family coverage and $337 a month for individual coverage. Lower-ranking state employees pay a premium of $49 a month for individual coverage and $175 a month for family coverage, with the remainder subsidized by the state.
Advocates for the poor question the free-insurance policy.
"That's pretty incredible," said Anne Swerlick, a lobbyist for Florida Legal Services. "I think that's plain unfair."
Addressing concerns Many lawmakers say neither ordinary citizens nor the poor will be forgotten in this year's health care debate.
Among them is state Sen. Rudy Garcia, R-Hialeah, a former House budget chairman who has become a tireless advocate for trying to restore the Medicaid coverage for hearing aids, glasses and dentures.
"We definitely want to fix that problem," Garcia said. "It's going to be one of my session priorities."
Garcia said one of the problems with denying the coverage is that the lack of dentures or hearing aids can result in problems for the elderly that eventually require more costly Medicaid services, such as emergency room care.
Another irony is that while the elderly can get eye and ear exams through the federal Medicare program, they are often left with no means of correcting the problems.
"What good is it, if they tell you what it is and they don't do anything for it?" Bourassa asked.
While Gov. Bush did not recommend restoring the Medicaid services for hearing, glasses and dentures, he has asked for an 8 percent increase in Medicaid, which now totals about $13.8 billion a year.
But he also said spiraling costs in the program, which has grown by an average of 12 percent in recent years, threatens the entire budget as well as Medicaid services themselves.
"If we can't control costs, we can't increase services for the people who truly, truly need it," Bush said.
He is continuing to advocate changes in federal law to allow the state more flexibility to provide services and to incorporate "consumer driven" market approaches to providing Medicaid.
"We can't sustain what we've got," Bush said. "Either we're going to have to raise taxes to continue on as is, or we're going to cut services. Neither one of those options, it seems to me, is acceptable."
Aside from Medicaid, lawmakers will be looking at a number of other health care initiatives in their annual session to help the 2.8 million Floridians who don't have health insurance.
Among the proposals:
  • Expanding of the popular Kidcare program that provides subsidized health insurance to children in lower-income families who earn up to about $37,000 a year. About 100,000 children are on the current waiting list and lawmakers are expected to act on the issue early in the session.
  • Creating insurance pools that will allow small businesses - with 25 or less employees - to purchase health insurance for their employees.
  • Expanding a pilot program, now operating in three areas of the state, to allow insurance companies to offer basic coverage to low-income Floridians. The program allows the insurers to offer less coverage than 51 mandated services now required in the state insurance law. The downside is some services, such as hospitalization or mammograms, wouldn't be covered.
  • Creating a high-risk state insurance pool that would help about 20,000 Floridians who can't get insurance coverage because of their medical conditions.
  • Requiring hospitals to provide more information to consumers on the cost of their services.
    Bush calls the initiatives a good beginning to try to resolve the widespread problem of the uninsured in Florida.
    "But it won't change the fact that we will still have too many uninsured residents in our state," he said, noting it is going to take long-term changes in the public and private sectors to address the problem.
    Bourassa said lawmakers should use the session to help her and other Floridians who are having trouble with their health care.
    "I think they really should make it better," she said.
    Sean Rinehart and Gary Fineout of the Tallahassee Bureau contributed to this report.
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