4 issues top list of health care concerns

Published: Monday, March 1, 2004 at 6:01 a.m.
Last Modified: Monday, March 1, 2004 at 12:01 a.m.



  • The Medicaid bottom line is expected to cost $13.9 billion next year, up from $12.7 billion this year.

  • Who will pay for the state's trauma centers, which are now bleeding red ink? Will the state seek a waiver to rein in a ballooning Medicaid budget, which is expected to cost more than a billion dollars this year?
    Those who follow health care issues in North Central Florida say these are two of the four key areas to watch as the new legislative session opens:
  • Medicaid funding: Lawmakers will have to devote even more money to cover the growth in this joint federal-state program that pays for most of the nursing home care provided in Florida and also for basic health care for some poor families.
    The Medicaid bottom line has climbed steadily and next year is expected to cost $13.9 billion, up from $12.7 billion this year.
    Richard Bucciarelli, vice president for governmental relations at the University of Florida, warns that any decision on Medicaid will have tremendous reach here.
    "The Medicaid budget is growing quickly and it looks like the state will try for a waiver," the UF lobbyist said. "That would allow them to decide just what benefits are offered. And when that happens, it's never to add more bene- fits."
  • Trauma center funding: Shands at UF is seeking certification as a Level 1 trauma center, and continued funding for trauma centers across the state is critical to the success of that effort.
    A Level 1 center sees the most critically hurt trauma victims, those who have survived the impact of an immediate accident but whose injuries could kill them within minutes.
    To become certified, hospitals must meet rigid staffing, equipment and facility standards. A trauma surgeon must be on call 24-hours a day, and must be backed up by a full complement of anesthesiologists, intensive care unit personnel, burn specialists, nurses, physicians assistants and so on. An operating room must be available at all times, and personnel must be continually trained to react to trauma situations.
    It is not an inexpensive operation.
    The cost of operating the remaining 20 trauma centers in Florida (not even counting Shands) is estimated at $126 million a year. To date, the Legislature has not provided a dependable source of revenue to help support these centers.
    A Senate staff report prepared before the opening of the Legislature is recommending "a stable, predictable fund source" to help support trauma centers.
    "Certainly, we want to be sure that this trauma center that we've all worked so long for will be funded well enough to keep it in business," said Susan Crowley, executive vice president of the Alachua County Medical Society.
  • End-of-life directives: Crowley said she'll also be watching the progress of a bill proposed in the judiciary committee that would ban people from being withdrawn from life support unless they have advance directives.
    "This would leave families and spouses in limbo, unable to withdraw a loved one from life support for who knows how long, unable to end their pain and suffering," Crowley said.
  • Medical malpractice: It's an issue that kept legislators in special session last summer, but not much has been heard about the high cost of medical liability insurance since then.
    It's not an issue that has gone away, Bucciarelli and Crowley agree.
    "I think legislators will say they just took care of it and it's going to take time to see what effects the caps have," Bucciarelli said.
    Instead, Crowley notes, the battle over medical liability may move to the constitutional level.
    The Florida Medical Association is proposing an amendment to the state Constitution assuring that patients receive 70 percent of the first $250,000 of any award for medical malpractice, and 90 percent of the remainder.
    That proposal has been countered by the Academy of Florida Trial Lawyers, which has floated three possible amendments to counter what they see as an assault on their profession, Crowley said.
    Bucciarelli said about the only sure thing as this session of the Legislature opens is that "it will not run a day longer than necessary."
    After all, he points out, it is an election year.
    "We certainly won't see another special session. Everybody wants to get home to campaign."
    Diane Chun can be reached at (352) 374-5041 or chund@gvillesun.com.
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