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Senate health care panel narrowly advances CON, balance billing changes

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Monday afternoon, the Senate Health Policy Committee narrowly approved a pair of closely-watched health care bills, with exchanges between lawmakers that predict much more debate will still be to come.

Bills weakening the state’s “certificate of need” regime for hospital licensure, and shielding patients from a medical collections practice known as “balance billing” each passed by votes of 6-3 and 5-4, respectively.

Former Senate Don Gaetz joked his SB 1144 was simply an “another uncontroversial bill” after the panel approved a number of relatively minor measures, but the bill saw half an hour of debate and testimony before passing with three ‘No’ votes.

The bill would create significant exemptions in a state hospital review process that require prospective medical facilities to obtain a “certificate of need” 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 would enforce a requirement in his bill that would mandate 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 added.

Gaetz called CONs “a regulatory burden that costs more than its worth,” saying they are outdated in a time where negotiated rates have supplanted the actual cost of providing services for insurance reimbursement. He also quoted an Obama-appointed Federal Trade Commission member who echoed his sentiments.

The bill passed 6-3, and will next be taken up by the Senate Health Budget panel.

The last measure that was taken up by the committee (SB 1442) from Miami Republican Sen. Rene Garcia, was similarly contentious.

Garcia’s bill protects patients from receiving at-times astronomical bills after a hospital stay after unintentionally receiving treatment from out-of-network providers — known as “balance billing.” Debate on the issue has been heated.

Garcia introduced a strike-all amendment that tweaked the bill prohibiting balance billing in particular cases, while leaving intact the existing billing formula for reimbursing providers, rather than replacing it.

Representatives from Florida CHAIN, HCA, and other hospital groups support the bill, saying it is in the best interest of consumers; several ambulance groups opposed it, arguing it would shift costs for uncompensated care onto EMTs, who are required to treat patients regardless of their ability to pay.

A lobbyist representing Pensacola said the bill would have a six-figure negative fiscal impact for Escambia County ambulances.

The debate ended abruptly at 3:29 p.m. after Sen. Oscar Braynon requested a time-certain vote.

The bill passed 5-4, with Republicans Sen. Anitere Flores, Sen. Denise Grimsley, and Garcia joining Joyner and Braynon voting in favor.

Gaetz, Sen. Bill Galvano, and Committee Chair Aaron Bean voted ‘No,’ joined by Sen. Eleanor Sobel, who broke with fellow Democrats in opposition.

Ryan Ray writes about campaigns and public policy in Tampa Bay and across the state. A contributor to and before that, The Florida Squeeze, he covers the Legislature as a member of the Florida Capitol Press Corps and has worked as a staffer on several campaigns. He can be reached at

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