Health Care Regulation Debate Getting Refueled


Florida lawmakers could be preparing for a renewed debate about easing regulations in the state’s health-care industry.

A House panel last week began considering the “certificate of need” process — a long-controversial system that requires state regulatory approvals before facilities such as hospitals and nursing homes can be built. Also, bills have been filed in the House and Senate that address issues such as the regulation of ambulatory surgical centers and clearing the way for “direct primary care” agreements between doctors and patients.

The issues are not new: House leaders in recent years have repeatedly sought to scale back certificate-of-need laws and make other regulatory changes. The House and Senate, however, have not agreed on the issues, which have been closely watched by lobbyists for sometimes-competing parts of the health-care industry.

House leaders have backed eliminating the certificate-of-need process for hospitals, arguing that such a free-market approach would improve access to care. Though a proposal has not been filed for the legislative session that starts March 7, the House Health Innovation Subcommittee spent nearly two hours last week taking testimony about the certificate-of-need issue from people on both sides of the issue.

Rep. Shawn Harrison, a Tampa Republican who is vice-chairman of the subcommittee, said he expects the panel to be the “tip of the spear when it comes to some of the House’s ideas on health-care reform. We’re going to have first crack at some of those ideas.”

But proposals to make major regulatory changes in the health-care industry also will draw detractors. As an example, opponents of eliminating the certificate-of-need process have argued that such a move would lead to hospitals being built in affluent areas to serve insured patients, while longstanding public and safety-net hospitals would be left to treat low-income and uninsured patients.

“Without the CON, this will make it easier for people to build hospitals anywhere they want and take the patients that are from the counties and the cities, and the counties and the cities will get stuck with … people without medical plans, and the affluent hospitals will be making money, and the people who need it (care) will be getting stuck with, I hate to say the word, crappy hospitals and they will be dying, and everybody else will be all happy and hunky-dory,” Rep. John Cortes, D-Kissimmee, said as he questioned a speaker during last week’s meeting.

Efforts to revamp health-care regulations in Florida come amid broader questions nationally about changes in the industry. Many of those questions center on the push by President-elect Donald Trump and Republican members of Congress to scrap the Affordable Care Act — a push that would affect patients, medical providers and insurers.

Along with the certificate-of-need issue, the Legislature also likely will revisit proposals dealing with ambulatory surgical centers and what are known as “recovery care” centers.

Rep. Heather Fitzenhagen, R-Fort Myers, and Sen. Greg Steube, R-Sarasota, have filed bills (HB 145 and SB 222) that would allow patients to stay up to 24 hours at ambulatory surgical centers. Current law bars overnight stays. Also, the bills call for allowing the operation of recovery care centers, a new type of entity where patients could stay 72 hours after surgery.

Lawmakers also could look again at proposals that would help clear the way for what are known as “direct primary care” agreements between doctors and patients. Such agreements generally involve monthly payments that patients or their employers make to physicians or other health providers. The payments cover patients’ routine primary-care services, cutting out the role of insurers.

Rep. Danny Burgess, R-Zephyrhills, and Sen. Tom Lee, R-Brandon, have filed bills (HB 161 and SB 240) that would make clear that direct primary-care agreements are not considered insurance and are not governed by state insurance laws.

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