Originally published at Naples Daily News.
Alexandra Glorioso , alexandra.glorioso@naplesnews.com; 239-435-3442 Published 4:04 p.m. ET Feb. 17, 2017 | Updated 8:50 p.m. ET Feb. 17, 2017
TALLAHASSEE – Florida legislators are capitalizing on the uncertain fate of "Obamacare" to resurrect a controversial overhaul of Florida's health care system nicknamed “CorcoranCare.”
Named for House Speaker Richard Corcoran, the Republican proposal first surfaced four years ago and would change the way Florida’s health care is delivered.
The proposal would create a private prepaid plan for all patients to see primary-care doctors and would redirect Medicaid money to help subsidize private health insurance for poor people.
Republicans in Congress say they plan to change Medicaid — the federal-state health program for the poor — and scrap "Obamacare" over the next year.
But their colleagues who run the Florida Legislature say they’re moving ahead now with their own reforms.
“We're not waiting for the feds to act," said state Senate President Joe Negron, R-Stuart.
"We have to fund the Medicaid program this session, and if we can lay the groundwork for exploring that right now, we should,” Negron said, indicating he could get behind some aspects of House Republicans’ health care alternative.
Medicaid, which is a third of the state's $80 billion-plus budget and growing, can't be totally overhauled without some direction from the federal government.
But the rest of the House's health care policies have been proposed piecemeal by Republican members this session.
And the insurance mechanism state Republicans would like to see implemented in Medicaid reform has been added to a bill dealing with health insurance for state employees.
Next week, House legislators are expected to draft a memo to the White House detailing this mechanism and how they envision Medicaid going forward.
The House health care proposal known as "CorcoranCare" eventually died during a combative 2015 session in which House Republicans, led in part by Corcoran, shut down the session early and blocked Florida’s expansion of Medicaid envisioned under President Barack Obama's Affordable Care Act.
The expansion, funded in part by the state, would have added an estimated 800,000 Floridians to health insurance rolls.
Corcoran, R-Land O'Lakes, said he is optimistic about how the House can influence Florida’s health care policy.
“All of our reforms are geared to creating a real free market in health care which we know will help bring about the greatest access, the lowest costs, and the best outcomes for patients,” he said.
Now that President Donald Trump’s administration is flirting with the idea of giving states more autonomy through lump-sum Medicaid payments known as block grants, Florida legislators are hopeful they can implement "CorcoranCare."
“We would like to partner with the federal government, essentially, and be able to have some free-market principles that would say, ‘Hey, not everybody needs a robust plan,’” said Rep. Travis Cummings, R-Orange Park.
“There would be vouchers that would allow you to get direct primary-care services," Cummings said. "It obviously would have some hospital catastrophic coverage as well. It would have some dental coverage.”
Cummings, who has sponsored past "CorcoranCare" bills, said the main idea was to make health care consumer driven, like other industries are, by giving people more choices and more information about their health plans.
The Florida Republican lawmakers' vision requires a private, competitive market for all health care, even Medicaid.
And just as their federal counterparts must battle special interests like insurance groups in Washington that carve out turfs and ultimately challenge how competitive that market can be, state lawmakers will have to do the same in Florida.
Even given these difficulties, much of the House Republican vision, Cummings said, is already encapsulated in a bill filed this session by Rep. Jason Brodeur, R-Sanford, which attempts to encourage employees to shop around for care by listing prices for common procedures. The bill also offers different insurance options like health savings, flexible spending accounts and health reimbursement arrangement.
Lawmakers hope the legislation, which has failed for several years in a row, will provide a model for the rest of Florida’s care.
Rep. Cary Pigman, a Republican emergency room physician from rural Avon Park, said he wasn’t as opposed to some of the features of Obama's Affordable Care Act as other Republicans. But he said "Obamacare" wasn't innovative enough.
“It was basically just an insurance plan,” Pigman said. “We have to redesign the health care delivery system. We simply can’t continue to do what we are doing now. We have to do this or we will go broke.”
Pigman is handling a bill this session for Corcoran that would expand the scope of practice for advanced practice registered nurses. It would allow some of them to practice independently and give patients remote access to their providers through “telehealth.”
Florida Medical Association “hates it,” Pigman said, referring to the longtime and influential doctor lobby.
“Allowing nurses to practice independently will lead to more fragmentation, which is counterproductive to the goals of high quality, affordable health care,” wrote Tim Stapleton, CEO of the Florida Medical Association, in a statement.
"It's a long shot, but maybe pieces or all of it will pass," Pigman said about his bill. Since it was heard in committee Wednesday, all of the bill's components are up for lawmakers to consider.
Pigman argues doctors often profit from their supervision contracts with nurses, but the association waved away that claim as missing the point.
The Florida doctor lobby is one of several interest groups opposing House Republican health reforms this session, including hospitals, hospices and nursing homes, who argue deregulating their industries by repealing certificates of need that determine how many of these facilities can be in an area will actually drive up costs and endanger patients.
The doctor association's concerns are currently being echoed throughout the Senate, where a version of Pigman's bill has yet to be filed.
And the doctors' concerns are sometimes being repeated by Senate leaders who support other controversial House initiatives through their own legislation such as repealing the certificates-of-need system that regulates how many health care facilities such as hospitals, hospices and nursing homes operate in the state.
“I’m comfortable that the (certificate-of-need repeal) bill addresses access without impacting quality,” said Sen. Rob Bradley, R-Fleming Island.
"I’m not there yet on these other proposals, but that’s why we have hearings," Bradley said.
"I’m always open-minded when it comes to hearing good-faith efforts and ideas to improve health care," he said.