“A Mystery Wrapped in an Enigma”: How Florida Hospitals Won (Again).Look no further than the most recent Florida legislative session to see how hospitals dominate, at patients’ expense. By Alexandra Glorioso
People sometimes ask me why I beat up so much on hospitals.
It's because they get most everything they want from lawmakers, and then, they complain they didn't get enough.
Look no further than the most recent Florida legislative session as an example:
Hospitals succeeded in largely prohibiting patients from suing them for covid-related medical malpractice.
They successfully lobbied to repeal a new law that hadn't even gone into effect yet that would have required them to report to the state their tax-deductible community benefits.
They preserved $300 million in additional Medicaid, and they managed to increase payments to Moffitt Cancer Center in Tampa by at least $10 million annually.
And they successfully fought at least 10 other bills, including some that would have forced hospitals to:
- Visibly list prices for 300 common procedures.
- Pay parents of adult children they negligently kill.
- Notify the state of their mergers and acquisitions.
As I said, hospitals getting what they want isn’t unusual. Hospital associations have been lobbying lawmakers for more than 100 years. They donate heavily to campaigns and receive billions of dollars from state and federal lawmakers each year. Lawmakers can associate, erroneously, that caring for hospitals means caring for patients.
When I was a full-time Florida health care reporter for POLITICO, I wrote my annual post-session roundup from that perspective.
But until I became a patient, I didn’t realize that many of the favors hospitals get each year hurt patients.
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Florida’s 2021 legislative session made that clear. When I did my roundup of bills this year, I found lawmakers failed to pass measures that empower patients and passed bills that put the patient at a disadvantage.
I found just two pro-patient measures that hospitals and I both like: One covers new mothers under Medicaid for an additional year, and another makes clear that patients must give written consent to pelvic examinations when they are under anesthesia or unconscious.
Hospitals put up with at least one bill that passed (again) that they didn’t like, which requires some hospitals to contract with all the Medicaid plans in their regions or the state.
Barred Owl Press’ first legislative health care roundup shows which bills hospitals were for, and which ones they were against.
And I’m highlighting three areas that stood out this year:
For the last decade, price transparency was the centerpiece of Gov. Rick Scott’s health care reforms.
Scott, a former executive of the nation’s largest hospital chain, believed that exposing health care to free-market competition would lower costs. Central to free-market forces — and empowering patients — is knowing what something costs.
This year, the House unanimously passed a bill that would require hospitals to list prices on their websites for 300 common procedures so that patients could shop around.
But Senate Republicans wouldn’t entertain it, and it died in that chamber without a hearing.
I asked Sen. Jeff Brandes (R- St. Petersburg) why, as chairman of the Senate Judiciary Committee, he refused to hear the bill. His committee was the Senate bill’s first stop. (The House bill passed its chamber and then was assigned to Senate Appropriations, where it was also never discussed).
Brandes has said in committee that he's a proud libertarian "big ‘L’" and Republican "little ‘r,’" so wouldn’t he want price transparency?
He said price transparency doesn't matter when patients pay their insurance carrier's negotiated price, not the retail price.
And he disagreed that price transparency would lead to lower prices. Brandes called hospitals "natural monopolies" and said they would all post the same retail price, which would push prices up, not down.
But hospitals were against the bill, and I told Brandes how I’ve heard hospital executives grouse for years over Scott's transparency efforts.
"There's a reason why I don't do a lot of health care policy," Brandes said. "It's a mystery wrapped in an enigma."
In the House, bill sponsor Bob Rommel, a Naples Republican, said the ordeal was "a tad frustrating." He said the idea that insurance negotiations should allow hospitals to avoid providing up-front costs just didn't make sense to him.
Rommel said dentists, who often charge the patient directly, can provide the price for a procedure "down to the penny."
"Some people talk about access, but even when there is access, nobody knows what it costs," Rommel told me last week. "In the end, the consumers all stand there scratching their heads."
What's on their minds?
"How can it cost so much when no one can tell me what it costs?" Rommel said.
BENEFITS TO WHOM?
Former House Speaker Jose Oliva, a Miami Lakes Republican, was an ally of Scott's free-market approach to health care.
Last year, he advocated for a new law that would make nonprofit hospitals tell the state how much in “community benefits” they provide. Nonprofit hospitals avoid paying a certain amount in property taxes each year in exchange for providing “community benefits,” usually in the form of charity care to low-income patients.
In Florida, nonprofit hospitals report billions of dollars in “community benefits” each year, but questions have been raised about whether the benefits to the hospital are greater than the benefits to the community.
Oliva’s bill passed last year but didn’t take effect until 2022. Now it won’t take effect at all.
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Sen. Ana Maria Rodriguez, a Doral Republican, ran the bill that repealed the law this session, a move that stung for Oliva.
Oliva had helped Rodriguez campaign for her new Senate seat when she was in the House, carving out money for her in the budget for health projects in her district.
"It was disappointing to see a fellow Republican and former colleague undo an accountability measure she had supported just a year earlier," Oliva texted me. "Not sure how removing a guard against the misuse of taxpayer dollars was a 'win' for her constituents."
Rodriguez told me that she carried the bill on behalf of the Senate president, Wilton Simpson, a Trilby Republican, but she agreed with it. She said the state Agency for Health Care Administration, which regulates hospitals, doesn’t need a law to look into hospital community benefits that are already reported to the IRS.
"It was duplicative," Rodriguez said about the repealed law. "The state can still monitor it through their tax forms."
BILLIONS IN FEDERAL AID
Every year, health care gets more than a third of the $90-billion-plus state budget. It’s the largest budget silo, it continues to grow, and it keeps lawmakers from being able to invest more, for example, in the state’s future through schools or infrastructure.
In short, they tend to suck all the oxygen out of the room.
This year was unique only in the astronomical sums hospitals received due to the pandemic.
The federal government has set aside at least $320 billion for covid-relief aid related to health care expenses. Of that, at least $134.2 billion has gone to states to distribute and at least $187 billion has gone directly to hospitals and other health providers.
Of that, Florida has received at least $12.7 billion, with $7.7 billion going to the state to distribute and $5 billion going to health providers. Of that $5 billion, nearly half has gone to hospitals.
Florida has received considerably less money for pandemic-related health expenses than New York — $21.5 billion. But they’re all all extraordinary amounts that hospitals most likely won’t have to pay back.
Yet Florida hospitals claim their share is not enough.
Two former state regulators, now representing Florida's two biggest hospital associations, Mary Mayhew and Justin Senior, told state lawmakers on March 4th and 10th how their facilities were still suffering billions in losses even after the federal aid.
During those discussions, Senior estimated a third, or about 5, of his 14 large safety-net hospital systems would walk away with operational losses. Mayhew said some of her more than 300 members would report a net loss for 2020, but didn’t specify how many.
As hospital executive Alan Levine said two weeks ago, this just isn't sustainable.
Hospitals need to become better, more efficient businesses that require less support from the government.
Or they need to throw in the towel and become government-run entities.
Correction: A previous version of this article misstated the amount of the state budget hospitals receive. It is about 5 percent, according to the Safety Net Hospital Alliance of Florida.