Fl Health Lobbyist rake in $24M

By Jim Saunders 
3/2/2010 © Health News Florida

When legislative committees discuss health-care issues, lobbyists fill the seats and line the walls. There's big money at stake for their clients -- and themselves.

Lobbyists for dozens of health-industry companies and groups in Florida pulled in an estimated $23.9 million last year and just over $24 million the year before, according to a review of state records by Health News Florida.

Figuring out the exact total is impossible, because lobbyists do not report how much they are paid down to the dollar. Instead they report ranges that are used to calculate estimates. 

Senate Health and Human Services Appropriations Chairman Durell Peaden, R-Crestview, said he is amazed at the amount spent on lobbying.
"$20 million?'' he asked. "You've got to be kidding me. That's a racket.'' 

Peaden said he does not get lobbied heavily, which he attributed to being in the Legislature since 1994. 

"If you've been here a long time, everybody knows your position (on issues),'' Peaden said.

Michael Garner, president of the Florida Association of Health Plans, pointed to the "breadth'' of health care as a key reason for the large amounts of spending on lobbyists.

"It is such a huge issue that you're communicating a lot of different ideas all the time,'' said Garner, whose health-insurer industry group spent $250,000 on lobbyists last year.

Lobbyists for many groups aim to get more health-care money or --- with the state facing budget shortfalls --- avoid funding cuts. As an example, lobbyist Brian Ballard guards income from the state Medicaid program for nursing home companies HCR ManorCare and Northport Health Services of Florida.

"Our job is to keep them (nursing homes) one step ahead of the chopping block,'' said Ballard.

The state report, compiled in February, shows the biggest spenders on health lobbyists last year included hospital giant HCA; the Safety Net Hospital Alliance of Florida; the Florida Hospital Association; the Pharmaceutical Research and Manufacturers of America; and the Florida Medical Association.

The spending in Tallahassee also came at a time when the health-care industry was pouring money into lobbying at the federal level. A report released this month by the Center for Responsive Politics indicated the health-care sector spent about $544 million on federal lobbying last year.

In most cases, Tallahassee lobbyists file quarterly reports that show their clients and list compensation amounts in ranges, such as $10,000 to $19,999 or $20,000 to $29,999. The state assigns a mid-point amount to each range to come up with totals --- for example, lobbyist compensation between $10,000 and $19,999 would be counted as $15,000.

With that caveat, the state report indicates HCA companies spent $805,000 on lobbyists last year. Similarly, the Safety Net Hospital Alliance, which includes public and teaching hospitals, spent $575,000, and the Florida Hospital Association spent $505,000. 

The Pharmaceutical Research and Manufacturers Association spending in Florida totaled $355,000, and the Florida Medical Association spent $300,000.

The most-common thread among health groups lobbying the Legislature is Medicaid, the program for low-income people that is expected to spend about $18.8 billion this year. Legislative decisions determine how much hospitals, nursing homes and doctors get paid to care for Medicaid beneficiaries --- decisions that are particularly difficult when the state is short on money.

But lobbyists also work on other regulatory and policy issues that, at times, can lead to arcane fights among different players in the health-care industry.

Bruce Rueben, president of the Florida Hospital Association, said his group's biggest lobbying effort last year centered on convincing lawmakers to pass a $1-a-pack increase in cigarette taxes. The measure is expected to bring in between $900 million and $1 billion a year to fund health programs.

"That was a huge challenge for us to accomplish,'' Rueben said. "That was where we put the bulk of our effort.''

But the hospital association and the Safety Net Hospital Alliance also became embroiled in a battle about the state's Low Income Pool, which is a $1-billion-a-year program that primarily provides funding to hospitals.

The hospital association and the alliance worked to block an HCA-backed bill that could have eliminated a council that recommends how the Low Income Pool money should be distributed. Ultimately, lawmakers changed the makeup of the council but did not eliminate it.

In another high-stakes lobbying fight last year, the Florida Medical Association pushed through a bill that made changes in how doctors are paid when patients seek care outside of an insurer's network --- an issue known as "assignment of benefits.'' The change was opposed by Blue Cross and Blue Shield of Florida, which spent an estimated $185,000 on lobbyists last year, according to the state report.

In the 2010 legislative session, which started Tuesday, lobbying on health-care issues again will be heavy.

One big issue that's brewing: whether lawmakers should expand a pilot program that requires Medicaid beneficiaries to enroll in managed-care plans. The managed-care industry is pushing for the expansion, which has already drawn fierce opposition from hospitals and other providers.

But the session also will include smaller-scale industry fights. As an example, FMA spokeswoman Erin Van Sickle said the doctors' group will oppose attempts by optometrists and advanced registered nurse practitioners to gain new prescribing powers.

Ballard said such regulatory issues, along with the state's continuing budget shortfalls, make health care "the place where most of the action is in Tallahassee.'' 

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail.