Gov. Rick Scott is having a hard time getting officials in the state's largest counties to back his proposal that would require cuts for many public hospitals and instead funnel money to for-profit ones.
The governor's plan could mean a possible hit of more than $80 million for Miami's Jackson Memorial Hospital and $22 million for Broward General Hospital. Leaders in both counties have said they won't support that. Federal officials also worried Friday that the plan was not viable for local communities.
Miami-Dade County Commissioner Xavier Suarez said the cuts would come on top of 15 percent that the hospital doesn't get reimbursed for caring for patients who are uninsured or living in the country illegally. He said the timing couldn't be worse because the hospital is undertaking a massive expansion to meet the demand of newly insured patients.
"That would mean we would have to turn away a lot of folks," said Suarez.
Another Miami-Dade Commissioner, Daniella Levine Cava, said she is considering an emergency motion for commissioners to take up the issue when they meet June 11. Miami-Dade raises $375 million a year in tax dollars to help the hospital draw down federal money.
"I will not support it," Broward County Mayor Tim Ryan said of the governor's plan. "We have a hard enough tax burden as it is."
The governor wants to replace the existing federal hospital funds, known as the low-income pool, with a system that increases reimbursement rates to hospitals. That means the hospitals might not get back as much money as they were getting under the low-income pool.
Scott's proposal guarantees a 10 percent return on investment for local communities, but local officials say it's not enough.
"It's obviously not acceptable to us to not get back what we're putting into the system," said Levine Cava.
The Safety Net Hospital Alliance of Florida said Scott's proposal would cut funds to public hospitals by $302 million and could put some out of business. But the proposal increases payments to for-profit hospitals, most of which are headquartered outside Florida, by nearly $100 million, the organization said in a statement.
The Obama administration said Friday that it would not approve Scott's request until the state includes a plan for the 2016-2017 year, when federal funds will be slashed by 75 percent.
Governor's spokeswoman Jackie Schutz said "only a handful of hospitals would lose money as a result of reducing the funding that their record profit margins show they could not afford."
"This group totals only around $60 million in losses."
As many hospital officials have warned they would be forced to cut services or close down without the low-income pool funds, the governor has attempted to show that the hospitals aren't as bad off financially as they maintain.
He's taken an increasingly adversarial stance against public hospitals, urging them to share profits and starting a commission designed to dig through their financial records to uncover any possible mismanagement of taxpayer dollars.
Scott once led one of the nation's largest hospital chains but he was forced out amid a federal investigation that resulted in a then-record $1.7 billion fine. He was not charged with any wrongdoing and has repeatedly said he was unaware of the problems going on underneath him.
Scott's hospital stance comes as he faces a looming hole in his budget since the Obama administration announced last week that it was cutting the federal government's contribution to the low-income pool in half. The governor has a few options to build those dollars back up. He can expand Medicaid to more than 800,000 Floridians or increase reimbursement rates to hospitals.
The Obama administration and the state Senate have pushed vigorously for Medicaid expansion, arguing that it is more efficient to use the federal funds to give people insurance than to pay hospitals for caring for the uninsured retroactively. The Senate has proposed a plan that would use the federal funds to allow the expanded Medicaid population to buy private insurance, but Scott and House Republicans remain adamantly opposed to taking any money tied to the federal health care overhaul.
Lawmakers will return for a special session Monday to attempt to find a health care compromise and to pass a budget. The stalemate could threaten Scott's priority: a $700 million tax cut package.