TALLAHASEE--Bruce Rueben was ecstatic talking about the success of the first Florida legislative session he has participated in since being named president of the Florida Hospital Association (FHA) last July.

 

After spending nine years as head of the St. Paul-based Minnesota Hospital Association, Rueben succeeded Wayne NeSmith, who retired in 2008.

 

Medical News spoke to Rueben about the 2009 legislative highlights, and what FHA members should keep an eye on next year.

  

BR: From a healthcare standpoint, gaining a cigarette tax increase was the most significant legislation that happened in the session. The tax on tobacco, or the tobacco user fee, was critical. That alone represents nearly $1 billion in new revenues. It provides a strong disincentive to smoke. It's good health policy that is connected to and combines good fiscal policy.

BR: For the past two years, advocacy organizations have proposed an increase in the state's tobacco tax. However, legislative leaders have resisted supporting an increase in the tax. The FHA Board of Trustees made an increase in the tax a cornerstone of its state advocacy agenda. The goal was to generate dedicated revenues for the Medicaid program. Recognizing that next year is an election year, and it would be politically impossible to enact any tax increases next session, the only option was to push for the increase this year. To do so, FHA partnered with a coalition of other organizations and provided grassroots support and strategic direction for the upcoming legislative battle.
Additionally, FHA developed and led a comprehensive communications and advocacy strategy that resulted in passage of the first tobacco tax increase in Florida since 1990. The dollar increase in the tax will be deposited into the state Healthcare Trust Fund and used to finance Medicaid. Without the increase in the tax, Florida would be looking at significant rate reductions this year. And in 2010, when the stimulus monies expire, the state could face further dramatic cuts to Medicaid without these recurring revenues.

BR: The increase in the tax was possible due to the overwhelming support of Florida's hospitals and the countless number of grassroots activities across the state, including editorial board visits, op-eds, letters to the editor, press conferences, personal meetings, letters, and e-mails. These combined efforts resulted in not only passage of a tax that will benefit Medicaid, but also improve the health of thousands of Floridians by making tobacco more costly, resulting in many quitting their addiction. Florida's children will be immediate benefactors as an increase in the cost of cigarettes prices our young people out of the marketplace for tobacco.
When Florida's hospitals unite, the results cannot be overlooked by legislative leaders or opinion makers. The outcome can be felt in every community and at the patient's bedside. This year's challenges were tremendous and the results will provide a lasting, positive impact.

 

BR: First of all, the sheer number of cigarettes sold in this state is staggering. There are more cigarette smokers in Florida than anywhere else in the country. We knew that if we were ever going to get on top of demand, it seemed that one smart thing we could do was to provide a financial disincentive to smoke. From a health policy standpoint, it was an important position for Florida to take.

 

Second of all, if we were ever going to find a permanent or predictable, reliable source of funding for programs for the needy, certainly it made sense fiscal policy-wise for the cigarette tax to be that source. We spend so much money on the effects of smoking. It only makes sense to recruit some of that money to provide health insurance for folks. The programs cover 50,000 people who are chronically ill. With the terrible economic challenges we have in this state, it made sense. It was an uphill battle to get that increase, but we were very, very fortunate to have some strong leadership from the Florida Senate, which helped us immensely.

 

BR: As you know, the Medicaid program is paid for partly by the state and partly by the federal government. Each state has a different federal match through FMAP. Florida, like all other states, got a temporary increase through the stimulus package the president pushed for and Congress passed early last winter. Florida was helped tremendously by that. We were very cognizant about doing our part to support that national effort of the stimulus package.