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Jeff Atwater's tax pledge and the healthcare budget

Just a few months ago, Senate President Jeff Atwater told his chamber's budget committee "we will not extract one more dollar from the small business owner of this state or from any Floridians wallet to accomplish the task."

Looks like hospitals don't count in the no-more-taxes pledge.

To help balance the budget and raise $55 million, the Senate's Health and Human Services Appropriations Committee proposed a .5 percent increase in the "sick tax" paid by hospital patients. The budget also cuts hospital, nursing home and HMO Medicaid reimbursement rates by 7 percent.

The budget also proposes expanding managed-care in Medicaid in up to 19 counties for a $30 million savings. The savings would come because of the elimination of the fraud-ridden pay-as-you go (and bill-as-you like) fee-for-service system.

There's also a $22.7 million savings that the state estimates it was save through capping rates and cracking down on Medicaid fraud -- savings that are not guaranteed. But, if the most recently announced fraud legislation passes, it's more guaranteed to give Atwater a good political platform (more here on that).

But this budget is only a first draft. And it's truly incomplete. The proposed budget doesn't include anywhere from $740 million to $1 billion in federal money that could likely arrive from Washington now that the U.S. Senate has approved a state Medicaid bailout.

Still, the budget is especially grim for Miami's Jackson Memorial Hospital. Thanks to some financial mismanagement and a series of unfortunate incidents, the hospital is $230m in the hole right now and, under the healthcare budget, could sustain anywhere from $33m to $100m in cuts and expenses. Jackson CEO Eneida O. Roldan is in Tallahassee today, spreading the word that she has a plan and, eventually, sure could use some more cash. That's not a gimme, said Durell Peaden, chairman of the Senate health budget committee.

"There's no money," he said.

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