Tobacco, ‘certificate of need’ issues may go on ballot

TALLAHASSEE — Floridians could wind up voting on two contentious health care proposals that on Thursday drew closer to the 2018 ballot.

A panel of the Florida Constitution Revision Commission approved separate proposed constitutional amendments that would alter how much money is set aside for anti-smoking programs and eliminate longstanding state regulations about the construction of hospitals and nursing homes.

Florida receives money each year as part of a landmark 1997 multibillion-dollar settlement with tobacco companies. Part of that money is dedicated to anti-smoking programs, including an advertising and marketing campaign that currently receives $23 million a year. This requirement was put in the state Constitution at the urging of anti-smoking and health groups in 2006 after legislators cut funding to the program.

State Rep. Jeanette Nunez, who is a member of the Constitution Revision Commission, wants voters in 2018 to approve a proposal that would guarantee that a part of the anti-smoking money is shifted to research and treatment of cancer. If ultimately passed by voters, it would result in about $14 million being set aside in 2019.

“Research is absolutely an important component of prevention,” Nunez, R-Miami, said. “It is one of our most important tools of prevention.”

But Nunez’s proposed constitutional amendment drew fire from anti-smoking groups and other health care organizations such as the American Cancer Society. They said Florida’s current programs, including the advertising campaigns, have been successful in reducing smoking rates among adults and teenagers.

Matt Jordan with the American Cancer Society Cancer Action Network called it “counterproductive and counterintuitive to divert money from cancer prevention to cancer treatment and research.”

It’s not clear yet if the proposal will be placed on the ballot. The commission is a 37-member body that meets every 20 years to consider and recommend changes to the Florida Constitution. The full commission must approve any amendments that will go before voters. Amendments then would need to get 60 percent support from voters to pass.

Along with approving Nunez’s proposal Thursday, the commission’s General Provisions Committee also backed a proposed constitutional amendment that would eliminate “certificate of need” regulations for health care facilities. The proposal would prohibit the state from limiting the number of hospitals, nursing homes, hospices or intermediate care facilities for individuals with disabilities.

Frank Kruppenbacher, an attorney and commission member, said the state should eliminate barriers that he contends limit consumer choice and innovation in health care. He cited battles in Central Florida over a children’s hospital and a new hospital for the University of Central Florida that he said were sparked by a tug-of-war over money and competition.

Under the certificate of need process, the state must sign off on the construction of facilities such as new nursing homes and hospitals and the addition of services such as organ transplants or pediatric open-heart surgery.

The proposal to eliminate the so-called CON requirements was strongly opposed by the nursing home industry and groups representing hospitals.

Opponents predict the amendment would diminish quality and access to care in many geographical areas, especially those in low-income neighborhoods.

Nunez, who noted that the Florida House has pushed for repeal of certificate-of-need laws, voted against the proposal after saying that the issues should be dealt with by the Legislature and not placed in the Constitution.

“Putting this in the Constitution would be asking voters to weigh in on a highly technical nuanced issue,” Nunez said.

But Kruppenbacher said it was time to take the CON battle to voters.

“I don’t have faith in the Legislature,” he said. “I think the public should have the right to vote on (whether) they want an open and free market that is otherwise stifled.”