The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: SB 7018
INTRODUCER: Health Policy Committee
SUBJECT: Health Care Innovation
DATE: January 9, 2024 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
Brown, et al. Brown HP Submitted as Comm. Bill/Fav
1. Brown, et al. Yeatman FP Favorable
I. Summary:
SB 7018 sets forth legislative intent related to health care innovation in this state and creates a
framework to implement that intent. The intent is to harness the innovation and creativity of
entrepreneurs and businesses, in collaboration with the state’s health care system and
stakeholders, to lead the discussion on innovations that will address challenges in the health care
system and to transform the delivery and strengthen the quality of health care in Florida.
The bill creates the Health Care Innovation Council, a 15-member council within the Department
of Health (DOH) to facilitate public meetings across the state to lead discussions with
innovators, developers, and implementers of technologies, workforce pathways, service delivery
models, or other solutions. Based on the public input and information gathered at public
meetings, the bill requires the council to create best practice recommendations and focus areas
for the advancement of the delivery of health care in Florida, with an emphasis on:
Increasing efficiency in the delivery of health care;
Reducing strain on the health care workforce;
Increasing public access to health care;
Improving patient outcomes;
Reducing unnecessary emergency department visits; and
Reducing costs for patients and the state without reducing the quality of patient care.
The bill creates a revolving loan program within the DOH to provide low-interest loans to
applicants to implement one or more innovative technologies, workforce pathways, or service
delivery models in order to:
Fill a demonstrated need;
Obtain or upgrade necessary equipment, hardware, and materials;
Adopt new technologies or systems; or
BILL: SB 7018 Page 2
A combination thereof to improve the quality and delivery of health care in measureable and
sustainable ways that will lower costs and allow that value to be passed onto health care
consumer.
The council will review loan applications and submit to the DOH a prioritized list of proposals
recommended for funding. Loan recipients enter into agreements with the DOH for loans of up
to 10-year terms for up to 50 percent of the proposal costs, or up to 80 percent of the costs for an
applicant that is located in a rural or medically underserved area and is either a rural hospital or a
nonprofit entity that accepts Medicaid patients.
The bill requires both the council and the DOH to publicly report certain information related to
the activities required under the bill and requires the Office of Economic and Demographic
Research (EDR) and the Office of Program Policy Analysis and Government Accountability
(OPPAGA) to evaluate specified aspects of the revolving loan program every five years.
The bill makes the following appropriations:
For State Fiscal Year 2023-2024, appropriates $250,000 in nonrecurring General Revenue
funds for the DOH to support the council.
For State Fiscal Year 2024-2025, appropriates $1 million in recurring General Revenue funds
for the DOH to support the council.
For State Fiscal Years 2024-2025 through 2034-2035:
o Requires the Chief Financial Officer by August 1 each year to transfer $75 million from
the General Revenue Fund to the Grants and Donations Trust Fund in the DOH.
o Appropriates $75 million in nonrecurring funds from the Grants and Donations Trust
Fund each year for the DOH to make loans under the revolving loan program. The DOH
may use up to three percent of the funds for administration.
The bill takes effect upon becoming a law.
II. Present Situation:
Challenges of the Health Care System
There are numerous challenges facing the health care system in the United States, including
provider shortages, lack of access for certain populations, affordability, and ongoing challenges
with health care outcomes for certain populations. Compared with other wealthy nations,
Americans have poorer health, lower life expectancy, and less access to health care.1
Health Care Professional Shortages
The United States has a current health care professional shortage. The U. S. Department of
Health and Human Services designates an area, population group, or facility as a Health
1
Centers for Disease Control and Prevention, U.S. Health Disadvantage: Causes and Potential Solutions, available at
https://www.cdc.gov/policy/chep/health/index.html (last visited December 3, 2023).
BILL: SB 7018 Page 3
Professional Shortage Area (HPSA) if it is experiencing a shortage of professionals.2 The three
types of HPSAs are:
Geographic HPSAs, which have a shortage of services for the entire population within an
established geographic area;
Populations HPSAs, which have a shortage of services for a particular population subset
within an established geographic area, such as low income, migrant farmworker, or Medicaid
eligible; and
Facility HPSAs, which indicate shortages in facilities such as correctional facilities, state or
county hospitals with a shortage of psychiatrists, and other public or non-private medical
facilities serving a population or geographic area designated as a HPSA with a shortage of
health providers.
As of December 3, 2023, there are 8,544 Primary Care HPSAs, 7,651 Dental HPSAs, and 6,822
Mental Health HPSAs nationwide. To eliminate the shortages, an additional 17,637 primary care
practitioners, 13,354 dentists, and 8,504 psychiatrists are needed, respectively.3
This shortage is predicted to continue into the foreseeable future and will likely worsen with the
aging and growth of the U.S. population.4 Aging populations create a disproportionately higher
health care demand due to seniors having a higher per capita consumption of health care services
than younger populations.5 By 2030, all baby-boomers will be over the age of 65, and by 2034, it
is projected that the number of individuals over the age of 65 will surpass the number of children
under the age of 18 for the first time in U.S. history.6 Additionally, as more individuals qualify
for health care benefits, there will necessarily be a greater demand for more health care
professionals to provide these services.
Health care workers may experience an extreme amount of stress due to the demanding work
conditions, including taxing work, exposure to infectious diseases, long hours, and challenging
interactions with coworkers, patients, and their families.7 Prior to the COVID-19 pandemic, the
National Academy of Medicine found that burnout had reached a crisis level, with 35-45 percent
of nurses and physicians and 45-60 percent of medical students and residents reporting
2
U.S. Department of Health and Human Services, Guidance Portal, Health Professional Shortage Areas (HPSAs and
Medically Underserved Populations (MUA/P) Shortage Designation Types (Aug. 1, 2019), available at
https://www.hhs.gov/guidance/document/hpsa-and-muap-shortage-designation-types (last visited December 4, 2023).
3
U.S. Department of Health and Human Services, Health Resources and Services Administration, Health Workforce
Shortage Areas, available at https://data.hrsa.gov/topics/health-workforce/shortage-areas (last visited December 4, 2023).
4
The U.S. population is projected to increase from almost 336 million in 2023 to nearly 370 million in 2080, before
decreasing to 366 million in 2100. See U.S. Census Bureau, U.S. and World Population Clock, available at
https://www.census.gov/popclock/, and U.S. Census Bureau, U.S. Population Projected to Begin Declining in Second Half of
Century (Nov. 9, 2023), available at https://www.census.gov/newsroom/press-releases/2023/population-projections.html
(both sites last visited December 4, 2023).
5
Id, at p. 33.
6
J. Vespa, L. Medina, and D. Armstrong, Demographic Turning Points for the United States: Population Projections for
2020 to 2060 (Mar. 208, rev. Feb, 2020), available at
https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf (last visited December 4, 2023).
7
J. Nigam, et. al., Vital Signs: Health Worker-Perceived Working Conditions and Symptoms of Poor Mental Health – Quality
of Worklife Survey, United States, 2018-2022, MORBIDITY AND MORTALITY WEEKLY REPORT (Oct. 24, 2023), available at
https://www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7244e1-H.pdf (last visited December 4, 2023).
BILL: SB 7018 Page 4
symptoms of burnout.8 During the pandemic, the high levels of stress and the increased demands
for care led to record numbers of health care workers quitting or planning to quit.9 In 2022,
nearly one half of health care workers reported burnout.10
Florida is not immune to the national problem and is also experiencing a health care practitioner
shortage. This is evidenced by the fact that as of September 30, 2023, there are 304 primary care
HPSAs, 266 dental HPSAs, and 228 mental health HPSAs designated within the state. It would
take 1,803 primary care physicians, 1,317 dentists, and 587 psychiatrists to eliminate these
shortage areas.11
According to data from the DOH, by 2035, Florida will need 17,924 physicians, 50,700
registered nurses, and 4,000 licensed practical nurses to meet the demand in Florida.12 In the next
five years almost 10 percent of Florida physicians are planning to retire, and in nine counties, at
least 25 percent of physicians are planning to retire.13 Nurses make up the largest segment of
Florida’s health care workforce. Approximately 20 percent of the nursing workforce is over the
age of 60 and may leave the workforce in the next five to ten years.14
Access to Health Care
Access to health care means the timely use of personal health services to achieve the best
possible health outcomes.15 There are several barriers that limit an individual’s access to health
care services. Some lack access because they reside in a medically underserved area or are
members of a medically underserved population, which means that they lack access to primary
health care services.16 Florida has approximately 130 federally designated medically underserved
areas or populations.17
8
Office of the Surgeon General, Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a
Thriving Health Workforce (2022),, available at https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf
(last visited December 4, 2023). “Burnout” is an occupational syndrome characterized by a high degree of emotional
exhaustion and depersonalization and a low sense of personal accomplishment at work.
9
Id. at p. 14.
10
Supra, note 7.
11
Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health and
Human Services, Designated Health Professional Shortage Areas Statistics, Fourth Quarter of Fiscal Year 2023
(Sept. 30, 2023), available at https://data.hrsa.gov/topics/health-workforce/health-workforce-shortage-areas?hmpgtile=hmpg-
hlth-srvcs (last visited December 4, 2023). To generate the report, select “Designated HPSA Quarterly Summary.”
12
Presentation before the Florida Senate Committee on Health Policy by Emma Spencer, Department of Health, Florida’s
Physician and Nursing Workforce (Nov. 14, 2023), available at
https://www.flsenate.gov/Committees/Show/HP/MeetingPacket/5979/10504_MeetingPacket_5979_4.pdf (last visited
December 4, 2023).
13
Id. Those counties are Glades, Gulf, Hamilton, Madison, Union, Calhoun, Hendry, Levy, and Liberty.
14
Id.
15
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People
2030, Access to Health Services, available at https://health.gov/healthypeople/priority-areas/social-determinants-
health/literature-summaries/access-health-services (last visited December 4, 2023). (Hereinafter “Healthy People 2030”).
16
Health and Resources Services Administration, What is Shortage Designation?, available at
https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation (last visited December 4, 2023).
17
See, Heath Resources and Services Administration, MUA Find, available at https://data.hrsa.gov/tools/shortage-area/mua-
find (last visited December 4, 2023). To generate a list of medically underserved areas and populations, select Florida as the
search criteria.
BILL: SB 7018 Page 5
Other factors that play a role in access to health care include health care affordability and the
lack of health insurance coverage.18 Studies show that having health insurance is associated with
improved access to health services and better health monitoring. Additionally, nonfinancial
barriers significantly impact a patient’s ability to access care. Among the most prevalent
nonfinancial barriers are the ability to get an appointment and inconvenient or unreliable
transportation.19
Health Care Outcomes
Although the United States spends more on health care per capita than other wealthy nations, it
has some of the worst health care outcomes, according to an issue brief published by The
Commonwealth Fund. Compared to other wealthy nations, the U.S. has the lowest life
expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest
maternal and infant mortality, and among the highest suicide rates, according to the issue brief. 20
Sixty percent of adults in the U.S. have a chronic health condition, and 40 percent have two or
more.21 A chronic condition is a physical or mental health condition that lasts more than one year
and causes functional restrictions or requires ongoing monitoring or treatment.22 Chronic health
conditions are the leading drivers of the nation’s $4.1 trillion in health care costs, accounting for
nearly 75 percent of aggregate health spending.23 More than two thirds of all deaths are caused
by one or more of the five most prevalent chronic health conditions: heart disease, cancer, stroke,
chronic obstructive pulmonary disease, and diabetes. Unfortunately, these outcomes are because
of the nation’s inability to effectively manage chronic conditions, which could be achieved by
reducing unhealthy behaviors.24
Maternal mortality refers to deaths occurring during pregnancy or within 42 days of the end of
pregnancy, regardless of the duration of the pregnancy, from any cause related to or aggravated
by the pregnancy, but not from accidental or incidental causes.25 In 2021, more than 1,200
women died of maternal causes in the United States compared with 861 in 2020 and 754 in 2019.
The national maternal mortality rate for 2021 was 32.9 deaths per 100,000 live births. Racial and
ethnic gaps exist between non-Hispanic black, non-Hispanic white, and Hispanic women. The
maternal mortality rate of these groups is 69.9, 26.6, and 28.0 deaths per 100,000 live births,
18
Centers for Disease Control and Prevention, Division of Heart Disease and Stroke Prevention, Health Care Access,
available at https://www.cdc.gov/dhdsp/health_equity/health-care-access.htm (last visited December 4, 2023).
19
Healthy People 2030, supra, note 156.
20
M. Gunja, Evan Gumas, and R. Williams, The Commonwealth Fund, U.S. Health Care from a Global Perspective, 2022:
Accelerating Spending, Worsening Outcomes (Jan. 31, 2023), available at
https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 (last visited
December 4, 2023). Other wealthy nations included in the study are Australia, Canada, France, Germany, Japan, the
Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom.
21
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, About
Chronic Diseases, available at https://www.cdc.gov/chronicdisease/about/index.htm (last visited December 4, 2023).
22
W. Raghupathi and V. Rahupathi, An Empirical Study of Chronic Diseases in the United States: A Visual Analytics
Approach to Public Health, INTERNATIONAL JOURNAL ON ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 15(3):431
(Mar. 2018), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876976/ (last visited December 4, 2023).
23
Id., and CDC, supra, n