One of the biggest loss leaders in Florida's deteriorating budget is Medicaid, but, as of now, lawmakers are reluctant to pursue reforms that could save the state billions of dollars.

Senate President Mike Haridopolos is leading the charge against the new federal health-care law, saying, "I don't think there is anything more important than balancing the budget and health care. We're going to fight for what is right."

Last week, the Senate Health Regulation Committee voted to block a portion of the federal health-care mandate requiring individuals to buy health insurance or face penalties. The full Senate is expected to pass Haridopolos' measure when lawmakers convene next year. But the Senate president's resolution also requires a vote of the people, which would not take place for two years.

Meanwhile, Florida's costs for Medicaid, the indigent-care program, are expected to rise from $21.3 billion to $23.3 billion in 2011. Expenses will climb even higher as the federal health-care law moves more Floridians into Medicaid.

"The number is going to be big," state budget analyst Amy Baker warned.

To stanch the fiscal hemorrhage, the conservative Heritage Foundation says Florida could save $28 billion over five years by simply opting out of Medicaid. Though that might sound like a radical move, it dovetails philosophically with Attorney General Bill McCollum's lawsuit challenging the constitutionality of Obamacare.

Opting out also matches legislators' determination to pass a constitutional amendment to prevent the federal government from compelling people to participate in any health-care system. Both the House and the Senate have listed the resolution -- AJR 1 and SJR 1 respectively -- as their first order of business in 2011.

THE BENEFITS OF OPTING OUT

Starting in 2014, Medicaid is scheduled to expand to include anyone with incomes up to 133 percent of the federal poverty level, which is $29,327 for a family of four in 2010.

Heritage analyst Edmund Haislmaier says that in states which drop Medicaid, the program's low-income clients would instead receive federal subsidies to buy private insurance through state exchanges, also due to take effect in 2014.

States opting out of Medicaid would become wholly responsible for remaining Medicaid patients who require nursing homes and other long-term care, for premiums and other Medicaid costs for Medicare beneficiaries.

But Haislmaier says that would be a net gain for Florida because everyone else would go into the insurance exchanges.

"Florida would save up to $3.8 billion in 2014 and save $28 billion over the first five years," he projects, contingent on how the plans are designed.

Texas, whose five-year savings are pegged at $45 billion, is among the states actively considering quitting Medicaid.

Incoming Gov. Rick Scott, a former health-care executive, may be amenable to such surgery in Florida.

But Joe Negron, chairman of the Senate Health and Human Appropriations Budget Committee, says the opt-out option isn't on the table. Instead, his panel is exploring a host of reforms that he believes will make the existing system more cost-efficient.

Declaring that he and other senators are starting with a "blank page," the Stuart Republican said he is, among other things, looking at Arizona's use of performance bonds to cut Medicaid costs.

Negron said lawmakers also are zeroing in on optional medical services covered by Medicaid. He declined to specify which "soft services" might be on the chopping block, but said, "If you're not feeding, housing or providing medical care to someone, we can't afford to do what you're doing.

"In other words, if you're in the advice and guidance business, and you're giving out information and hectoring and lecturing the citizenry, we can't afford your programs and there's a number of them like that," Negron explained.