The report notes that the most limited insurance plans offered in Florida are expected to cost $150 per month, which is unaffordable for low-income residents. “Because most uninsured people have low incomes, they need subsidies to help them afford coverage,” according to the report (Wessel, Orlando Sentinel, 7/21).

Online The report is available online.

Medicaid Pilot Program

In other Florida news, a report by Cleveland State University professor Michael Bond found that a state Medicaid pilot program provides beneficiaries with more products and services and that local physicians are supporting the program, the Miami Herald reports. Under the pilot program, beneficiaries are required to enroll in an HMO or other managed care network and plans are given flexibility to provide tailored health care services to beneficiaries, the Herald reports.

The report — sponsored by the James Madison Institute, a “free-market think tank” — found that the program reduced costs by 7.2%, increased access to specialists, provided more than 100 new services, reduced out-of-pocket expenses and helped retain primary care physicians, according to the Herald. The report disputed findings in reports by state Inspector General Linda Keen of the Florida Agency for Health Care Administration and a Georgetown University research team that were critical of the program, the Herald reports (Jordan Sexton, Miami Herald, 7/19).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Tue, 07/22/2008 – 18:14

Experts are lauding the new legislation, the Cover Florida Health Access Act, as a positive step toward affordable health insurance and a model program for other states.

Mandates Cause Uninsurance

Every state has laws requiring certain procedures and illnesses be covered by every insurance policy sold within its borders. Florida currently has the 13th most among the states, with 48 coverage mandates, including hair prosthesis, orthotics, and second surgical opinion. It also has one of the highest uninsured rates (21 percent, or roughly 3.8 million people) in the country–a fact experts say is no coincidence.

“Government regulation drives up the cost of health insurance and is a significant factor in denying health insurance to the working poor,” said Michael Tanner, a senior fellow at the Cato Institute. “If government were to mandate that the only car anyone could own was a Lexus, it wouldn’t be long before the poor lacked transportation. Sometimes people have to drive a Kia. Kudos to the Florida legislature for belatedly recognizing an economic fact of life.”

“This important step forward by Florida reflects what many [people] nationwide know all too well: Consumers can’t afford the ‘benefits’ lawmakers force on them,” said Joel White, a senior fellow at the Galen Institute. “In many cases the good intentions of lawmakers to ‘protect’ consumers by mandating benefits they cannot afford or do not want has ‘protected’ them into the ranks of the uninsured.

“The U.S. Congress should take heed of Florida’s action and pass legislation that expands consumer choices,” White added.

‘Giant Step Forward’

Cover Florida, signed by Crist in early June, will allow individuals who qualify to purchase “bare bones” insurance policies that cover only the treatments consumers want to pay for instead of all the treatments and procedures Tallahassee has declared mandatory in the past. It is expected to save eligible Floridians hundreds of dollars in premiums while reducing the number of uninsured in the state.

“Florida’s new insurance law is a giant step forward toward affordable health insurance that should serve as a model for other states,” said Stephen J. Entin, president of the Institute for Research on the Economics of Taxation.

Entin explained, “It will allow consumers who have been without insurance for at least six months to buy policies that meet their personal requirements, free of expensive mandates formerly required by the legislature at the behest of special interests.”

Florida Health Insurance Consumers in Driver’s Seat

“Other states should follow Florida’s lead and allow insurers to sell innovative policies consumers actually want,” said Devon Herrick, a senior fellow at the National Center for Policy Analysis.

Cover Florida “puts the consumer in the driver’s seat, instead of the providers,” said Entin. “The resulting competition for the consumer’s dollar will make insurance attractive to many who must now go without.”

Jeff Emanuel (emanuel@heartland.org) is research fellow for health care policy at The Heartland Institute and managing editor of Health Care News.

By: Heartland.org – Mon, 07/28/2008 – 01:52

The measure (see “Florida Passes Model Legislation Allowing More Health Insurance Choice,” Health Care News, August 2008) has come under fire from the Center on Budget and Policy Priorities (CBPP), an activist group that has released a study claiming the measure will do little to reduce the number of uninsured in the Sunshine State.

Health policy experts, though, support the new measure, known as the “Cover Florida Health Access Act,” as a positive step toward affordable health insurance and, in fact, a model program for other states.

Eliminated Unwanted Health Insurance Mandates

Cover Florida, signed by Gov. Charlie Crist (R) in early June, allows individuals who qualify to purchase “bare bones” health insurance policies that cover only the treatments consumers want to pay for, instead of all 48 treatments and procedures Tallahassee has declared mandatory. It aims to make health insurance more affordable for Floridians who have not been able to pay for policies made artificially expensive by state mandates.

CBPP questioned that outcome.

“Cover Florida has received considerable attention, but the track record for bare-bones policies suggests that they will not attract many uninsured Floridians, especially when–as with the new state law–premium subsidies for low- and moderate-income consumers are not provided,” wrote CBPP Senior Fellow Judith Solomon in the study, released July 1.

Joel White, a senior fellow at the Galen Institute, disagreed, saying the Florida measure is an example of government not forcing expensive, unwanted provisions down consumers’ throats.

“This important step forward by Florida reflects what many nationwide know all too well: Consumers can’t afford the ‘benefits’ lawmakers force on them,” said White. “In many cases the good intentions of lawmakers to ‘protect’ consumers by mandating benefits they cannot afford or do not want has ‘protected’ them into the ranks of the uninsured.”

Most Treatments Unaffected

Paul Guppy, vice president for research at the Washington Policy Institute, called the Florida program “a major step toward bringing common sense to its health care market.

“Getting rid of mandates for at least some policies allows people in Florida to buy health insurance that best fits their needs, at a price they’re willing to pay,” Guppy said.

Twila Brase, president of the Citizens’ Council on Health Care, disagrees with the CBPP study’s claim that fewer mandated coverages means less real coverage. “Eliminating treatment mandates doesn’t mean the automatic elimination of the treatment,” she said.

“Just because coverage for a certain treatment isn’t mandated by law does not necessarily give the insurer the subsequent right to deny coverage for those patients who actually need that service. Most medical treatment is not specifically mandated by law,” Brase noted. “Most medical treatment is provided because the individual needs it and the doctor orders it.”

Jeff Emanuel (emanuel@heartland.org) is The Heartland Institute’s research fellow for health care policy and managing editor of Health Care News.

For more information …

“New Georgia and Florida Health Plans Unlikely to Reduce Ranks of Uninsured,” by Judith Solomon, Center on Budget and Policy Priorities, July 1, 2008: http://www.cbpp.org/7-1-08health.htm

“Florida Passes Model Legislation Allowing More Health Insurance Choice,” by Jeff Emanuel, Health Care News, August 1, 2008: http://www.heartland.org/Article.cfm?artId=23576

By: Heartland.org – Wed, 08/27/2008 – 14:31

In letters to the state agency last month, Amerigroup Florida, UnitedHealthcare of Florida and WellCare Health Plans’ HealthEase of Florida and WellCare of Florida — which cover 60% of people enrolled in Florida “Medicaid Reform” plans — said they would leave the project by Dec. 1 and asked to be assigned no new members.

The reform plan, which began in 2006 and operates in five counties, requires that most non-institutionalized Medicaid beneficiaries be enrolled in private plans that carry the risk of providing their care (Kaiser Daily Health Policy Report, 8/29).

Kent Jenkins, a spokesperson for Amerigroup, said the smaller payment cut is “just enough” to keep the insurer in the program (LaMendola, South Florida Sun-Sentinel, 8/30). HealthEase and Staywell also notified AHCA that they will continue to participate in the pilot program. UnitedHealthcare was the only insurers that had threatened to withdrawal from the program and that had not rescinded its decision by the deadline on Tuesday (Florida Health News, 9/2).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Wed, 09/03/2008 – 15:34

In 2007, 197 defendants were prosecuted on charges of submitting $638 million in false Medicare claims, and 111 defendants in 2006 were indicted on charges of billing $138 million in false claims, the Herald reports.

Most of the prosecutions involved medical equipment operators and HIV clinics. Acosta said, “We’re getting much better at catching them.” However, Acosta said that increased efforts to prosecute offenders will not resolve the problem and that CMS should be more aggressive in detecting and rejecting claims that raise suspicion. “The only way we’re going to stop the fraud is through prevention,” he said (Weaver, Miami Herald, 10/1).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Fri, 10/03/2008 – 18:23

A chief concern about the law is whether it will increase employers’ health insurance costs. According to Becky Cherney, president and CEO of the Orlando-based Florida Health Care Coalition, adding young adults to employer-supplied health plans could further damage businesses that already have financial difficulties. “More people are liable to drop group coverage (for their workers) than there are between 25 and 30 who need this coverage,” Cherney said.

Ron Pollack, executive director of Families USA, said some companies might benefit from adding young adults to their coverage pool because young adults generally are healthier than the rest of the population. He said, “The fact that the group is going to be much more predominantly a lower-age group is probably going to result in lower premiums for the entire group.”

The Florida Office of Insurance Regulation plans to hold a workshop in the coming weeks to clarify some of the details of the law (Myers Palm, Orlando Sentinel, 10/2).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Fri, 10/03/2008 – 18:25

However, Florida Agency for Health Care Administration Secretary Holly Benson earlier this week said that the availability of the information on which companies were selected would be delayed until between Oct. 15 and Oct. 22. AHCA spokesperson Fernando Senra said “scheduling challenges” caused the delay. The goal is to close the contracts by “mid to late” November so that the plan can be implemented by Jan. 1, 2009, Benson said.

Meanwhile, a change in insurance law that would extend to 30 the age a young adult can remain on a parent’s health coverage has been delayed over questions concerning who decides — the employer offering the coverage or the parent of the young adult — whether a young adult can remain on the policy, according to Florida Health News. On Monday, Blue Cross and Blue Shield of Florida announced that it will suspend optional coverage for dependents ages 25 to 40 until the provisions of the law have been clarified.

In addition, a 15-member board that would have provided oversight of the Florida Health Choices, a program that would offer a virtual health insurance marketplace for employees statewide, has yet to be formed. One member has been appointed by the state House speaker, Florida Health News reports. The House speaker, Crist and the state Senate president each would make four appointments, while the final three members would be representatives from AHCA, the state Office of Insurance Regulation and the state Department of Management Services (Jordan Sexton, Florida Health News, 10/1).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Mon, 10/06/2008 – 17:37

For the study, researchers with the Kaiser Family Foundation, the Urban Institute and the University of Florida Center for Medicaid and the Underinsured surveyed 1,848 beneficiaries in the two counties from November 2006 to March 2007. Researchers found that three in 10 beneficiaries did not know they were supposed to choose a plan and many others were confused by the options. In Broward county, 56.3% said it was difficult for them to understand information about the health plans (Dorschner, Miami Herald, 10/14). In addition, the survey found that more than 60% of beneficiaries did not know they could opt out of the pilot program by using their Medicaid funding to purchase private coverage and about 30% did not know they were enrolled in the pilot program (Dolinski, McClatchy/Tampa Tribune, 10/14).

The Times-Union reports that when the number of people not aware of the changes is combined with those who opted to allow state officials to pick a plan for them, about half of the beneficiaries played no part in choosing their policy (Florida Times-Union, 10/14). According to the survey’s authors, the program’s viability “hinge[s] on the ability to translate complicated health care information for consumers” and “then help consumers use that information to make informed health care decisions.” They added, “Without a well-informed consumer, a fundamental piece of the competitive model is missing, jeopardizing hoped-for efficiencies and cost savings” (Miami Herald, 10/14).

Samantha Artiga, a co-author and senior associate with the Kaiser Family Foundation, said, “The premise of the reform program is to offer plans of various packages to create more competition among the plans and create a more competent enrollee,” but if the beneficiaries are “not actively making a choice of a health care plan, that’s a key piece of the model that’s missing” (Florida Times-Union, 10/14). She said that many beneficiaries reported both having low-incomes and being chronically ill, so “it will be important to continue to track how well they are able to engage in making a plan choice” (McClatchy/Tampa Tribune, 10/14).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Tue, 10/14/2008 – 18:17

However, the proposal was made at the same time the agency plans to comply with Crist’s request that state agencies reduce staff by as much as 10% in the event that the current economic downturn forces further spending cuts. Greg Mellowe, newsletter editor for the consumer group CHAIN, in an e-mail said that “it’s almost surreal,” adding, “It reveals the extent to which AHCA continues to be in denial about the problems dogging the Reform Pilot.” According to Mellowe, “The Agency is essentially telling the governor that expansion is simply an automatic next step and that they’re ready to proceed.”

A report released last week by Georgetown University Health Policy Institute researchers stated that too little information is available to know whether the pilot saves any money for taxpayers or improves patient care. The report noted that doctors in the two largest counties where the program is operating have “complain[ed] about paperwork hassles” and that some patients have trouble getting access to specialized care, Florida Health News reports. The researchers also found that beneficiaries have expressed confusion about how the program works. According to the report, the project “appears to be moving in the wrong direction” (Gentry, Florida Health News, 10/20).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Thu, 10/23/2008 – 11:05

Child advocates and officials with Florida Healthy Kids said that notices to some families about premium due dates or enrollment renewal were sent late or not at all. In other cases, letters were not properly sent to inform parents that additional documentation was required to maintain coverage. Robleto said that some of the enrollment data may not have transferred properly when the new system was put in place in May. Robleto said eventually, the new system will “significantly improve service.”

Florida Healthy Kids officials have started contacting the families of all 62,500 children, although it is unknown how many children were affected by the problem. The Florida Healthy Kids board recently reinstated some of the policies effective Nov. 1, for at least 30 days, until staff can determine that the cancellations were not caused by the computer problem, Robleto said (Circelli, Daytona Beach News-Journal, 11/5).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

By: kaisernetwork.org – Sat, 11/08/2008 – 05:15