TALLAHASSEE – A panel of Florida lawmakers today is taking up a privatized alternative to Medicaid expansion that could result in as many as one million low-income Floridians qualifying for the first time for subsidized health-care coverage.
The plan, nicknamed “Negron-care” for its Senate sponsor, Joe Negron, R-Stuart, is the Legislature’s first attempt under the Affordable Care Act to look at a way to insure people who are poor, but not poor enough to qualify for existing Medicaid coverage.
“I’m optimistic we’re going to get it done,” Negron said.
But there are still a lot of unanswered questions about Negron’s plan, including whether the House – and the federal government – will agree to it.
We look at what’s in the plan, how it impacts you, your health care and your tax dollars.
What exactly is the Legislature trying to do?
Lawmakers are looking for alternatives to the Medicaid expansion option offered by the Affordable Care Act, which for the first three years would pay 100 percent of the cost of adding roughly 1 million uninsured people to the federal/state health-care program and at least 90 percent after that.
According to projections by state economists, Florida would receive $51 billion in federal money over 10 years – at a cost of $3.5 billion to the state.
Gov. Rick Scott has endorsed the expansion, at least for three years, but legislators are seeking alternatives based on private insurance. Negron’s `plan will be heard by the Senate Appropriations Committee today.
Do we have to do this? What’s the benefit for me if I wouldn’t qualify?
The U.S. Supreme Court has said any Medicaid expansion is optional. But healthcare experts say there are substantial benefits to Floridians, including those insured now.
Right now, the state’s hospitals spend roughly $2.8 billion a year providing treatment for uninsured people who can’t pay. Those costs are passed on to insurance companies and thus, to everyone who buys coverage. And the Florida Hospital Association, which strongly backs expansion, has released a study showing that it would create 54,228 jobs.
OK, so what does Negron’s plan do?
His plan would use Medicaid dollars to extend private health-insurance to roughly 1 million individuals and families earning up to 138 percent of the federal poverty line, or about $15,000 for an individual and $26,000 for a family of three. Coverage would be contracted through Florida Healthy Kids, a state plan that now provides subsidized private coverage for about 250,000 low-income children.
What type of care would people receive?
The proposed plan would have to offer what’s called “benchmark” benefits, including preventive care such as yearly physicals, emergency care, maternity care and mental health and substance abuse treatment. It would not include preventive dental care, which Florida Healthy Kids currently requires.
Would patients have to pay anything for this?
A little bit. Under Negron’s plan, patients would have to pay low monthly premiums and co-pays, with the amount set by the Legislature yearly.
Isn’t Medicaid free today?
That’s the big concern of health-care advocates, who worry that some people can’t afford premiums and co-pays.
“Since this is a low-income population, the out-of-pocket cost protections that exist in Medicaid are really essential,” said Ron Pollack, executive director of Families USA, an advocacy group in Washington. “Otherwise people will be priced out of the health care they need.”
Haven’t Republicans expressed concern that the federal government won’t live up to its promises and continue supporting the program in the future?
Negron has accounted for that. If federal support drops below 90 percent, the program would end.
Are there other alternatives out there? What about the House?
Senate Healthy Policy Chair Aaron Bean, R-Jacksonville, has put out a competing idea, which would try to use state money to help this same population buy basic insurance. Senate President Don Gaetz, R-Niceville, said it was possible that they would take some parts of both plans in the final product.
However, Negron, as budget chair, is seen as the architect of any plan to overhaul the system. The House has said it is still examining the Senate plan.
Would using private insurers save money?
That’s the big, controversial question.
Negron says yes and is using a study commissioned by the state Agency for Health Care Administration to back up his argument. Milliman, an actuarial company, said offering the “benchmark plan” services through a private company would save more than $100 million per year.
But critics note that private insurance is generally more costly than Medicaid. And some who have studied Florida’s five-year-old experiment with enrolling Medicaid patients in managed care in Broward and four other counties aren’t so sure.
“There is no clear evidence that they’ve saved money or provided better quality care, in Florida’s case,” said Joan Alker, a health policy researcher and co-executive director of Georgetown University’s Center for Children and Families, who led a study of the Florida program. “Whether this is a cost-effective approach is a key question.”
What about the 3.3 million people getting Medicaid today? Would they switch to private insurers?
They will not be a part of this plan. However, pending final approval from the feds, they’ll be moved in 2014 into managed care plans run by either HMOs or doctor-run networks. Those private companies have not yet been selected by the state.
What’s the timeline for the expansion?
The state must seek federal approval by June 14 and begin enrolling patients on Oct. 1. The program must be fully operational by January 2014.
What if Florida is not ready by January?
There’s no hard deadline. Once a plan is approved, Florida can collect the federal money from that point on. If, say, expansion begins in July 2014, Uncle Sam will pay the full cost from then through 2016.
How likely is the Obama administration to approve a plan using private insurers?
Five other states – Arkansas, Indiana, Louisiana, Maine and Ohio – are exploring private alternatives. And the Department of Health and Human Services is encouraging alternatives, at least so far.
“We have not received or approved any proposals from Florida, but will carefully review any proposal when we receive it,” an official at the U.S. Department of Health and Human Services said in a prepared statement. “HHS is committed to providing states with flexibility and working with them to design Medicaid programs that work for their residents, within the confines of the law.”
Copyright © 2013, South Florida Sun-Sentinel
Tags: Aaron Bean, Agency for Health Care Administration, Department of Health and Human Services, Don Gaetz, Families USA, Florida Healthy Kids, Florida Hospital Association, Joe Negron, Medicaid expansion, Patient Protection and Affordable Care Act, Rick Scott