March 10, 2015

Economists adjust predictions of an Obamacare disaster

It’s kinda scary how accurate state economists were in projecting revenues for next year’s budget. When they met Tuesday, they adjusted their general revenue forecasts by a mere 0.5 percent from December.

But one area they were a bit off was estimating the insurance premium tax. On Tuesday, economists acknowledged that they reduced the amount of revenue the tax will bring in this year by $82.8 million and another $41.3 million in next year’s budget.

And who can blame them from anticipating such fat revenue from the insurance premium tax?

Remember all the speculation and anecdotes about runaway insurance premiums once the Affordable Care Act was implemented? There was CNN Money, in a widely-circulated 2013 piece, predicting that Florida’s premiums would skyrocket 35 percent. Florida Blue, the state’s largest carrier, announced last year it was increasing its rates by 17.4 percent. The Republican Party of Florida ran an ad last year that predicted premiums were going to jump by as much as 30 percent. When pressed by PolitiFact (which found the ad’s claim “mostly false”), party officials cited a Morgan Stanley survey that showed Florida was seeing a 37 percent increase in individual plans and a 21 percent increase in small group plans.

No wonder they estimated such a spike in tax revenues.

But as state chief economist Amy Baker explained Tuesday, forecasters overestimated just how high the premiums would go. On Tuesday, they made the necessary corrections to their corresponding tax revenues.

“We’re assuming a little bit cheaper policy prices than what we originally anticipated when we put our estimate together,” Baker said. “There’s some more behavioral changes than we originally thought would exist. We did see some shifting of individuals who had policies go over into the marketplace to find something that’s more affordable for them. We did see some shifting among very small businesses that felt like (ACA) was offering a better option for their employees than what they could offer through their business. So some of those behavioral changes we weren’t anticipating, and it did bring down the estimate (of what the state was anticipating to collect) we had associated with that originally. We’re just now starting to see the first bits of data.”

So at least for now, Obamacare isn’t leading to skyrocketing premiums in Florida. SCOTUS permitting, plan accordingly.

March 09, 2015

Senate panel to consider Medicaid expansion proposal

GardinerA Senate committee will consider a controversial plan Tuesday that would extend federally subsidized health insurance to more than 800,000 poor Floridians — but require a waiver from the federal government to pay for it.

The proposal (SPB 7044) would establish a state-run private insurance exchange available to Florida residents who earn less than $16,000 in annual income, or $33,000 for a family of four. Beneficiaries would be required to work or attend school, and pay monthly premiums.

It won't be the first time Florida lawmakers debate the issue. The Republican-led Legislature refused to expand Medicaid in 2013 as part of the Affordable Care Act. But the question of federal funding has resurfaced in the Senate, because the state now risks losing a separate pot of federal money that helps hospitals pay the costs of treating uninsured, under-insured and Medicaid patients.

Senate President Andy Gardiner, R-Orlando, has said expanding Medicaid could help the hospitals that would be affected by covering some of the health care costs for low-income Floridians.

"Some say Florida should not expand the existing Medicaid program and I agree," Gardiner wrote in a memo to the Senate. "But we have the obligation to make coverage affordable and the opportunity to develop a consumer-driven approach — one that provides access to high-quality, affordable health care coverage while promoting personal responsibility. We should develop options that uniquely suit the needs of Floridians."

A spokesperson for House Speaker Steve Crisafulli, R-Merritt Island, declined to comment on the Senate proposal. But last week Crisafulli said House Republicans were "not interested in expanding Medicaid as we know it."

More here.

March 04, 2015

Scott won't backfill federal LIP funding

If the state and federal government can't reach an agreement on Florida's Low Income Pool program, Gov. Rick Scott won't backfill with program with state dollars, he said Wednesday. 

"Florida taxpayers fund our federal government and deserve to get a return on their investment," Scott wrote in a letter to President Barack Obama. "Moreover, we have worked hard to turn Florida's economy around and cannot afford to fund programs started by the federal government."

The Low Income Pool is key to Florida's budget.

The $2 billion program, which reimburses hospitals that treat large numbers of poor and uninsured patients, is scheduled to expire on June 30. The state Agency for Health Care Administration is hoping to reach a deal with the federal government to keep the federal portion of the funding in place.

The U.S. Centers for Medicare & Medicaid Services, or CMS, has made it clear that the program will not continue without significant changes.

Scott is open to restructuring LIP.

"In our current discussions with CMS, Florida is not proposing to continue the LIP waiver in its present form, but to maximize the value of our tax dollars to further the same goals for the Medicaid program that we have shared with CMS over the last four years," he wrote in the letter.

If the program were to end, Scott added, it would "hamper future efforts to improve health care services for low-income individuals."

"As with previous negotiations, we are optimistic that you will not terminate LIP and we will be able to reach an agreement on how best to structure this program in a way that protects both our state's most vulnerable residents as well as state and federal taxpayers," he wrote.

February 13, 2015

In Miami GOP stronghold, people sign up in droves for Obamacare -- but they don't necessarily like it


Obamacare a epfThe man stood up in a huff after spending half an hour of his Saturday in Hialeah reluctantly signing up for health insurance he didn’t want.

“It’s like Communism!” Pedro Fuentes said, spitting out the words after enrolling in a plan through the Affordable Care Act that would cost his family more than $90 a month.

No city in the country, when measured by ZIP codes, has more enrollments through the federal insurance exchange than Hialeah, one of the most Republican cities in America. But many of the people registering aren’t happy about it.

They don’t like President Obama. They don’t want health insurance. And they certainly can’t fathom having to pay a tax penalty for failing to get covered.

That has brought them here, to Ñooo Qué Barato (“Damn, How Cheap”), Hialeah’s best-known bargain store, where a banner by the entrance reads, in Spanish, REFORMA DE LA SALUD. Infórmese aquí. Inscríbase ahora.HEALTHCARE REFORM. Inform yourself here. Enroll now.

More here.

Photo credit: Patrick Farrell, Miami Herald staff

February 04, 2015

Lawmakers hope to find compromise on telemedicine

Telehealth2Florida lawmakers are rallying behind legislation that would let doctors use advanced communications technology to diagnose patients.

Both the Senate and House tried passing telemedicine bills last year. But the two chambers failed to find a compromise on several key points. The House, for example, wanted to let various types of healthcare providers make use of the technology. The Senate insisted telemedicine be limited to licensed physicians.

This year might be different.

On Tuesday, a bipartisan group of lawmakers including Senate Health and Human Services Committee Chairman Aaron Bean, R-Fernandina Beach, and House Health Policy Committee Chairman Jason Brodeur, R-Sanford, said they expect to reach an agreement.

"Telehealth programs are a cost-effective alternative to traditional consultations and examinations between providers and patients," said state Rep. Travis Cummings, who has filed a telemedicine bill in the House. "Telemedicine increases access to healthcare for patients who do not have access to care and is generally available at a reduced cost."

To help drum up support, Miami Children's Hospital brought a telehealth kiosk to the Capitol on Tuesday. The 8-foot-by-7-foot enclosure is outfitted with touchscreens and medical devices, and lets Miami Children's Hospital providers conduct medical consultations remotely.

February 02, 2015

Gov. Rick Scott proposes repeal of hospital funding law

A recommendation tucked into Gov. Rick Scott’s proposed budget could help Jackson Health System avoid a $40 million budget cut.

Scott wants to repeal the so-called “hospital tiering” law set to take effect later this year. Under the controversial policy, counties that use local dollars to attract federal matching funds for healthcare would have to share the money with counties that don’t raise local funds.

Hospitals like Jackson that serve a large number of poor and uninsured patients say the new funding formula would cost them millions.

"We not only applaud the governor on this [recommendation], we believe it is the right thing to do," Jackson CEO Carlos Migoya said Monday. "Hopefully, the Legislature will follow suit."

Legislative leaders, who will spend the next three months crafting Florida’s $77 billion budget, were receptive.

Read more here.

January 23, 2015

A Hialeah ZIP code leads nation in Obamacare enrollment

@chabelih @NickNehamas @dchangmiami

In one Hialeah ZIP Code, where signs selling “Obamacare” are plastered across storefronts and cover freeway billboards, more people have selected a plan on the Affordable Care Act insurance exchange than in any spot in the country, according to the data release by the U.S. Department of Health and Human Services on Thursday.

Despite the political rancor associated with the healthcare reform law, residents of Hialeah signed up in record numbers for coverage in 2015. A total of 12,330 people in Hialeah’s 33012 ZIP Code selected a plan or were re-enrolled as of mid-January, the highest number in any ZIP Code in the 37 states that use the platform.

The number illustrates a 19 percent increase in enrollments in the 33012 ZIP Code from last year. The data reflects plan selections between Nov. 15 and Jan. 16 and could change if consumers fail to pay their monthly premiums. The enrollment period opened Nov.15 and ends Feb. 15.

The other ZIP Codes in the top five: 33126 in Miami, 33313 in Fort Lauderdale, 33015 in Hialeah and 33165 in Miami, each with enrollment between 8,000 and 9,000.

More here.

January 19, 2015

Support builds for Medicaid expansion in Florida

For the past two years, the Republican-dominated Florida House has turned away federal funds intended to expand healthcare coverage to nearly a million uninsured Floridians.

But there is a growing list of reasons why 2015 may be different.

Chief among them: increased pressure from businesses, which could soon face fines for failing to provide healthcare coverage to employees.

Since December, two influential business groups — Associated Industries of Florida and the Florida Chamber of Commerce — have issued policy papers urging lawmakers to accept the federal dollars to expand Medicaid. Both advocate for a Florida-specific plan that would require a waiver from the federal government.

House Speaker Steve Crisafulli, R-Merritt Island, won’t say outright if he supports either proposal. But he said last week that "many of the policies they are advocating for are policies that the House has passed, or worked on over the years."

Consumer advocacy groups like Florida CHAIN are encouraged.

"There are more hospitals, businesses and community leaders standing up and saying we can’t afford to wait any longer," advocacy director Athena Smith Ford said. "We feel really good about our chances for success in 2015."

Read more here.

January 13, 2015

Florida Chamber supports "alternative plan" for Medicaid expansion

Another influential business group wants to see Florida lawmakers accept federal dollars to help extend healthcare coverage to uninsured Floridians.

In a report issued Tuesday, the the Florida Chamber of Chamber said it opposes "the traditional expansion of Medicaid."

But the group would be willing to support a plan to use the federal funds that "embraces private solutions with flexible steps to eliminate the $1.4 billion cost shift on Florida families and caps Florida's Medicaid budget at 32 percent."

The report also expressed the Chamber's support for legislation that would expand the use of telemedicine and allow nurse practitioners and physician assistants to "practice to their fullest potential."

The Republican-dominated Florida House has blocked efforts to expand Medicaid for the past two years. But new pressures have been mounting.

Last month, a coalition of business groups including the powerful Associated Industries of Florida, released a Florida-specific plan for accepting the federal dollars. Billed as a "free-market solution," it would require beneficiaries to make mandatory premium payments and search for employment.

"Florida has an opportunity to show the nation that health care can be delivered based on a free market framework and on conservative principles," Associated Industries of Florida President Tom Feeny said in a statement.

When asked to weigh in on the Chamber's proposal, House Speaker Steve Crisafulli, R-Merritt Island, said "the only thing that is different about the Chamber plan than AIF's plan is the list of additional policy issues the Chamber would like to see addressed."

"Many of the policies they are advocating for are policies that the House has passed, or worked on over the years," he said.

January 07, 2015

Agency seeks $2.7 million to fight court ruling that says state deprives needy kids

AHCA budgetGov. Rick Scott’s health care agency is asking for up to $2.7 million in additional funds to hire private lawyers to fight a judge’s ruling that the state has systematically deprived children on Medicaid of needed health and dental care.

U.S. Circuit Judge Adalberto Jordan ruled last week that Florida’s healthcare system for needy and disabled children was in violation of several federal laws because the state has chronically underfunded the state’s Medicaid program and improperly dropped children from the program.

A 2015 budget request from the Agency for Health Care Administration states that because Jordan plans a second trial to determine what the state must do to remedy its treatment of impoverished children, the state must hire lawyers to assist the attorney general in fighting to inject more money into the troubled system.

The low-reimbursement rates discouraged pediatricians and other specialists from taking needy children as clients, the judge concluded, essentially leading to a rationing of care.

Justin Senior, the state Medicaid director at the Agency for Health Care Administration, told the Senate Health and Human Services Appropriations Subcommittee on Wednesday that the state disagrees with the ruling, which came nearly a decade after a group of pediatricians first filed the 2005 lawsuit , and considers it moot.

Senior said Jordan’s ruling was an outdated because Florida has transformed Medicaid to a managed care-based program that provides incentives for quality care and accessible services.

“Everything around the program has changed,’’ Senior said. “Whether you agree with what the judge said or not, the ruling that came out involved a program that doesn’t exist anymore.” Story here.