Compromise near on state health insurance plan

Miami Herald–May 01, 2008

BY MARC CAPUTO

Up to 3.8 million uninsured Floridians could soon buy inexpensive health-coverage packages, after legislators tentatively agreed Thursday to a two-step plan serving individuals as well as businesses.

The legislation blends Gov. Charlie Crist’s proposal, offering stripped-down plans for as little as $150 a month, along with House Speaker Marco Rubio’s proposal to establish a public-private corporation that acts as human-resources department and a virtual marketplace for health plans.

Crist and the state Senate initially balked at the corporation concept, saying it created too much bureaucracy and too little regulation.

Under the tentative compromise, the Senate plans to amend the legislation Friday to ensure that: The state Office of Insurance Regulation would have more say, employees would have more time to keep their current health plans if an employer switches to cheaper plans, and the corporation would abide by open-records laws and be free of industry board members who would otherwise profit from their votes.

House leaders say they’ll likely take the legislation and pass it Friday unless some unexpected poison pill ruins the deal. But even if the House signs off on the proposal, the big question remains: Will it all work?

Small-business owners like Danny Lister of Lister Jewelers in Coral Gables said he’s not sure. He’s heard of promises of big savings on property insurance and taxes but hasn’t seen much yet. But he’ll keep an open mind, and seems to favor Crist’s approach.

”The first thing that comes to my mind is that it sounds better because it sounds simpler,” Lister said. “The other sounds like too much bureaucracy.”

Still, Lister said, he might avail himself and his 15-employee company of the corporation’s services if his insurance broker recommends it.

The House’s healthcare council chief, Republican Aaron Bean of Fernandina Beach, said the House and Senate are ”very close” to an agreement that should pass the House Friday if their top concern — who regulates what — is cleared up.

”We want less government regulation,” he said, “and they want more regulation.”

To Crist and the state Senate, those regulations are “consumer protections.”

The remaining sticking point: Which agency — if any — should regulate the non-insurance health plans, such as chiropractic treatment programs or walk-in clinic visits, under the House proposal.

Under the House ”Florida Health Choices” plan, the corporation would be designed to help employers like Lister, with fewer than 50 workers, navigate the complex world of employee-sponsored healthcare. It would help them define what benefits they seek, how much they want to contribute to an employee health plan and help them figure out and file the proper paperwork.

At the same time, the corporation would negotiate with health-plan providers, whether they’re insurers or are part of a new health network providing anything from traditional outpatient care to chiropractic services to acupuncture.

The corporation would collect the monthly premium from the employer and keep a percentage to keep running. The cost to set up the corporation: More than $1 million. The money isn’t in the budget, though, and House members are trying to find a way to plug in the cash.

The House plan always incorporated Crist’s proposal. The corporation is geared toward small business and Crist’s ”Cover Florida” concept is for individuals. The House proposal seeks to offer multiple boutique plans, while Crist’s looks more like traditional insurance and would use one or two insurance companies. If an employer selects a new plan from the public-private corporation under the House proposal, an employee must be notified and then has 90 days to switch over to the new coverage plan, drop his insurance altogether or buy one of Crist’s Cover Florida plans.

The Crist plan removes many of the roughly 50 government mandates for health coverage, thereby lowering the risk to the insurer and the price. Crist’s Cover Florida plans would still have to offer some mandatory coverage, such as for diabetic supplies, but the extent and scope of the benefits still have to be worked out.

Consumer advocates want a buyer-beware disclaimer that a cheaper plan will result in less coverage, but no such disclaimer is mandated by the current legislation.

Insurance companies would have to negotiate with the state to determine what they’ll offer. So no one knows what exactly will be covered, what the plans will cost and what people will want and be able to afford. Crist said Cover Florida plans should be available by next year, while the House package would take longer to start up and run.

At the least, the insurance companies would have to offer two plans: one with so-called catastrophic coverage and one without. Crist said it’s a must that some version of his Cover Florida plan pass the Legislature.

Florida has the third-highest rate of the uninsured in the nation, with 20.2 percent of its population uncovered. About 43 percent of all Floridians age 18 to 34 are uninsured.

”I think we’re probably close to a deal on health insurance for 3.8 million Floridians,” Crist said. “But I don’t want to pre-judge because I don’t count them before they hatch. But I think it’s going to hatch.”