Florida has much at stake as Supreme Court reviews health care mandate

The following article was published in the Sarasota Herald-Tribune on March 25, 2012:

Florida has much at stake as Supreme Court reviews health care mandate

By Barbara Peters Smith

When oral arguments begin Monday before the U.S. Supreme Court over the controversial health care coverage “mandate” in the Affordable Care Act, perhaps no state has as much at stake as Florida.

State leaders have refused tens of millions in federal funds for implementing early portions of the 2010 law, betting on the success of a 26-state legal challenge that has finally reached the nation’s highest court.

Florida is the lead plaintiff in that suit, with Attorney General Pam Bondi arguing that a requirement by Congress for all who can afford it to purchase health insurance in 2014 is “an affront on Americans’ individual liberty.” Bondi also has asked the justices to rule on whether other portions of the law — including a vast Medicaid expansion — are an intrusion into states’ rights.

But if Florida wins that argument, it also stands to lose.

 

Almost 4 million Floridians are without health coverage — making the state second only to Texas in the number of uninsured residents. An estimated 156,000 of them live in Sarasota, Manatee and Charlotte counties. If the Supreme Court overturns the health care law, their chances of getting steady access to health care soon would evaporate.

“It’s great for those people who are healthy and feel they’re having their rights imposed on if they’re required to buy insurance,” said Geoff Simon, administrator of Sarasota’s Intercoastal Medical Group. “But it stinks for those people who have been denied coverage and are priced out of the current market.”

Katherine Betta, a spokeswoman for outgoing House Speaker Dean Cannon — a leading opponent of the Affordable Care Act in Florida — says Cannon disagrees “with the assumption that government is responsible for providing health care to Americans who don’t currently qualify for Medicaid.”

Betta says Cannon’s objections to the law “are related to the individual mandate, as well as the infringement on state sovereignty that is created by expanding the number of citizens who could qualify for Medicaid coverage to a level the state cannot afford to maintain.”

Ironically, if Florida loses the case, it may emerge as a financial winner in the long run. It could turn out that waiting while other states conducted pioneering and costly experiments in health reform was a good strategy. If Florida fails to have its own system in place this year, a federal option will be there as a backup.

One thing is certain: If the Supreme Court tinkers with any portion of the sprawling health reform legislation, it will upset the intricate funding mechanisms that support other sections. The effect would be like pulling on a single strand of a sweater, and unraveling the whole.

That would please opponents, who mostly believe it would add more layers of bureaucracy to federal and state governments without achieving its goals: more access to health care and control over staggering cost increases.

Other critics say the law will fail because it relies too much on the private marketplace, and profit-taking will eat into the new system’s potential savings.

This makes the Affordable Care Act a tough law to love, even for those who understand its complexities. But if the measure were dismantled, all the daunting problems it was designed to address would still remain.

The biggest losers

About a quarter of the young and working-age population in Florida is uninsured — well above the 18 percent national average. Simon says this is not one solid group of people, but three:

•Those who choose to spend their money on other things than health insurance, and hope they do not get sick or hurt;

•Those who cannot afford insurance now, but could obtain it in 2014 under the new law;

•Those whose incomes are so low they have never had adequate health care.

Simon contends that the third classification “is a major concern.”

“They’re the ones that chew up all the costs once they hit the Medicare window” because their health problems have accumulated over a lifetime, he said.

If the Supreme Court tosses out the mandate that everyone carry insurance, the system cannot afford to insure those who need it most. Simon says this would only be a good thing for the people who are uninsured by choice.

But the group in general escalates the costs for all in the health care system “by going to the emergency room when they have a health issue.”

An added irony in the Supreme Court case is how well Florida’s lead plaintiff, Mary Brown, 56, proves reform advocates’ argument that the health care web touches everyone.

When the case began, Brown owned an auto repair shop near Panama City. Now the shop is gone, and she and her husband filed for bankruptcy, owing $4,500 in medical bills.

The story so far

Many elements of the Affordable Care Act are already well under way — “invisible” but important changes like electronic health care records systems, and new networks that deliver care in more efficient ways.

Some groups already have benefited from pieces of the law now in effect, including young adults who can use their parents’ insurance policies until age 26; children and some adults with pre-existing conditions, and Medicare patients whose spending on prescription drugs takes them into the coverage gap known as the “donut hole.”

Each year, these people — about 250,000 in Florida — pay less out-of-pocket for the most costly drugs.

“The closing of the donut hole is one of the most beneficial things about the law,” says Jay Wolfson, a professor of public health and medicine at the University of South Florida. “The total reform is going to reduce the extraordinary subsidies we pay in this country for drugs, and bring down pharmaceutical costs for everyone.”

Some provisions of the law already available have been slow to get public attention, probably because health reform has so many moving parts. One is free annual wellness visits for people who have the traditional Medicare plan. Only 197,000 of those Floridians, out of a possible 2.4 million, got their free checkups in 2011.

“We think that number is encouraging,” says Brian Cook, a spokesman for the Centers for Medicare and Medicaid Services in Washington. “It takes a little while for word to get out about these new services.”

When the Supreme Court rules on the law, perhaps in June, Florida and 24 other states in the suit will be behind the curve if the Affordable Care Act is upheld. Among the plaintiff states, only Alabama has moved forward to enact meaningful reforms. When the court’s decision comes, the states will have only 18 months to catch up.

Wolfson, the USF professor, says this might not be so bad for Floridians. The federal default insurance exchange, he says, would offer “a larger and more diverse risk pool to offset the costs, with additional funding sources.”

If the court’s ruling leaves the law intact, Wolfson said he hopes Florida’s leaders will not scramble to set up an insurance exchange right away.

“It’s going to be very difficult to implement this complex system, and how well it’s done depends on the political tenor of the state legislature and leadership,” he said. “The danger or risk for folks in Florida is that because there is antipathy toward the concept of exchanges, it might lag behind in creating a system that can work.”

Find this article here:  http://health.heraldtribune.com/2012/03/25/florida-has-much-at-stake-as-supreme-court-reviews-health-care-mandate/