Florida moving to work on implementing health-care law

The U.S. Supreme Court has ruled, President Barack Obama has won re-election and a majority of Florida voters rejected Amendment 1, the effort to etch into the state constitution a permanent ban on mandatory health insurance.

With the Affordable Care Act more certain than ever, some lawmakers are calling for a careful look at how to implement it here. Even Florida Gov. Rick Scott, a staunch opponent, appeared to be softening his longstanding refusal to acknowledge the law.

“Just saying ‘no’ is not an answer,” he said in a statement released by his press office late Friday. “We need to focus on how Obamacare affects each of our families,” he said, adding he is concerned about the impact for cost, access and quality of care.

“I am looking forward to working with legislators and others on specific ways to address these issues,” he said.

The U.S. Department of Health and Human Services has given states reason to set up and operate the online marketplaces where consumers will buy insurance starting next fall. States with their own exchanges will have more leeway to decide how much coverage plans sold on the exchanges must offer. More generous base benefits likely would raise the cost of premiums, though.

“I am concerned about how it affects patients, jobs and taxes on Floridians,” Scott said.

On Wednesday, hours after Republican presidential candidate Mitt Romney had conceded, Scott sounded a more combative tone, saying it would cost too much to expand Medicaid and set up health insurance exchanges.

“No one has been able to show me that that health care exchange is going to do anything rather than raise taxes, raise the cost of our companies to do business,” Scott told the Sarasota Herald-Tribune.

In July, he told Fox News: “We’re not going to implement Obamacare in Florida. We’re not going to expand Medicaid.”

The health care law requires consumers to carry insurance beginning in 2014 — a little more than 13 months from now — or pay a penalty. That coverage will be purchased through online health marketplaces, if consumers lack employer-provided insurance, Medicaid or Medicare. Some who can’t afford insurance will be eligible for subsidies.

If Florida doesn’t establish its own online marketplace, the federal government will do it for the state. The deadline for governors to decide on running their own state’s insurance exchange is Friday. States planning to do so must supply a blueprint by Dec. 14.

Some state policymakers want to keep options open. Some private companies suggest they could create and run an exchange on behalf of the state. Meanwhile, the federal health agency will allow hybrid models, with the U.S. government responsible for the information technology element, and state regulators in charge of dictating the types of plans sold.

That would require the legislature to act in the 2013 session. But the Florida Legislature doesn’t convene until March — a time when insurers should be finalizing the plans they intend to sell next year.

Sen. Joe Negron, R-Stuart, said he doesn’t want to rush the process.

“This has enormous implications for our citizens, for our budget,” Negron said. “The decision should be made by the entire legislature.”

Industry experts say the runway may now be too short for Florida to land such a complex project.

Even states working on it for years aren’t ready. So far, just over a dozen states conclusively have said they will run their own online insurance marketplace.

The biggest changes of Obamacare are about to hit. Denials based on pre-existing conditions will be against the law in plans that will go on sale in October.

Meanwhile, people who buy health insurance through an exchange will be able to select among a handful of standardized, easier-to-understand plans.

If Floridians buy their insurance on a federally run exchange, benefits that are often not covered, such as maternity care and mental health, automatically will be part of all plans, along with preventive coverage for such things as vaccines and cancer screenings. And consumers will have a right to appeal insurance company decisions.

Questions remain. What will be the role of insurance brokers? How will they get paid? What would constitute discrimination? Can chiropractic care be substituted for physical therapy? More guidance is expected from Health and Human Services in the coming days.

Negron, a leading Senate voice on health care budget issues, wants more information. He is concerned about the federal grants that Florida may be leaving on the table — potentially hundreds of millions of dollars.

Additionally, if the legislature fails to pass a bill conforming state insurance law to federal law, health insurers will have to seek plan approvals in two separate places, insurance industry experts said.

Without action from the legislature, consumers with problems may have some types of disputes mediated in Tallahassee, but most will have to seek help in Washington. It’s a recipe for confusion, said Mila Kofman, a Georgetown University research professor who is working with states to implement the new health law. She’s a former insurance superintendent for Maine.

“You do have potentially a dual system,” Kofman said. “It’s not good for anyone. There’s no need to have two regulators when one is perfectly competent.”

Time is now short, she said. The law was passed in 2010. States were given years to assemble their plans, but as many as 30 may not be ready, because they expected the Supreme Court or the presidential election to lead to the law’s repeal, Kofman said. Her phone is now ringing off the hook.

The Robert Wood Johnson Foundation is supporting technical assistance to states. Kofman is an adviser for that program. She has assembled checklists for state’s planning to run health insurance exchanges.

The list has 10 big-picture items, including setting up a governance board, conforming state with federal law and building the information technology backbone to connect insurance companies as well as Medicaid systems, while offering a retail interface to everyday consumers.

“These IT systems are very, very sophisticated and very complex,” Kofman said. “That is probably the biggest challenge for the states, because no one before the Affordable Care Act had anything like it.”

The health law says the U.S. government will subsidize the health premiums of people earning up to four times the federal poverty rate, or about $45,000 for an individual, so verifying income will be a key part of the system.

Negron said he’s been told that upgrading the state’s computer systems could be enormously expensive, and it’s something the federal government potentially would pay for right now, if the state sets up an exchange.

Having a more modern system could improve the management of not just the insurance exchange, but also Medicaid and the Department of Children and Families, he said. So Negron wants more information before closing that door.

Florida has an estimated 4 million uninsured residents.

“What is best for Floridians who need our help, and how can we make sure that our budget lives within its means?” Negron asked.

If Florida doesn’t act, the federal government will set up and manage insurance marketplaces for the state. There are two commercial vendors designing exchanges for every state that lacks a plan, a Health and Human Services spokesman said. They must be running by October.

Florida Blue (formerly Blue Cross and Blue Shield) was among the private companies prepared to help Florida launch its exchange, a company insider said.

“We had it all set up for them,” the insider said, “and they said no.”