[Welcome Kaiser Network readers!]
From time to time, we present guest posts written by our readers. Recently, a long-time reader tipped us to new legislation in the Sunshine State; its goal is to help decrease the rolls of the uninsured. Since the reader in question is someone with whom we've corresponded for a while, and indeed has helped us in other efforts, we've invited our (herein) anonymous friend to dissect the Cover Florida Health Care Access Program:
■ What is it?
SB2534 was the driving legislation behind this program. The state of Florida has taken on the lofty goal of addressing the issue of the uninsured with a market driven approach. Under this plan, carriers would be allowed to bid on plans to be offered to the individual market. These plans are designed to cater to the uninsured.
There are two types of plans, a catastrophic and a non-catastrophic. Catastrophic would be based on hospital services, urgent care, outpatient surgery. Non-catastrophic would focus on wellness and preventative care, including office visits and office based surgery. These can be offered separately or in combination based on the bid from the carrier, but must include a prescription benefit. These plans are required to be guaranteed issue, but can have pre-existing limitations. The state is looking for them to hit a $150/mo price point.
In order to be eligible to participate, the potential enrollees must be below age 65, have family income below 300% of poverty level, and have been uninsured for at least 6 months. They cannot be eligible for other public health insurance programs. Exceptions are if they lost coverage due to loss of job with health benefits, expiration of COBRA, reaching a limiting age, or loss of benefits due to death or divorce of spouse.
Other provisions establish the Florida Healthy Kids Corporation to administer the Florida Kid Care Program. It removes the 10% cap for families paying the full premium for the Florida Kid Care Program. It adjusts the age of eligible dependents from 25 to 30. House additions include the establishment of the Florida Health Choices Corporation that acts as a clearinghouse for employees of small businesses (under 50) to purchase an array of benefits.
This is what I have gathered by reviewing the text of the bill as well as the official press releases. It's all subject to change based on any further action by the State of Florida or their Department of Insurance.
■ The good
As I see it, the biggest boogeyman of those pushing for universal health care is the issue of the uninsured. We hear the statistic in every argument and news report on the subject. We have disassembled the numbers, but a sound bite often has longer legs then an in depth analysis and is easier to repeat. So let’s go into the good things about this initiative.
It attempts to hit an affordable price point by exempting offerings from state mandated benefits. Often these mandates are placed into effect not by consumer complaints or needs, but by lobbying efforts of an advocacy group or providers of the mandated services. There are often mandates for questionable homeopathic services like acupuncture, and high dollar elective procedures like fertility treatment. These mandates can greatly increase the costs of a policy and put unnecessary claims dollars into the risk pool.
The increase in dependent age to 30 will help cover the young invincible segment. This helps to address those in the 19-30 segment that choose to go without coverage for a variety of reasons. This is the largest segment of the uninsured. Also by bringing those low utilizers into the risk pool, it helps balance the overall risk profile of the employer based segment.
By removing the cap on full pay enrollment in KidCare, it allows parents another option for insuring their kids. The key here is that these parents are paying the full premium cost of the program and creating an economy of scale in the program that would allow it to become less dependent on government subsidies.
Guarantee issue policies also address the next big issue for universal advocates, the uninsurable. With the guarantee issue provision in this initiative, anyone who fits the market and wants to purchase the coverage can do so. With pre-existing condition limitations allowed, it also allows the carrier to offset some of the excessive risk associated with guarantee issue products.
The last point I will mention in the good category: no Massachusetts-style individual mandate.
Whew! That's a lot to digest, and we're only beginning. In Part 2, our guest blogger has the other side of the coin, as well as some thought-provoking questions.
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