FLORIDA GOVERNOR LOOKS TO BRING SUNSHINE TO UNINSURED

Volume 29, Issue 510 March 3, 2008

Matthew Gever

Florida has plenty of sunshine—and plenty of uninsured. Seeking to counter this, Governor Charlie Crist has unveiled a series of legislative proposals.

Currently, the state has roughly 3.7 million uninsured residents, approximately 21 percent of the population, according to the Kaiser Family Foundation. This is an increase from 17 percent in 2001, and it now makes Florida the state with the third-highest rate of uninsured individuals in the country. Much of the increase is attributed to the high number of tourism and service- sector jobs, which often do not come with employer-sponsored coverage.

To counter this trend, Crist has introduced a legislative initiative called the “Cover Florida Health Access Act.” A major part of Crist’s plan would expand access to private insurance by allowing insurers to sell scaled-down policies exempt from the state’s list of benefit mandates. The state would negotiate with insurance companies to develop what are called “Consumer Choice Benefit Insurance Plans,” which the Governor says would provide preventive, primary and urgent care as well as hospitalization at a cost of $150 per individual per month. Whether there will be a high-deductible is subject to negotiations.

The insurance industry so far is supportive of this idea. “Many…insurers are working with the Governor and his staff to develop flexible insurance products that can be affordable to Florida’s uninsured,” said Bob Wychulis, president and CEO of the Florida Association of Health Plans.

“These premiums look suspect,” commented Senator Nan Rich. The plans offered would be “guaranteed issue,” meaning insurers will have to make the plans available to all uninsured Floridians ages 19 to 64, regardless of their health conditions. This will likely lead to a high number of signups from those with high-cost medical conditions, casting doubt on the sustainability of the mandated premiums. “Some of our analysts don’t think that’s possible,” said Senator Rich.

The Governor also wants to make all children in the state eligible for KidCare, Florida’s SCHIP program, by removing all income limitations. According to his office, this would help insure the 126,000 uninsured children in the state whose family income is too high to qualify them for SCHIP or Medicaid. Parents with incomes above 200 percent of poverty would pay premiums on a sliding-scale based on income, with the state contributing $60 million to this expansion.

CON Revisited

Another part of the proposal would seek to encourage the construction of new hospitals by eliminating the “Certificate of Need” (CON) requirement. This requirement, currently in practice in 36 states, requires that any new hospital built must be justified through a needs matrix which incorporates questions such as whether the hospital will help or hurt care at neighboring hospitals and whether the new hospital will provide an appropriate amount of charity care. These provisions are intended to ensure that “the needs of the community are best met,” according to Rich Rasmussen of the Florida Hospital Association.

The Governor believes that removing this requirement will “foster a competitive business environment, spur economic development, and improve access and quality of care,” he says in his proposal. He points out that burdens related to the CON process can add $1 million to the costs of building and opening a hospital. Additionally, he mentions that the process can be delayed by lawsuits from local competitors—currently, 20 out of the 27 CON applications from 2005 are still in litigation.

Not all agree. “The [CON] process has worked very well,” said Rasmussen, who also mentioned that hospitals in Florida have expanded their number of beds in recent years and have a bed-to-patient ratio that is well above the national average. He also expressed concern that new hospitals not subject to the needs of the community can lead to a “two-tiered system of care,” in which hospitals can cherry-pick their patients based on health status and ability to pay. As an example, he brings up Dallas, Texas, which has no CON regulations. In that city, he says, 21 new physician-owned hospitals are under construction which do not have charity care or emergency rooms, or are small “boutique hospitals” with as few as 20 beds. Crist’s proposal would require new hospitals to have an emergency department and to provide charity care to Medicaid and underserved populations.

Crist also hopes to improve access to dental care by adjusting the state’s licensing requirements. His proposal would ease licensing for out-of-state dentists who want to practice in Florida public health facilities. Additionally, the state would expand the scope of practice for dental hygienists to allow them to perform more complex procedures such as applying sealants.

This has organized dentistry worried. “Changing current licensure and scope of practice structures under Florida statues would serve as a premature act that does not take into consideration the unique dynamics of the state,” said Dr. Nolan W. Allen, president of the Florida Dental Association.

Additionally, in his budget, Crist added $21.9 million in order to increase the reimbursement rates for Medicaid dentists. “Currently, 52 percent of Florida counties have only one Medicaid dentist and 25 percent of Florida counties have no Medicaid dentists,” said the Governor. Allen calls this increase a “step in the right direction,” but also noted that this would still leave Florida well below the national average for Medicaid dental reimbursement.

A final piece of the proposal would allocate $63 million from general revenues over three years for a pilot program to reach out to underserved communities. The pilot would create partnerships between hospitals, county health departments and providers to provide outreach and primary health-care services in 14 counties with large populations of uninsured. The funds would go towards extending county health departments' hours, adding staff and employing mobile health units to provide primary care to individuals to keep them away from the emergency room.

The proposal next moves to the Legislature which will consider this and other health reform proposals, while facing a billion-dollar budget deficit. “Everything is going to be seen through the prism of the budget,” said Senator Rich.