Crist to seek narrower, less-expensive coverage for uninsured
By Christine Jordan Sexton
2/18/2008 © Florida Health News
TALLAHASSEE -- Today, Gov. Charlie Crist is handing out copies of a health proposal that would lift some regulations on health insurance – abolish some so-called “mandates” – so that carriers would have an incentive to cover more of the uninsured.
Crist also wants to expand access to dentists for the poor and uninsured by boosting pay in health department dental clinics and loosening licensure restrictions for retired dentists, according to staff at the governor’s office and in industry groups involved in negotiations.
His plans are more modest than the universal coverage law now in effect in Massachusetts. Crist won't require uninsured Floridians who can afford health insurance to buy it, nor will the state provide subsidies to lower the cost, those familiar with his program say.
Instead, Crist will ask private insurers to compete for Florida’s uninsured population by offering two policy options with a shorter list of benefits than standard coverage but will include preventive care. It will also be “guaranteed issue,” available to all who want to buy it, which means that insurers can’t screen out those who have health problems.
"We've been negotiating with members in the private sector .... to provide more insurance to the uninsured in Florida, and those negotiations continue," Crist told Florida Health News last week.
Crist's plan for the uninsured is still a work in progress, his staff says. Many of the details remain unresolved, such as pricing.
It doesn’t stray far from a plan that Crist laid out for providing health care to the uninsured during the 2006 election. In a campaign document, Crist said he supported "flexibility in plans so that policies can be tailored." He also endorsed the idea of allowing small groups to "join together to leverage purchasing power."
While health coverage is a national problem – some call it a crisis – Florida’s position is particularly difficult because of its economic dependence on tourism and other service-sector jobs that often don’t come with group insurance coverage or don’t pay enough for workers to pay their premiums. Recent studies estimate that about one in four Floridians under age 65 lacks coverage. In 2007, the Census Bureau estimated that the state had 3.6 million without insurance.
One company that has talked with members of the governor's staff about the plan is Blue Cross and Blue Shield of Florida. Spokesman Bruce Middlebrooks said the company supports initiatives that allow carriers to offer insurance plans with different benefits and prices.
"We need flexibility in the types of products we are able to offer," he said.
Indeed, insurance companies have tried for years to offer plans that are shorn of mandates, but have not been able to muster the votes in the Legislature to do so because of heavy lobbying by health professionals who like laws requiring coverage for their services. Sometimes opposition to bare-bones plans comes from patient advocates who worry that, for example, they’ll be kicked out of the hospital right after giving birth if insurers aren’t legally required to let them stay overnight.
"There are so many interest groups with niches in these mandates, they team up and they fight hard," said Gerald Wester, who represents Aetna, CIGNA, and the Florida Association of Health Plans.
The Florida Dental Association, which represents the majority of the 9,568 dentists who have active licenses, opposes Crist's plan to make it easier for retired dentists to work at county health departments or attract dentists from other states.
Clearwater dentist Nolan W. Allen, president of the Florida Dental Association, released a statement that said changes to license requirements would be "premature" and would "not take into consideration the unique dynamics of the state."
Florida has 44 county health departments equipped with dental clinics and three more are being built, said Department of Health spokeswoman Eulinda Jackson. Recruiting dentists to work at the clinics is difficult, though, because they can earn far more in private practice than the starting $130,000 health-department salary, she said. In his proposed $70 billion budget, Crist asked for a $21 million Medicaid reimbursement increase for dentists.
The governor has already unveiled three other parts of his health initiative:
--A $60-million expansion of Florida KidCare, the state and federal program that covers the working poor, to enroll 46,000 more children.
--A $63.9 million pilot program to find uninsured adults in 14 counties and help them find a medical home that provides free or sliding-scale care, such as a county health department or federally qualified health center.
--Elimination of the law that bars construction of a new hospital without a “certificate of need,” or CON, the tool Florida uses to control duplication of high-priced services. By making it easier to build hospitals without years of paperwork and litigation, he said, “we get more health care provided to more Floridians in a more timely fashion."
The Florida Hospital Association has taken a hard-line stand against elimination of CON. That’s not surprising, said Ruben King-Shaw, former Gov. Jeb Bush's first Secretary of the Agency for Health Care Administration, which administers CON. He left that post in July 2001 to serve as Deputy Administrator and Chief Operating Officer of the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services.
CON is a politically divisive issue and changing it won’t be easy, said King-Shaw, who is now chairman and CEO of Mansa Equity Partners Inc. "It will clearly take a lot of energy, a lot of political capital and a lot of good will. He's certainly up to the task, but in the health care policy world this is among the most difficult things to do," he said.
Health care policy analyst and consultant Brian Klepper agrees with King-Shaw that Crist will have to use political energy to pass the CON proposal. But Klepper wonders whether the investment ultimately is worth the return. "I don't know why anybody would think it matters,” said Klepper. “From a public policy point of view, and when you stop and think (about) what kinds of things can we do to make health care higher quality and more affordable for Floridians, (CON reform) hardly comes to mind."
