Florida Health News

HMOs are for Medicaid patients, not us, lawmakers say

By Christine Jordan Sexton
4/30/2008 © Florida Health News

TALLAHASSEE -- Florida lawmakers in recent years have touted HMOs as a way to hold down costs in the state’s Medicaid program. But few choose HMOs for their own coverage. Only 15 percent of legislators, who receive free health insurance for themselves and their families, have enrolled in HMOs, according to the Office of Legislative Services. Instead, the vast majority are enrolled in the state’s self-insured plan administered by Blue Cross and Blue Shield of Florida, a preferred provider organization (PPO). While it’s a type of managed care, it’s much more flexible than an HMO; members can go outside the network without permission if they’re willing to make a larger co-payment.

“My colleagues clearly are not treating everyday Floridians as well as they treat themselves,’’ said House Democratic Leader Dan Gelber. Legislators advocating HMOs for Medicaid beneficiaries but refusing to enroll in the plans themselves are like public school administrators enrolling their children in private schools, he said.

“There is no question that there are plenty of folks here with oversight that they don’t apply to themselves,’’ said Gelber, D-Miami Beach. He is enrolled in the state plan but has never actually filed a claim, he said, since he is also covered by his wife, a federal prosecutor. “Relativism is alive and well in the Legislature,” Gelber said.

Regardless of which plan legislators choose, the state pays the entire premium. For family coverage that translates to $968 a month, more than $11,600 a year. Individual coverage costs $428 a month, or about $5,000 a year. The Office of Legislative Services says 29 legislators have individual coverage and 126 signed up for family coverage. That translates to about $1.6 million annually in premiums. 

Florida Health News reported last week that the Legislature, whose leaders call themselves conservative, provides free health coverage for all lawmakers, their families, and 24,000 senior state officials, including many political appointees. According to the National Conference of State Legislatures, Florida is one of only eight states that completely subsidizes health insurance premiums for legislators, and the group was unsure whether any others go as far as to completely subsidize family members, as well.

Legislators aren't the only ones turning their backs on HMOs, said Kim Streit, vice president of research for the Florida Hospital Association. According to an FHA report released earlier this month, enrollment in HMOs in Florida fell 7 percent to 3.43 million enrollees. 

While HMOs are losing popularity among those who have employer- sponsored insurance, the Legislature has been moving more Medicaid patients into them. Medicaid figures show that as of April 783,695, beneficiaries were enrolled in HMOs, compared with 611,363 enrolled in alternative coverage. 

Just five legislators turn down free health insurance, according to the legislative services office. Staff there said they could not identify them.

The perk was criticized last week by health-care experts from the Cato Institute, a right-leaning think tank, and the Florida Health Care Coalition, which helps employers purchase more affordable health insurance. Both said that unless you contribute to the costs of insurance, you are cushioned from rising costs.

But House Speaker Marco Rubio, R-West Miami, on Tuesday defended the generous benefit. "The problem in Florida is not that legislators have coverage," Rubio said. "The problem in Florida is that there are not more options for those who are not legislators to get coverage.”

Rep. Curtis Richardson, a Democrat from Tallahassee who works as an independent contractor in higher education, is one of only a handful of legislators enrolled in an HMO, along with his family. He’s a member of Capital Health Plan, an HMO that draws high patient-satisfaction rates. Tallahassee has the highest managed care penetration in the state; nearly 40 percent of those who are insured here are enrolled in an HMO, according to the hospital association report.

"I have never had a complaint," Richardson said. "If I thought that everybody was getting the same level and quality of service that I get, I would have no problem with that; but I hear that is not the case all over the state. That is what has concerned me about us forcing our Medicaid clients into managed care."

Since being elected in 2002, Rep. Ed Homan, an orthopedic surgeon from Tampa, has fought for legislation that would give doctors and other providers more clout when it comes to managed care contracts and payments. Homan said he’s enrolled in the state-funded PPO.

"Is there a double standard? I guess you could make an argument of it," said Homan. He predicted that if the state gave Medicaid beneficiaries the choice of health care plans, "they would choose a PPO, too.”

Tallahassee correspondent Christine Jordan Sexton can be reached at cjordansexton@hotmail.com