Florida Health News

Conservative groups urge legislators to rely on private sector

 By Michael Peltier
2/8/2008 © Florida Health News 
TALLAHASSEE--They may have been invisible, but the hands of Adam Smith were unmistakable Thursday as Florida House members convened to discuss private market fixes to the state’s health care system. 
For scores of House Republicans and a handful of Democrats, the Scottish economist’s 18th-century ideas served as the template for suggestions to improve health-care access and quality in Florida. The uninsured rate among the state’s under-65 population is one of the highest in the nation.
“When rich people get sick they come here (to the United States),” House Speaker Marco Rubio told attendees to open the seminar. “The frustrating part is that many Americans cannot access that health care.”
For much of the day, speakers extolled the benefits of letting the private market drive health care and insurance reform, saying Smith’s “invisible hand” of enlightened self-interest and market forces would remedy many of the challenges now facing consumers and the state.
“We’ve overused government for the past 60 years in health care,” said Aaron Bean, R-Fernandina Beach and chairman of the House Healthcare Council. “We need to start using the power of competition and consumer choice.”
Speakers at the daylong seminar, sponsored by the James Madison Institute, a conservative Tallahassee-based think tank, were all advocates of a private-sector approach to health reform. Dissent came from a few audience members who questioned whether a deregulated health care industry would be in the best interests of consumers. Meanwhile key lawmakers said that some of the suggestions may find their way into law when the 2008 session begins in March. They called for: 
--Tightening Medicaid eligibility to block those who can afford private insurance from using the health plan funded jointly by the state and federal governments. Florida’s Medicaid program covers about 2.1 million people, mostly women and children; however, two-thirds of spending is on the elderly and disabled.
--An end to “mandates,” health care services or treatments that state law requires insurers to cover, such as chiropractic sessions or acupuncture. Instead, workers could choose from a menu of coverage options.
--Allowing small businesses to band together so they could qualify for the cheaper rates accorded to large groups.
--Permitting Floridians to buy insurance policies from companies that have no Florida license if they are licensed in other states.
Legislative leaders said such options are especially critical for large, diverse states such as Florida, which in many ways has become a bellwether for the rest of the country.
“You can probably solve health care in North Dakota or in Delaware, small states where you have homogeneous populations,” Rubio said. “It’s much more difficult to solve those problems in a state like Florida, which represents not only all the challenges America faces today, but all the challenges it faces tomorrow.”

Less federal intrusion

Speakers also called on federal officials to stop telling states how they must operate their Medicaid programs and instead offer block grants so that states can design programs that more closely fit their needs.
On a grander scale, Michael Cannon of the Washington-based Cato Institute said states must wean themselves off the federal Medicaid matching funds that make the program so hard to change and politically impossible to abandon. This year, federal funds account for 57 percent of Medicaid spending in Florida.
“We’re not going to make any serious progress until we start talking about and only talking about eliminating the double-your-money mentality,” Cannon said.
More flexibility would also improve health care, said Mike Bond, director of the Center for Health Care Policy at Cleveland State University. Provisions that would lower costs include allowing couples who work at different companies to both contribute to a single policy, and giving employees coverage that could follow them if they move.
“As it is now you have to buy from the company store,” Bond told conferees. “When you buy from the company store you know what happens. You pay more.”
Long-term relief, however, will only come when officials shift their focus from health care financing to healthy living, said Jim Frogue of the Center for Health Transformation. For example, the rising incidence of obesity and diabetes in young people cannot be addressed by even major changes in the insurance delivery system.
“The biggest bang for your buck is promoting nutrition and exercise in children,” Frogue said. “We have to focus on a cultural change.”
Florida’s deputy insurance commissioner for health, who was in the forum audience, took a dim view of calls for deregulation – especially the suggestion that claims disagreements could be turned over to the courts.
“To say that people can go to court to settle a dispute is ridiculous, quite frankly,” Mary Beth Senkewicz told Florida Health News. “If a claim is $500, that’s a lot to a consumer but not much to an attorney. You’re never going to get help that way. That’s where the Office of Insurance (Regulation) comes in and plays a significant role.”
And until states come up with more viable long-term care solutions, Medicaid must remain a safety net for middle-class nursing-home patients whose personal savings are exhausted, said Florida AARP Director Lori Parham.
“Medicaid has been an important piece of the health care system,” she said. "AARP has always taken the position that there is not (just) one answer.”

Upcoming legislation

Some of the suggestions aired Thursday may come back as early as next month, said Rep. Gayle Harrell, R-Stuart, and chairwoman of the Committee on Health Quality. While budget constraints will make wholesale reform difficult, legislators could consider allowing small businesses to share risk and lower costs.
“ I think we’re going to look very carefully to see if there is a way to do that,” Harrell told Florida Health News. “I want to make sure, however, that that is going to be a cost-saver. We don’t want to spend a lot of state money developing something that doesn’t save any money. We don’t want to be the next Massachusetts.”
She is also interested in reviewing insurance mandates and the idea of allowing the sale of health insurance across state borders.
“This is a private, market-driven initiative,” Harrell said. “It’s about individuals taking responsibility to make choices.”

Michael Peltier, a freelance journalist in Tallahassee, can be reached at mpeltier1234@comcast.net.