Florida Office of Insurance Regulation, Florida Health Insurance Advisory Board Meet Jointly To Hear State/Federal Health Care Educational Updates

Jul 19, 2012


The Florida Office of Insurance Regulation held a joint public meeting with the Florida Health Insurance Advisory Board (“FHIAB”) today, July 19, 2012, to provide educational updates on state and federal health care issues.  To view the agenda, click here.

Florida Insurance Commissioner Kevin McCarty, who serves as FHIAB Chair, opened the meeting by discussing the U.S. Supreme Court’s recent decision on the Affordable Care Act (“ACA”), which he felt left many ambiguities to be clarified.  

As part of the agenda, the following updates and presentations were given on state and federal health care issues:

OIR Deputy Commissioner of Life and Health Michelle Robleto outlined the ACA’s current impact in Florida.  High-risk pools have been expanded to allow patients with pre-existing conditions to have more access to health insurance.  Currently, there are approximately 70,000 Americans and 6,000 Floridians enrolled in the expanded high-risk pools.  Florida companies have received $12 million in related rebates for low-income patients through the ACA.  

States must notify the federal government by November 2012 whether they will establish a health care exchange, or partner with the federal government in establishing one, Ms. Robleto advised.  However, the federal government has not set any requirements or regulations for the exchanges.  Florida Governor Rick Scott, along with many other states’ Governors, has expressed his unwillingness to adopt the Medicaid reforms incorporated in the ACA. 

Edmund Haislmaier, Senior Research Fellow from the Health Policy Studies Center for Health Policy Studies at The Heritage Foundation, discussed the ACA’s impact on the private health insurance market.  Mr. Haislmaier indicated that the federal government has not established a minimum benefit requirement but regardless of the minimum benefits, the mandate, along with the prohibition on rejecting patients with pre-existing conditions, is expected to increase costs.  He analogized the ACA as turning employer group health insurance into a public utility with a captive audience and no product differentiation.  He also noted that no regulations have been developed to ascertain the value of an employee health plan, which will determine if an employer is compliant with the new law.  Mr. Haislmaier shared his belief that the impending November election will be a referendum on Americans’ acceptance of the ACA. 

Michael W. Garner, Ph.D., Florida Association of Health Plans President and CEO,  presented concerns about the ACA shared by Florida health maintenance organizations (HMOs) and preferred provider organizations (PPOs).  Mr. Garner quoted Congressional Budget Office (“CBO”) statistics to show that health insurers and health plans will be subjected to $8 billion in additional fees in 2014 and $13 billion by 2016.  Associated premium increases are estimated at $2,600 for an individual plan and $6,000 for a family plan over 10 years.

Mr. Garner explained that the CBO data also indicates that Medicare reimbursement rates will decline until they are 25 percent of the Medicaid rate, which is expected to reduce the number of physicians who accept Medicare and thus endanger the financial health of public hospitals. These issues could negatively impact affordability and accessibility of health care in Florida, he added.

David Rogers, Florida Agency for Health Care Administration (“AHCA”) Assistant Deputy Secretary for Medicaid Health Systems, provided an update on Florida’s Medicaid Managed Care reform.

AHCA is currently seeking the necessary waivers to implement the program from the federal government.  An Invitation to Negotiate (“ITN”) for the Long-Term Care program was issued on June 29, 2012.  Mr. Rogers advised that notices of intent to award contracts will be published in January of 2013.  In order to be eligible for the Long-Term care program, patients must be in need of nursing care.  Services go beyond medical care, with a focus on home and community-based services.  AHCA is anticipating that the ITN process and resultant contracts will lead to increased quality and access to care.  Provider contracts will be five-year terms, with stiff penalties for early withdrawals, which is expected to improve continuity of care as well.

Florida Health Choices (“FHC”) Chief Executive Officer Rose M. Naff, provided a presentation on Florida’s Health Choice Marketplace.  FHC will provide a voluntary online marketplace for small group insurance. Providers are currently applying and registration of agents will begin shortly.  Employers will be able use the marketplace to evaluate, purchase and manage small employers’ group health benefit plans. 

Member Discussions

Laura Goodhue, the Board’s consumer advocate, expressed her opinion on the need for public input to be the basis for the setting of any minimum benefits.  She asked the Board to begin to include public input.  

Ms. Goodhue also believes more transparency is needed in the rate review process in order to justify any rate increases attributed to the ACA.

Commissioner McCarty responded that Florida has an excellent reputation for insurance consumer protection and transparency.  Ms. Robleto shared existing tools for consumers to receive information related to rate filings and many other issues related to their insurance carriers. 



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