HNF Stories
8:43 am
Fri January 10, 2014

State's Report Wrong, Navigator Says

The chief navigator for Healthcare.gov plans for Southwest Florida says a state report on costs that Florida families have to pay for health insurance greatly overstates the premiums.

Navigator Lynne Thorp

"Their numbers were very high," said Lynne Thorp, who at the request of Health News Florida ran the numbers on the first case that was presented to a legislative committee on Thursday. "I can't figure out where they got them."

She said the hypothetical family in the report by the Office of Insurance Regulation would have a monthly premium of $220.50 at their income level. That isn't even close to the premium costs in the OIR presentation by Deputy Insurance Commissioner Wences Troncoso.

He said the family would have to pay $475 a month if they lived in Miami-Dade, $326 in Orange County, and $171 in Leon County.  The hypothetical family in the presentation had two adults and two children and an annual income of $42,000, and no one smokes.

Friday morning in a phone interview, Troncoso said the premium cost listed in the report represents an average of the cost for all of the silver plans in each area. That naturally skewed the prices higher than would happen in the real world, where a family looks for the most economical plan that meets their needs.

"There are lower-cost options" than the ones he presented, Troncoso said Friday. He said he hoped people would consult insurance agents and others to find out what it would cost for them. 

Under the health law, applicants can choose from four levels -- expressed as metals: bronze, silver, gold and platinum -- that represent how much of a patient's expenses they will cover, as calculated by actuaries. The Obama administration has in the past used the second-lowest-priced silver plan in each county as the so-called "benchmark" plan. 

Health News Florida had asked OIR early Thursday about the accuracy of the prices in the report after they were questioned by Greg Mellowe, policy director of a consumer advocacy group, Florida CHAIN. A couple of members of the House Select Committee on the Patient Protection and Affordable Care Act also questioned their accuracy.

At the hearing Troncoso conceded the OIR estimates did not take into account that the children in the example would likely have qualified for one of the Kidcare programs in Florida -- Medicaid or Healthy Kids, a sliding-scale insurance plan for children of modest-income families.

Mellowe said, after watching Troncoso's presentation, "I can’t remember ever hearing that many errors, misstatements and evasions in that short of a legislative presentation."

He called the presentation "agency malpractice," and said he was disappointed that most committee members treated the information as though it were valid.

Troncoso says the information is valid; it just doesn't represent the cheapest options.

--Health News Florida is part of WUSF Public Media. Contact Editor Carol Gentry at 813-974-8629 (desk) or e-mail at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.