Affordable Care Act

Pediatricians challenging how the state pays for Medicaid services to children could see the nine-year-old case end in October, the Miami Herald reports.

The lawsuit, filed in 2005, claims that the Agency for Health Care Administration, Department of Health and Department of Children and Families violated federal law, and also hampered patient access by making low Medicaid payments to providers, the Herald reports.

HMO, PPO, EPO: Which Plan Is Best?

Aug 19, 2014

What’s in a name? When it comes to health plans sold on the individual market, these days it’s often less than people think. The lines that distinguish HMOs, PPOs, EPOs and POS plans from one another have blurred, making it hard to know what you’re buying by name alone - assuming you're one of the few people who know what an EPO is in the first place.

“Now, there’s a lot of gray out there,” says Sabrina Corlette, project director at Georgetown University’s Center on Health Insurance Reforms.

Florida looks to lose more federal money set aside for Medicaid than any state that has opted out of expanding the health care program for the poor, says a new report from the Robert Wood Johnson Foundation and the Urban Institute.

Hospitals May Help Pay ACA Premiums

Aug 14, 2014

Low-income consumers struggling to pay their premiums may soon be able to get help from their local hospital or United Way.

Some hospitals in Florida, New York and Wisconsin are exploring ways to help individuals and families pay their share of the costs of government-subsidized policies purchased though the health law’s marketplaces – at least partly to guarantee the hospitals get paid when the consumers seek care.

The clock is ticking for hundreds of thousands of people who have unresolved issues affecting their coverage under the new health care law. Florida has the most cases at 93,800.

The Obama administration said Tuesday that letters are going out to about 310,000 people whose citizenship or immigration details don't match what the government has on file. 

These consumers need to send in their documentation by Sept. 5. Otherwise their coverage will end Sept. 30.

FMA Supports Medicaid Expansion Money

Aug 6, 2014

I recently attended the Florida Medical Association annual meeting, where the organization develops policies for the coming year. The legislative agenda is drafted and approved.

FMA delegates from the specialty groups and county medical societies will vote on each resolution coming before the House. FMA lobbyists will then bring approved policy to Florida’s legislators and congressional representatives.

Advocates: FL Consumers to Pay for Lawmakers’ Decision

Aug 6, 2014

Republicans were quick to pounce Monday on Florida’s announcement that residents buying health insurance on the individual market for next year will face a 13.2 percent average increase in monthly premiums — one of the steepest rate hikes announced for any state. “Obamacare is a bad law that just seems to be getting worse,” said Florida Gov. Rick Scott, a Republican who is running for re-election.

  The Florida Medical Association's House of Delegates overwhelmingly adopted a resolution supporting Medicaid expansion to cover uninsured low-income adults at FMA's annual meeting on Sunday, according  to doctors who were there.

(Editor's note: This story has been updated with the statement from FMA.)

Insurers must pay $41.7 million in rebates to Florida individuals and employers this summer, an amount that far exceeds refunds in any other state, according to a federal report released Thursday. 

Companies affiliated with Florida Blue in Jacksonville -- Blue Cross and Blue Shield of Florida and Health Options Inc. -- owe a total of $20 million, nearly half of the total.

US Court of Appeals

An appeals court in Washington, D.C. issued a decision Tuesday that would wipe out an estimated $4.8 billion a year in subsidies to Florida individuals and families who signed up for a health plan on the federal health marketplace this year. That would make health insurance unaffordable to most of the nearly 1 million Floridians who enrolled.

A court case challenging the Affordable Care Act's subsidies for plans sold on the federal marketplace could have an outsize effect on Florida, according to a new analysis.

A ruling is expected any day on Halbig v Burwell from a three-judge panel of the U.S. Court of Appeals in Washington, D.C. If the government loses and further legal maneuvers fail, the 34 states that rely on the federal exchange would see a $36-billion loss of subsidies, three Urban Institute researchers project.

Lottie Watts

How much will it cost Floridians to buy coverage next year on Lots of people want to know, but the insurers are keeping the prices secret in an unprecedented way.

(Editor's note: This is a conversation between WUSF All Things Considered Host Craig Kopp and Health News Florida Editor Carol Gentry.)

Florida ranks last in the country in per-person funding from the Affordable Care Act, a new study shows, and that doesn’t even include the billions of dollars the state is forfeiting by saying no to Medicaid expansion.

The Center for Healthcare Research & Transformation at the University of Michigan performed the analysis of ACA grant totals between the time the law was signed in March 2010 and the end of September 2013.

Nearly 1 million Floridians have signed up for coverage via the Affordable Care Act (ACA), but some in South Florida are having to battle with doctors for treatment, the Miami Herald reports.

A lot more Floridians have health coverage compared to a year ago, but the state continues to have one of the nation’s highest uninsured rates, two new studies show.

An estimated 26 percent of working-age Floridians remain uninsured, according to a new Commonwealth Fund survey that looks at enrollment since the Affordable Care Act enrollment launched last October.

The White House will release a state-by-state report Wednesday which estimates that a Medicaid expansion in Florida would generate 63,800 jobs from 2014-2017.  Most of the jobs would be in health care, while providing health care to 848,000 people, according to the Tampa Bay Times.

The number of health insurers willing to compete in the federally run Health Insurance Marketplace for Florida enrollees for 2015 has grown, according to forms filed with a state agency by Friday's deadline. One that stayed out last year, giant UnitedHealthcare, is among them.

Orlando Health announced Wednesday that it is no longer seeking a partner for merger or acquisition because its own finances are healthy and there is no longer a need, the Orlando Sentinel reports.  While the not-for-profit health-care system had received several proposals, its board decided Monday to remain independent, a decision that goes against the nationwide trend of hospital mergers.  The board also decided to begin a national search for a new

The information posted by health insurers on a state website indicating they would not seek a rate increase for 2015 in Florida's individual market was "incorrect" and has been taken down, the Office of Insurance Regulation said late Tuesday afternoon.

Unfortunately, the false information came to light only after Health News Florida published an article on Tuesday with the headline: "No Rate Increase? Can It Be?"

The answer, it turns out, is no.

Update: Late Tuesday, the state Office of Insurance Regulation said information posted about 2015 individual market health insurance rates was incorrect and has been taken off its website. See more.

Something unprecedented may be unfolding in Florida's individual health-insurance market: None of the nine companies that have filed their 2015 rate requests so far wants an increase.

Floridians who bought health insurance on the Affordable Care Act marketplace and received tax credits got a pretty good deal, according to federal data.

They spent an average of $68 a month, considerably less than the national average of $82, the charts show. (See page 23 in the report)

Some people refuse to buy insurance that complies with the Affordable Care Act for political reasons. Others simply don't think it's really affordable.

The New York Times reports that a growing number of them have turned to the religious loophole in the health law. Two of those profiled are Florida women who are members of a faith-based nonprofit called Christian Healthcare Ministries.

Two health organizations filed a complaint with federal health officials Thursday alleging some Florida insurance companies are violating the Affordable Care Act by structuring their insurance plans in a way that discourage consumers with HIV and AIDS from choosing those plans.

The National Health Law Program and The AIDS Institute of Tampa said four insurance companies offering plans in Florida through the federal online exchange required HIV and AIDS patients to pay a percentage of their often expensive drugs instead of a flat co-pay.

Tampa Bay Times columnist John Romano tells how Indiana Gov. Mike Pence, a long-time opponent of the Affordable Care Act, nevertheless has asked the federal government for ACA funds to cover his state's uninsured citizens.

Floridians who feel they have been deluged by negative political ads with an anti-"Obamacare" theme are not mistaken: A new study shows spending on negative Affordable Care Act ads dwarfed positive ones 15 to 1.

An example of one such ad by Americans for Prosperity aired for three weeks in the Panhandle district of Congressman Steve Southerland, R-FL.

Here is the national story from Associated Press:

Since being diagnosed with a heart condition, Mark Heath has lost his home, his boat and most of his possessions. As one of the 800,000 Floridians trapped in the state’s Medicaid gap, he told the Daytona Beach News-Journal he didn’t have the means or access to needed medical care.

When Marie Bien-Aime first enrolled in a plan, she picked one that avoided a monthly payment.

Then the 59-year-old cook at a Miami restaurant realized her longtime health clinic didn't take the plan. Shortly before the enrollment deadline, Bien-Aime upgraded to a plan that costs $37 per month.

"Paying $37 isn't good for me, but I had to do it because I wanted to keep my doctor because he's so good," said Bien-Aime, who was previously uninsured.

Taxpayers have been good to Tampa-based WellCare Health Plans Inc., and they're about to get even more generous. 

In WellCare's case, the benefactor is Medicaid. But Humana, another company that is big in Florida and is releasing earnings, apparently is benefiting from enrollment through the Affordable Care Act, as Forbes reports.

Nearly 1 million Floridians signed up for a health insurance plan through the federally-run Health Insurance Marketplace during the first open enrollment period, according to numbers from the U.S. Department of Health & Human Services.

Among the states using the federal government's exchange -- -- Florida had the highest number, with 983,479 enrolled.

Gov. Rick Scott, who has been orchestrating anti-"Obamacare" meetings with senior citizens around the state and using them as fodder for campaign commercials, picked the wrong senior center in Boca Raton. As the South Florida Sun Sentinel reports, of 20 older voters he talked to, only one had a complaint, about having a hard time finding an orthopedic surgeon.