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Veto fight heats up on doctors’ pay

By Christine Jordan Sexton and Carol Gentry
5/14/2009 © Health News Florida

In a case of odd bedfellows, consumer groups have joined the state’s largest insurer in seeking a veto of a bill that would make it easier for doctors to treat health plan patients without joining the plan's network. Doctors and the bill's sponsors are fighting back, accusing consumer advocates of being hired guns for Blue Cross and Blue Shield.

Both sides are peppering the office of Gov. Charlie Crist with letters and e-mails, spurred by appeals such as one that went to doctors Monday from Steven R. West, president of the Florida Medical Association.

“The managed care companies …will stop at nothing to achieve (a veto),” West wrote. “Their goal is clear: to cause as much confusion and fear of this bill as possible.”

By Wednesday, the governor’s office had received about 250 letters on the bill even though it hadn’t arrived. Once it gets there, Crist will have 15 days to sign it into law, veto it, or allow it to become law without his signature. He gave no insight into his plans, simply noting that he was “studying” the issue.

A summary of the two sides' arguments can be found on Health News Florida's Analysis & Opinion page in the left-hand column. There, Walter Dartland, executive director of the Consumer Federation of the Southeast, calls SB 1122 "the biggest threat to consumers this year: a bill that serves no purpose but to drive up health care costs for patients, employers and taxpayers." He said the bill would provide a “secret pay raise” for doctors. 

Just underneath Dartland's letter is an aggressive rebuttal from the bill’s sponsors, Sen. Don Gaetz, R-Niceville, and Rep. Marcelo Llorente, R-Miami. The lawmakers say the bill just assures that doctors will get paid for care they provide, that Blue Cross opposes it because the status quo gives the company a competitive advantage to force doctors into its networks. 

They went further, saying the state's largest insurer is just using Dartland as a "beard,"  and that he's lobbying against the bill because he received money from Blue Cross and Blue Shield. Dartland, who lives on his state pension and investments and takes no salary from the consumer federation, says he accepted a contribution from the insurer on behalf of his non-profit to help pay for the lobbying effort but only after he had decided the bill was anti-consumer. Dartland pointed out that he has lobbied against the insurer on other issues, he said. (Editor's note: Health News Florida, a non-profit, received a $10,000 contribution last year from the Blue Cross and Blue Shield of Florida Foundation.)

Dartland declined to say how much his group received from the Blues but said it was tiny compared to the campaign contributions from medical groups and individual doctors that went to supporters of SB 1122, including the bill's sponsors.

It's unusual to see an attack on Dartland, a former Marine major and attorney who served as Dade County Consumer Advocate for 10 years and then as Deputy Attorney General under Bob Butterworth in the 1980s and again in the 1990s, serving as special counsel until 2000.  He's a board member of Consumer Federation of America and was on the board of the good-government group Common Cause Florida until it ran out of money and closed recently.

"It's ridiculous to impugn Walt's intentions or his commitment to consumer advocacy," said James VanLandingham of Ron Sachs Communications, which worked on the veto campaign with his group. "But I suppose it's not surprising for critics who don't have a case on the merits to make ad hominem attacks. "

Gaetz says he wrote the letter as a “response to a misleading piece. The facts had to be stated.’’

In any event, Dartland's group is not alone in calling for a veto. Another is Florida Public Interest Research Group (FPIRG), which usually concentrates on environmental legislation, such as fighting offshore drilling. FPIRG lobbyist Richard Polangin said it’s “strange” to work with the giant Blue Cross and Blue Shield of Florida, which has 4 million members, after being on the other side of corporate interests for so long. But he said they see SB 1122 the same way: that it’s a bad deal for the consumer and a good one for the doctor.

“There is danger in this,” Polangin told Health News Florida. “This is a huge problem.”

Joining FPIRG and the Consumer Federation of the Southeast in opposition is Florida CHAIN, a non-profit that lobbies for affordable health care for all.

The legislation requires insurers to pay providers who aren’t part of their prospective provider organization (PPO) network directly, instead of sending the payment to the patient, as long as the patient authorizes it. That authorization is called "mandatory assignment.” The bill allows the doctor’s office to bill the patient for the balance between the check from the company and the doctor’s usual charges.

Consumer groups told the governor that the bill will increase the cost of health care for those who are enrolled in Blue Cross’s PPO because the company will have to pay more to keep doctors from leaving the network.   Blue Cross estimates that the law would cost between $9.9 million and $25.7 million for the state group insurance plan, alone. Actuaries at the firm Gabriel Roeder Smith & Company agreed with the Blues’ figures, estimating the costs on the state group to be between $5.1 million $18.5 million.

A letter from the Consumer Federation to the governor set for delivery today asks Crist to send the bill back to the Legislature to add “vital consumer protections.” It asks that out-of-network doctors be required to disclose that patients will have to pay more than the insurance company covers.

Patients should be given an idea of how much money they’ll have to come up with, the letter says. It adds that the state should set limits.

“Doctors should not be able to charge out-of-network patients significantly more than the average rate they charge to other patients,” the letter says. 

The tussle over the legislation during the 60-day session was fierce. Gaetz insisted the bill would not have much impact on health insurance plans but would offer protection to doctors, assuring that they get paid for their work. Senate Democratic Leader Al Lawson of Tallahassee contended the measure would wind up wrecking the health insurance plan for state employees. Blue Cross serves as administrator for the state's self-funded PPO, which covers about 42 percent of those eligible for state coverage, about 44,000 people.

During the waning hours of the regular session, Gaetz agreed to an amendment that would repeal the direct-assignment provision in 2012 if the Office of Program Policy Analysis and Government Accountability determines the policy has had an adverse impact on the state group health plan.

“It’s an automatic repeal,” said Gaetz, adding “there would be no dashing around trying to find votes” to prevent it.

Most of the letters Crist’s office has received to date are in support of the legislation. The Obstetric and Gynecologic Society, the Florida Society of Ophthalmology, the Florida Society of General Surgeons and the Florida Society of Dermatology and Dermatologic Surgery have urged the governor to sign the bill into law.

A lot of the letters are identical, using phrases found in sample letters sent out by medical groups, despite a plea from FMA President West that they use their own words. In them, doctors claim the weakening economy is putting them under “enormous financial pressures.”

“As a physician, all we are asking is that the insurance companies honor the wishes of the patients and direct the payments directly to the providers,” the letter states.

--Contact Christine Jordan Sexton at this e-mail. Or contact Editor Carol Gentry at 727-410-3266 or at this e-mail.