Florida's small-business marketplace is in for major changes under the Senate's Medicaid expansion proposal. After a slow start getting up and running, Florida Health Choices could see its customer base grow exponentially under the Senate's plan.
Last week Senate leaders opened the door to using federal funds to support more than 800,000 uninsured Floridians. Now lawmakers in the chamber have a plan. But it’s not quite what some proponents of a Medicaid expansion, expected.
“A lot of the conversation that took place last week about the proposal, is not what this proposal is," says Karen Woodall, Executive Director of the Florida Center for Fiscal and Economic Policy.
The proposal crafted by the Senate Health Policy Committee is a change from one the Senate crafted two years ago. The original plan-- informally dubbed NegronCare after its sponsor and crafter, Sen. Joe Negron (R-Stuart)-- would have used the Florida Healthy Kids Program as a vehicle to funnel the Medicaid expansion population into private health plans using federal money. That plan, noted state Medicaid Director Justin senior in a recent meeting, was one the federal government may have approved, if it had passed.
“When it came to Senator Negron’s plan, they did feel it was approveable, as I recall," senior said to the Senate's Health Committee.
But the House killed it, and the conversation has been stalled. Until Now.
The Senate is back with a new, and different plan, SPB 7044. This time, Florida Healthy Kids—would fall under a different entity. The state’s current market place system--Florida Health Choices would become the new Florida Health Insurance Affordability Exchange. It would offer vouchers to people between 22 percent and 100 percent of the federal poverty level to make insurance purchases. And it would charge premiums ranging between $3 and $25 based on income. It also mandates work requirements, something supported by Sen. Aaron Bean (R-Jacksonville), the Senate Health Committee Chairman and former Florida Health Choices board member.
“We hear so many people are working Floridians that need a hand up, not a hand out. So, the work requirements--skin in the game I think is very important. That you pay a little bit. everybody pays a little bit. When I go to the doctor, I pay a little bit, and I think that’s important," he said after last week's meeting.
Florida Health Choices was created in 2008 by the state legislature to promote competition and transparency in the health insurance market and bring prices down for small businesses. Health choices looks similar to the insurance exchanges that the federal health overhaul says every state must create, but it pre-dates the Affordable Care Act by two years, and the state has worked to keep the two separate. It became functional last year. Today, Health Choices is selling ACA-compliant health plans but can’t tap into the federal subsidies. And its director, Rose Naff, says it only has about four dozen enrollees.
“Setting headlines aside about low enrollment, it went what I consider, perfectly. It was a soft launch. We only advertised in three areas. We saw the targets, the population targets did respond to our advertising. The majority of people were our target audience are those who aren’t eligible for subsidies in the federal exchange.”
Two other groups—a coalition of small businesses and health providers called A Healthy Florida Works, and the Florida Chamber of Commerce—have put forth plans. The Senate’s effort is buoyed by the impending loss of two-billion dollars in federal money, coupled with Indiana’s recent success in getting federal approval for a Medicaid expansion plan with similar components. But the proposal as written could run into problems with the federal government. Justin Senior, the state’s Medicaid director, told lawmakers the federal government has drawn no-go zones when it comes to certain payment issues.
“Things like work requirements, they’ve expressed as a no-go area. And there’s a real reluctance to impose cost-sharing on people below the federal poverty level ," he says.
Still, the Florida Center for Fiscal and Economic Policy's Woodall says she’s encouraged, because while imperfect—the proposal is a start.
“It’s keeping the conversation going, and that’s very important. I don’t want to minimize that," she says.
The Senate will unveil its proposal Tuesday. There is no House Companion.
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