Florida Blue CEO Talks ACA Marketplace Open Enrollment

Oct 18, 2018
Originally published on October 19, 2018 2:58 pm

About 1.6 million Floridians are enrolled in Affordable Care Act Marketplace plans.

Open enrollment starts Nov. 1 and ends Dec. 15. Florida Blue offers plans in all 67 Florida counties, and covers more than half of enrollees.

Health News Florida's Daylina Miller recently spoke with Florida Blue CEO Pat Geraghty about the upcoming enrollment.

Daylina Miller: The Affordable Care Act Marketplace open enrollment is Nov. 1 through Dec. 15. What do Floridians need to know about the enrollment period this year?

Pat Geraghty: “We are excited about the enrollment period. We want people to know that the Affordable Care Act is still alive and they have an opportunity to sign up or re-enroll. We have 23 retail centers around the state that they can come into to be assisted by Florida Blue in their re-enrollment. They certainly can work through their brokers. We have lots of great broker relationships around the state and they can call us for any advice or counsel they need to navigate through the process, but we are encouraged by low rate increase this year in the Affordable Care Act. So for individuals, it's about 4 percent on average. And for our small groups, it's less than a 1 percent rate increase so we think we're doing a pretty good job of trying to deliver on affordability. And we're excited about making sure everybody has access to health care.”

On that note, Obamacare rates across the country are falling. You said that Florida fits into that as well. What's the reason?

“I think a number of organizations around the country had very large rate increases. Our plan hasn't had a long history of large rate increases. In fact, they've been fairly moderate rate increases except for last year. Last year, the big change was that the cost share reduction -- which paid for those who are most subsidized, their deductibles and coinsurance -- that went away as part of the federal program. So it had to be picked up under the premium. And so there was rate increase related to that. But in general, we've had modest rate increases here in Florida. We've operated in the black each year. And so we've been able to keep our individual Affordable Care Act rates affordable for most people.”

The Trump administration is taking credit for some of these rates falling. Some experts are saying that they're falling because in the past insurers have over-priced plans in the marketplace. What's your perspective on that?

“Well, I won’t really comment on other plans around the country, but I would reiterate that in Florida our rates have been set pretty accurately each year. We haven't had big swings up and down and we've actually approached the market in a reasonable way. We're in all 67 counties. We offer plans in each of the different metal levels. And so we're committed to the entire state. We're committed to affordable health care and we're committed to the communities that we serve.”

Midterm elections are coming up. Health care is obviously a big topic. There's a lot of talk about the preexisting conditions clause going away. What happens if that happens here?

“So we've got to be very clear about what that means. Within the Affordable Care Act, the preexisting condition exclusion is not going away. There is a new set of plans that the current administration has offered, which were called short-term duration plans. Those plans, which were previously 30 to 90 days, are now able to be offered over the course of the whole year. Those plans have the ability to exclude for preexisting conditions. They're very different than the Affordable Care Act plans. And we, Florida Blue, will not be offering those plans under the branding, if you will, of the Blue Cross Association. So we're looking at possibly offering those to some people who may want those plans but they be offered under very different offering. Our offerings under the Affordable Care Act do not have a preexisting condition exclusion and will not.”

Another hot topic in health care is rising prescription drug costs. So what is Florida Blue doing to make sure that prescription drugs are affordable for patients?

“We’re doing a number of things. One of the areas where there's a lot of attention is opioids. And in that regard, we lobbied in Tallahassee to make sure that the initial prescription of opioids was reduced. Oftentimes people have situations like I personally was faced with when I had a knee surgery. I was prescribed a 30-day supply of opioids. I needed them for one day. That's way too much drugs being prescribed. That's much more than I needed to use. And now I have 29 days of opioids in my house where there are children present. That's part of the problem. So we lobbied in Tallahassee to reduce the number of days that initial prescription would be made for. In fact, most people can deal with their pain with Tylenol, which is an over-the-counter obviously, and many other over-the-counter drugs. So what we want to do, and we've been working with Tallahassee and we've been working with physicians, is really get to the right pain medication for the patient. And there are always situations where people need more intense pain management but they're the exception and not the rule. We got to a place where they were too prevalent in our society and they really created addiction. And the fallout from that level of addiction. So that's one area we've been active in. We also are very active in Washington D.C. working with the administration on some of the proposals that are coming forward from the administration to reduce the cost of drugs. We really had a big change happen when drug companies started to price for what they thought they offset as cost in the overall system, as opposed to adding a margin onto what it costs them to bring the drug to market. We need those pricing mechanisms in Washington to be very clear so that a drug company can get a fair reimbursement, but they aren't allowed to just set the price anywhere they want to.”

Trump recently signed a bill that would prevent pharmacists from telling patients that their prescriptions will be cheaper if they paid in cash instead of going through their insurance. What's your perspective on that that bill?

“I think patients always should have as much information as we can get to them. Patients should understand what the implications of price are so we believe in transparency. We believe in advocating for our members. We think members should have as much information as they possibly can. I think there are some rare instances where the price is lower than the copay but that's rare and it's because there's a whole bundle of drugs that are being purchased. Some of them may in fact fall below. But there's a lot of drugs that are well, well above what an individual would pay and they're getting a very steep discount off of the price coming from the manufacturer. So you have to kind of look at that issue collectively but it's very important, I believe, across all of health care that we have transparency and we give customers visibility to what it costs to have a procedure and what it costs from one drug to another.”

Some insurers are moving to accumulator adjustment programs which means some of the assistance that they would get from drug manufacturers they may not be able to use those to pay for certain copays or deductibles in relation to prescription drugs. Where do you guys fall? My understanding is you won't be using that sort of program.

“What we're looking at, what we should do in terms of these coupon programs, but I think we need to understand the issue at its base. It looks like the drug manufacturers are trying to do a good thing for the member by paying a coupon that allows to offset their copay. In fact, what they're trying to do is take that so that the member doesn't have any accountability for expense so that they won't care about the ultimate price of the drug. So if they move it up they've protected the member from that overall cost. At the end of the day, we all pay for whatever gets charged for that drug. So we'd like to get at the root cause of bringing the cost of pharmaceuticals down and then we can work with coupon programs that perhaps assist people when they are in a particular high-cost area. But I really think the important thing here is the game that the pharmaceutical industry is playing to try and run the price up and use a coupon to hide behind the real impact in the market.”

Is there anything else Florida Blue has done in terms of the opioid crisis, or you plan to do moving forward, to make sure that patients who need those opioids can get them but that were not contributing to people getting addicted.

“Education is a very important part of this equation, reaching out to the public health officials across the state and being a good partner with them. But I think the most important thing we're about to do and that's Oct. 22 we're having an opioid summit. It's going to be at an innovation center in Lake Nona and we're bringing together people who are providers of care, people whose families have been impacted, we're looking at hospital executives, academics, law enforcement -- really all the stakeholders so that we look at this issue comprehensively, not just from a single lens. We believe when you bring all of the stakeholders together, you get to real solutions and real answers. So our summit which happens on the 22nd again at Lake Nona is going to be a very important event for the state of Florida to really look at how do we collectively address this issue. No one part of the system is prepared to deal with the opioid crisis alone. This is a really clear example of where we have to work together to make it happen.”

Going back to the upcoming open enrollment, is there anything that's changed that Floridians need to be aware of?

“Well, there's always been some changes to the Marketplace. I think the changes for the individual market this year have not been that significant. I think it's important though that people understand: A. the Affordable Care Act is still here B. that it has actually been successful in the state of Florida. We have a million people that our company alone covers in the individual market and 1.6 million people being covered across the state. So you have options. We bring those options in front of people in our retail centers through our agents, through lots of different community-based organizations. And so educating people about their choices. Some people started in what are called silver plans and then they've looked at other plans. The bronze plan, as an example, as an avenue to be covered in a less expensive option or staying in the plan they have if in fact their subsidy protects them in the plan that they're in. We can take each and every individual through the impacts economically to them, through the options in terms of which providers are available to them, and that education process is really critical. So we're open to that, want to walk people through those programs and we'd like to enlighten people about the other services that are available in our retail centers. We literally have yoga classes in some of our centers, nutrition programs, flu shots -- lots of different things that all come together to help people navigate through their health journey. And those are all available through our retail centers.”