Exchange Watch: Florida

There's been solid coverage in the Sunshine State. Now it's time to treat Obamacare like the consumer story it is

What can we say about Florida, that bad boy of healthcare reform? Every time states are supposed to do something to implement Obamacare for the uninsured—and there are some 3.9 million in Florida, or nearly 21 percent of the population—the state throws another hissy fit. To its credit, the Florida press corps has been chronicling these outbursts pretty well, and their stories offer an unflattering picture. Here’s a look at the story to date—and opportunities for coverage ahead.

The hullabaloo over Medicaid expansion. The first hurdle was Republican Gov. Rick Scott, who once worked for Columbia/HCA (a for-profit hospital chain that got into hot water with Medicare over a billing fraud scheme), operated a string of urgent care clinics probed by The Palm Beach Post, and spent millions of his own money to fight Obamacare in the first place. After initially resisting a Medicaid expansion that would have provided coverage for about one million uninsured Floridians, Scott later embraced the deal, saying, “I cannot in good conscience deny the uninsured access to care.” (Some good reporting from the site Health News Florida helped keep the debate honest during this period.) But the GOP-controlled state legislature then trumped the governor and refused to sign off on the expansion—leaving many millions in federal funds on the table.

Refusal to set up a state insurance exchange. Scott apparently flirted with the idea of a state-run exchange but eventually dumped the thought, saying he didn’t have enough information from the feds about costs to Florida taxpayers. Meanwhile the Florida Senate launched its own webpage to make extra-clear that the state wouldn’t be setting up an exchange.

Furthering the misleading “rate shock” narrative. Florida insurance regulators also did their part to help out Scott and other Obamacare critics. In early August the Miami Herald in partnership with Kaiser Health News reported that the state was, in effect, passing along the “rate shock” meme. Insurance officials said that premiums for individual health plans would be 30 to 40 percent higher than “similar plans sold today.” That apples-and-oranges comparison again! The new policies have better benefits. The Herald article, by Daniel Chang and Patricia Borns, didn’t make that point explicitly, though it did report that insurance officials “conceded” their projections were based on a “hypothetical” health plan that doesn’t exist in the state—and that the cost estimates didn’t reflect federal subsidies that are part of the new law.

Insurance commissioner Kevin McCarty blamed the high rates on the central provision of Obamacare that requires all insurers to cover sick people with preexisting conditions. He didn’t mention that Florida has some of the highest medical costs in the country, and that what the state’s doctors and hospitals charge for their services is a major driver of the high cost of insurance inside or outside of the exchange. The Herald didn’t go there, either.

However, the paper’s coverage did offer some sharp details that call into question whether the top priority for Florida officials was keeping rates down, or trying to make Obamacare look bad. Chang and Borns wrote:

Under Florida law, insurance companies are required to explain to policyholders in writing how much of their premium cost increase is the result of the act’s “guarantee issue” and other mandates.

But insurers are not required to explain to policyholders one of the primary reasons that prices for health plans sold on the federally-run exchanges may run higher in Florida than in other states: Because Florida legislators this year stripped the Office of Insurance Regulation of the power to negotiate rates with insurers offering health plans on the federal exchanges until 2016.

That’s some good dot-connecting from the Herald.

Obstructing efforts to help people sign up for coverage. It remains to be seen how effective federally-funded “navigators” will be at walking patients through the insurance system, but they won’t be getting any help from Scott and his team. In mid-August, the Herald’s Chang and Marc Caputo reported that the governor and his cabinet “questioned the safety of private information” that Floridians will supply to navigators. “My concern is that we have no control over how the data’s going to be used.” Scott said. Pam Bondi, the state’s attorney general, said this privacy business was a “consumer protection issue.” But were their comments designed to side with traditional insurance brokers in the ACA turf wars, or even scare people into not signing up for coverage?

Then last week, Carol Gentry of Health News Florida reported that the state Department of Health had issued an order forbidding navigators from counseling people on the premises of county health departments—a logical place for sign-ups, since people often seek treatment there. Gentry asked why. “There was a need for ‘clarity’ and ‘a consistent message’ across the agency,” said a department spokeswoman. Dr. Marc Yacht, a retired county health director, told Gentry the order will “significantly compromise a multitude of needy Floridians from getting critical health care.”

Apparently the state of play in the Sunshine State has alarmed Secretary of Health and Human Services Kathleen Sebelius so much that she is making repeated trips to Florida to promote the Affordable Care Act. Last Friday, in response to the restriction on navigators’ access, Sebelius’ office sent out one of its ICYMI messages featuring an AP story about the Secretary’s visit to Orlando. Perhaps that inspired a report in The New York Times Wednesday that featured an unusually declarative headline: “Florida Among States Undercutting Health Care Enrollment.” (The story also quoted the insurance commission in neighboring Georgia saying the state would do “everything in our power to be an obstructionist.”)

Millions of Floridians need help navigating the insurance jungle. It falls to the press to step into the breach, not only to continue revealing the politics of Gov. Scott’s wagon train but also to give consumers the answers they need to buy insurance federal law says they’re entitled to. The coverage to date has been solid. But it’s time for the Tampa Bay Times, the Herald, the Sun Sentinel, and others to reach back into their archives and dust off the great stories they did during the heyday of the consumer movement and afterward—stories that revealed fraud and deception, stories that exposed who state regulators were listening to, and most important, stories that guided buyers through the marketplace. In this time of the state recalcitrance and public confusion, they would be doing their audiences a major service.

Related content:

Exchange Watch: The ongoing game of spin the rates

The Big Boys: Insurance agents protect turf

Obamacare: Here comes the information tsunami

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: , , , , ,