Scott's health-care law refusal makes federal ... - Health and Fitness

Gov. Rick Scott?s insistence that he will not implement the state health insurance exchanges mandated under the federal health care law doesn?t mean Florida won?t have one.

Instead, it most likely means the federal government will have control over Florida?s exchanges, including how they will operate, what benefits insurers will have to offer and who gets to sell the policies.

While Scott has spent much of the last week on national television and radio attacking the federal health-care program recently upheld by the U.S. Supreme Court, Florida Senate leaders have been working on a plan to not only implement the exchanges but to expand Medicaid, which Scott also said the state will refuse to do.

But Florida lawmakers have done nothing to authorize the executive branch to set up exchanges under the 2010 Affordable Care Act, and states have only until Nov. 16 to submit a comprehensive blueprint to the federal government outlining their plans for an exchange.

It all adds up to confusion over what Florida will do and, at least for now, points to likely federal control.

The federal government gave states a blueprint for the exchanges in May. According to those federal documents, the exchanges are meant to provide access to health insurance and subsidies for small businesses, and low- and moderate-income individuals. They must establish the minimum benefits packages insurers must offer, certify ?qualified health plans? and provide a marketplace where individuals and small businesses can shop for plans.

If the states don?t do those things, the federal government will, according to documents. States have three options for setting up exchanges ? a state-based exchange, a state partnership exchange in which the federal government operates the exchange but the state retains some regulatory functions, or a federal facilitated exchange in which the feds control virtually all aspects. States can also join the federal exchanges later.

Florida missed a June 29 to apply for $830 million in federal funds to explore and implement the exchanges. Scott returned the state?s $1 million exchange planning grant early this year.

?We?re increasingly behind the 8-ball,? said Greg Mellowe, health policy director at the left-leaning Florida Center for Fiscal and Economic Policy. ?There are policy decisions that have to be made. We?ve waited so long I?m not sure how that would happen in that period of time.?

State Sen. Joe Negron, R-Stuart, chairman of the Senate Health and Human Services Appropriations Committee, said this week, ?I think some of this can be done administratively through the Agency for Health Care Administration. As far as whether we need to have a special session, I think it?s too early to tell.?

He also shrugged off the Nov. 16 deadline and other requirements, saying that President Obama?s administration has given other states flexibility.

But Scott spoke adamantly against the federal health care plan last week.

?What has the government ever provided cheaper?? he asked Fox News host Greta Van Susteren. ?They don?t. They always overpromise and underdeliver.?

And AHCA spokeswoman Michele Dahnke, when asked about the exchanges this week, wrote in an email,?Florida won?t be implementing the exchanges.? A copy of Scott?s press release announcing he was rejecting the exchanges and the Medicaid expansion was attached.

Health care advocates in Florida say that would be for the best, since they believe a federal exchange would be better than a state one.

?I?m concerned that at the present time our (state) leadership doesn?t really believe in the mission of the exchanges. It will be important to be of the frame of mind that you want to make this work,? said veteran health care advocate Karen Woodall, executive director of the Florida Center for Fiscal and Economic Policy.

Negron, however, said the Senate has not ruled out ?consideration of a market-based exchange? as opposed to a ?cookie-cutter? federal exchange.

Negron is exploring converting Florida Health Choices ? the closest thing the state has to a health-care exchange ? into one of the federally-mandated exchanges. He wants to use such an exchange to handle the nearly 3 million low income, elderly and disabled Floridians covered under Florida Medicaid and to cover the expansion of Medicaid provided for under the federal law.

This would essentially be another attempt at the Medicaid waiver the state applied for two years ago but which the federal government has not approved. With the waiver, Florida is seeking to shift all Medicaid recipients into managed care programs.

?What?s emerging is an outline of the health care exchange that would allow the current 3 million recipients and if there are additional enrollees to shop for a plan,? Negron said. ?There?s competition. There are different prices.?

But the federal law limits the incomes of individuals who are allowed to use the exchanges and most of those on Medicaid now would not be eligible to participate in them, Mellowe said.

And Florida Health Choices is not even yet operational. Created under a law passed by the state legislature in 2008, it is slated to begin enrolling small business owners and a limited number of individuals on Oct. 1. Health insurance coverage will begin on Jan. 1, FHC executive director Rose Naff said.

Its scope is far narrower than the health care exchanges laid out in the federal law. They also will have the added complexity of requiring cooperation between a variety of state and federal agencies and insurance companies. And while federal officials have laid out guidelines for the exchanges, they have not yet established all of the rules for them, meaning even more uncertainty for states.

?I have a pretty good understanding of what I was trying to build and it?s taken me two years to do it. And it?s a much simpler approach than what was proposed for a state or federal exchange,? Naff said.

Article source: http://www.palmbeachpost.com/news/news/state-regional-govt-politics/scotts-health-care-law-refusal-makes-federal-contr/nPnKF/

Source: http://medicaltips.biz/scotts-health-care-law-refusal-makes-federal-control-more-likely-in-florida/

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