Obamacare in Florida – It ‘Coulda Been a Contender


Many Floridians are confused by the Obamacare health care system.  State officials have worked for three years to refine Obamacare for Florida’s needs, yet availability, price and the transition from today’s system remain unsettled.

The question — “Can I keep my existing health plan?” — has no simple answer.  Obamacare sets a broad standard for treatment coverage.  If your plan falls short of the Obamacare coverage standard, it will need changing.  Employer-sponsored plans offering lavish coverage face a “Cadillac plan” tax starting in 2018.  Some private sector employers may rescind health care benefits, preferring instead to pay a federal fine of $2,000.  The obligations for large employers will not kick in until 2015.  So, whether you can keep your plan depends on what it covers and on what your employer decides.

Florida chose to use a federally-run health insurance exchange, for 2014.  Florida plans on the exchange will follow the Bronze, Silver, Gold, or Platinum pattern (60%, 70%, 80%, or 90% of billed charges covered).  You are accountable for paying the remainder.  Employer and individual premiums will vary with age, sex and health status.  Actual premiums have been described as both “higher” and “lower” than those outside health exchanges today.  Federal subsidies will help families with incomes up to 400% of the federal poverty level.

Amidst these moving parts, your net cost is hard to predict.

Floridians enrolled in Medicare or Medicaid plans will face little change except for government’s customary tinkering with prices.  In 2009, 3.4 million Floridians were served by Medicaid, but the number will jump higher by 2014, because Obamacare entitles people with incomes between 100% and 138% of the federal poverty level to enroll in Medicaid with most of their premiums covered by federal subsidies.  To help contain costs, Florida plans to move all Medicaid patients into a managed care plan, by March 2014.

Florida’s government employees should experience little change in coverage.  Florida will offer its “Other Professional Services” employees (i.e., temporary or part time employees working for state agencies and universities) access to the government employees’ health plan.  Floridians who work as federal government employees or as  Congressional staffers or Members will see their plans pared back to Obamacare’s standard, much to the distress of government unions.

Florida’s elected officials made the best of this poorly designed federal health care program.   Design elements that are heavier in thought and lighter in politics would have yielded a plan far more consumer friendly.

Some restraint or a little flexibility in the overly expansive standard for treatment coverage would have cut costs and would have allowed employers to pursue their religious practices.

The plan should force patients to be aware of treatment costs being ordered by their physician – in real time.   Cost awareness is necessary for cost containment, especially for “third-party pays” programs like Obamacare.

The pharmaceutical industry should not have been insulated from negotiating drug prices with Medicare, in return for its support in passing Obamacare.  That sleazy “deal” will drain consumer pocketbooks for decades.

Congress’ attorneys gave their tort bar buddies a green light to continue rapacious malpractice suits.  Those suits directly add 2% in cost to all health care, and they induce another 7% in completely wasteful “defensive medicine” costs.

Electronic patient records (EPR) were encouraged, although they are not a precondition for reimbursement as they should be.  EPR makes billing and peer review/second opinions easier and cheaper. Since about 15% of all medical treatments plans are flawed, a second opinion can halt inappropriate treatment costs on a vast scale and can rescue patients from useless or dangerous treatments.

All these safety measures and cost savings should have been embraced and validated before expanding Medicaid entitlements and launching vote-friendly subsidies for families with incomes up to $80,000.

Because of design errors, Obamacare is not good enough – even for government work, but it’s what we are stuck with.

Alan Daley is a retired businessman who lives in Florida and who writes for The American Consumer Institute Center for Citizen Research