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Mini-med: John Q. and you

By MARTIN DYCKMAN, Times Associate Editor

© St. Petersburg Times, published February 24, 2002

TALLAHASSEE -- Ten years ago Americans elected a new president whose keystone promise was to deliver what everyone in Europe takes for granted, universal health care coverage. The insurance industry put Harry and Louise on television and that was the end of it.

TALLAHASSEE -- Ten years ago Americans elected a new president whose keystone promise was to deliver what everyone in Europe takes for granted, universal health care coverage. The insurance industry put Harry and Louise on television and that was the end of it.

Now, fittingly, the health racket is getting a bitter taste of its own media snake oil. A new movie, John Q, depicts a father holding a hospital emergency room at gunpoint to get a new heart for his dying son. Audiences are responding. The industry, on the defensive, is running ads attempting to suggest the movie is not an attack on HMOs but a case for insuring more people.

The factory where the father works has downgraded his health coverage to a "mini-medical" plan that has merely a $20,000 lifetime benefit, and for that the hospital is unwilling even to place the child on a transplant list.

Though film and political critics fault many of the assumptions in the plot, that $20,000 lifetime limit has an alarming ring of truth, as many Floridians will soon find out if they don't start raising hell and soon. Here, the lifetime limit could be as low as $10,000. That is not a misprint.

Insurance and business lobbies, including the Florida Chamber of Commerce, are pushing legislation (HB 913, SB 1134) that would open the small-group health insurance market to these cheap but often worthless policies. Larger employers (with 51 workers or more) can buy them now; some 30,000 Floridians are now "insured" that thinly, according to one broker. The proposed "flexible benefit" group policies that could be marketed to all employers under these bills might better be called "no benefit" plans because they could disregard nearly all of the coverages Florida law now requires.

The House is greased for that bill, which has now cleared three committees, despite wrenching testimony about the potential cruelty to children born with cleft palates, who need multiple surgeries that would no longer be mandatorily covered, and despite the black eye the House earned from the ham-handed way in which Rep. Frank Farkas, R-St. Petersburg, the sponsor, rammed the bill through his health care committee without hearing people who had come to object. (The campaign ads appear in the mind's eye even now: Farkas' picture juxtaposed with that of a newborn with cleft palate.)

The last committee cleared it Thursday, indifferent to the pleas of a Tallahassee businesswoman who tearfully asked them to consider how it could devastate families with insulin-dependent diabetic children such as her daughter.

One heart attack, or one cancer surgery, and you're on your own.

Farkas had the bill amended Thursday so that insurance companies offering these "last resort" policies, as he described them, would have to offer supplementary coverage for catastrophic illnesses. He conceded, however, that the offer would be "to the employer, not the employee." Moreover, the companies could turn down workers who are already ill.

Farkas' side of the argument is that without such alternatives, fewer employers will be able to afford health insurance, adding to the dismal tally of 2.1-million Floridians who are already uninsured. But it is painfully obvious that he's listening only to the insurance industry lobbyists when it comes to finding the solution. On the rare occasions when some legislator asks a tough question, Farkas invariably asks or lets some lobbyist answer for him. They designed the bill, they write his amendments, and they pull his chain.

Thursday, for example, Rep. Manuel Prieguez, R-Miami, proposed an amendment to require "flexible benefit" policies to specify what is not covered. Otherwise, they would come only with a vague notice saying in effect that it's up to you to find out what isn't. Farkas objected.

"I can tell you from my conversations with some of the carriers, they will choose not to participate with additional disclosures," he said.Gerald Wester, the HMO industry's lobbyist, objected also, as did the Chamber of Commerce.

The committee approved the amendment anyway, 8-4, which was the only decent thing it did that day. Rep. Frank Peterman, D-St. Petersburg, voted for the amendment. Rep. Leslie Waters, R-Largo, voted against it. Waters is a former Allstate executive. An Allstate subsidiary already markets policies with a $20,000 lifetime limit.

The committee also restored certain guaranteed coverages for dentists, optometrists, podiatrists and chiropractors. Farkas, a chiropractor, said the HMOs asked for that because of "contractual" obligations.

Is "some insurance better than none," as Farkas and the lobbies say? Not if employees and their families are misled into thinking they're insured when essentially they are not. Watch for an attempt on the House floor to get Prieguez's amendment removed.

Among the other present requirements that "flexible benefit" policies could ignore: emergency care, HIV, mammograms. Under the bill, policies covering mastectomies and maternity no longer would be obliged to let the patient stay in the hospital as long as the doctor recommends; mastectomy coverage would not have to provide for prosthetics or reconstructive surgery.

The Florida Association of Health Underwriters, representing some 1,000 agents, opposes the bill. Spokesman John Sinibaldi of Seminole reminded legislators Thursday that they have been voting for the bill without knowing what, if anything, the mandated coverages cost. "Nobody, including the industry, has any clue of what mandates cost," he said.

On the other hand, there is data on how much -- actually, how little -- it costs to provide workers with realistic lifetime benefits. According to Insurance Commissioner Tom Gallagher, the difference between a $25,000 lifetime ceiling and unlimited coverage is $71.85 a month.

No one in Gallagher's office is happy with the legislation, but he is supporting it. When a legislator asked Thursday whether the department liked the disclosure amendment, his lobbyist said that as it had "agreed with the language in the bill last year ... we do not feel this is necessary." So much for Gallagher as a champion of the informed consumer.

A "mini-med" policy is like buying insurance that pays for car repairs but not for major damage. It's precisely backwards. Mini-meds may pay for doctor visits, but leave you bankrupt over hospital bills.

The Legislature should be talking instead about raising co-payments and deductibles. That's where the real premium savings are likely to be.

The best hope of saving Florida from mini-med is in the intrigue between the House and Senate. There's support for mini-med in the Senate, where Majority Leader Jim King is a sponsor, but the Banking and Insurance Committee intends to combine it with two other bills, including one that the House may take as a poison pill.

That's the effort to apply Florida regulation to Golden Rule, United Wisconsin and several other out-of-state companies that market "individual group" policies to Floridians without any of the consumer protection Florida law offers. They're notorious for raking in new customers at low rates and then hitting them with staggering premium increases. This reform is a high priority for Gallagher, Sen. Jack Latvala, R-Palm Harbor, and Rep. Kim Berfield, R-Clearwater. Berfield's bill, of which I last wrote that she was "riding a tiger," made some progress last year but stopped dead when Speaker Tom Feeney intervened. He said something about not wanting to limit choices, which presumably did not include Golden Rule's frequent choice to contribute generally to state and national Republican campaigns. Golden Rule also employs one of Tallahassee's top lobbyists, former Speaker Sam Bell.

The tiger may think it ate Berfield, but she has filed her bill again this year. In the House, she can't get a hearing. In the Senate, Latvala means to see that no health insurance bill will pass except as part of a package that also reigns in the out-of-state profiteers.

Then it would be up to the House to choose: Golden Rule, or the Florida Chamber of Commerce? Golden Rule, or the Florida insurance lobbies?

The question should be: Mini-med, or the public interest? Speak now, or John Q. may be you.

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