Opinion: Flexible benefit comes up short

The fact that more than 2-million Floridians lack health insurance betrays a moral and economic crisis the Legislature should address. But the measure the House intends to debate today is not the right remedy. The insurance might be "affordable," as sponsors say, but it could turn out to be not worth even the low price.

The bill (HB 913) by Rep. Frank Farkas, R-St. Petersburg, and others proposes to expand the insurance market for workplaces of fewer than 50 employees by allowing the sale of "flexible benefit" policies with ceilings as low as $10,000 a year. Moreover, the policies could exclude any or all of the coverages Florida law now requires along with existing limits on co-payments and deductibles.

Such a policy could expose even a young, otherwise healthy family to financial catastrophe and emotional trauma in the event of a single serious illness. For example, the law now says that if a policy insures children it must also provide for treating infants born with cleft palates. All policies must cover "all medically appropriate and necessary" equipment for diabetes management. Mammograms are guaranteed. Women whose policies cover childbirth or mastectomies can't be kicked out of the hospital before their doctors say they're ready to go home. These and all other mandates would become optional under HB 913.

This is the wrong way to reform health care. If these "flexible" -- for which read, "insufficient" -- benefits remain in the bill, it should be defeated. If there were no other reason, this would suffice: None of the insurance lobbies supporting the bill has been able to tell legislators how much any or all of the mandates add to the cost of an insurance policy. Without that knowledge, it would be the political equivalent of medical malpractice to suspend them in the mere belief that the costs are significant. (Another of Farkas' bills, HB 911, has been amended to initiate a study that would determine the cost of mandates, and that bill should be enacted.)

Many experts, meanwhile, contend that the most significant inflation factors are not the mandates but rather the low co-payments and deductibles state law imposes on HMOs, and which also show up in many conventional health insurance plans. If HB 913 waived only those, it would be worth the experiment. Given the choice, most people might prefer to pay $50 for a doctor visit rather than be woefully underinsured for an expensive illness. But as the bill stands, they could be heavily out of pocket and underinsured. That goes much too far.

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