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Insurance gets baby-step fixes

The sweeping changes in health coverage Gov. Bush proposed have been scaled back in the Legislature.

TALLAHASSEE - This was supposed to be the year Florida confronted its pressing health insurance problems.

With millions of Floridians unable to afford insurance, Gov. Jeb Bush recommended sweeping changes he said would help lower costs for families, employers and taxpayers. Getting them through the Legislature was his top priority, Bush said.

But the changes the Legislature will pass in the coming days fall far short of the governor's goal.

Instead of a high-risk pool for the uninsured, Bush gets an actuarial study.

Instead of pooled purchasing for small businesses, Bush gets a new category of agent called an "insurance adviser."

And instead of helping low-wage workers find insurance, Bush gets bare-bones policies that consumer advocates say won't help families if they get sick. Lawmakers concede these are baby steps, but say a little progress is better than none. Other changes will have to wait for additional funding and study, they say. Observers blame an election year appetite for quick fixes rather than comprehensive overhaul.

"We want to give the governor everything we can, but we have to have something that members are comfortable with," said Senate Majority Leader Dennis Jones, R-Treasure Island, who sits on the Senate health care spending committee.

Bush said this year's bills are a good start. The House is expected to vote on its bill (HB 1629) today and the Senate (SB 2910) early next week.

"There is more we will have to do across the board on health care," Bush said. The recommendations lawmakers embraced, such as promoting Health Savings Accounts and helping patients with high deductibles shop for the cheapest hospital or clinic, will help lower insurance costs over time, Bush said.

"This is but one part of a longer-term strategy that's going to be necessary for the state to be actively engaged in," Bush said.

Still, even those who hoped for more say the bills will help families and small businesses.

"The task force came out with some really bold ideas, but we have to take baby steps to get there," said Leslie Dughi, government affairs director for the Florida Chamber of Commerce. "Are we happy with the bills? Absolutely. I definitely think we will be back, and I'm not at all upset about that."

About 2.8-million Floridians lack health insurance. An additional 2.2-million are covered by Medicaid, the state-federal health care program for the poor that is straining the state's resources.

The solutions suggested by Bush, and those accepted by lawmakers, are part of a growing trend around the country known as consumer-directed care. As health care costs squeeze families and companies, lawmakers are lifting policy mandates for covered services - such as mammograms - and by allowing people to save tax-free income in special savings accounts to pay for their own health care.

Because fewer services are covered, the bare-bones plans are cheaper. Supporters point to them as a smart alternative to traditional insurance policies for basic, affordable coverage.

"It's one more tool in the toolbox. If it doesn't work, we can take it out," said Rep. Frank Farkas, R-St. Petersburg, who wrote the House bill.

Both Farkas' bill and its Senate companion expand statewide a pilot project in which the no-frills plans were offered in a few parts of the state. One of the chief criticisms of such plans is they don't cover some screening tests that can detect diseases early. House Democrats tried unsuccessfully this week to add required coverage of mammograms to the pilot project before taking it statewide.

Critics point out that few people have signed up for the pilot project. Many people find they can't afford the up-front costs in the deductibles, said Sonya Schwartz, a health care policy analyst with Families USA, a Washington, D.C, health care consumer group.

"They're wasting their good money on something that doesn't help them when they get sick," Schwartz said.

Because patients foot more of the bill for their care, Bush proposed requiring health care facilities to publish information about their average costs and success so people can shop for the best deal. Both bills do that, and require hospitals to give uninsured patients, or those with a policy that lacks a contract with the hospital, an estimate of nonemergency charges.

One major proposal Bush lost was the reopening of the state's high-risk pool for uninsurable Floridians. The idea is to reduce the costs to businesses of insuring very expensive employees by shifting them to a pool financed by the state and the insurance industry. Bush proposed millions of dollars for the pool but shifted that money to eliminate a waiting list in KidCare, a popular subsidized health insurance program.

Both the House and Senate bills set the groundwork for the pool, but stop short of reopening it. Instead, they order the state to perform an actuarial study.

That doesn't help Michelle Guarino, a Weeki Wachee mother whose 14-year-old daughter Brittany is autistic and considered uninsurable. Although Brittany is grandfathered in under the family's policy now, Guarino said she will be dumped if the family updates the policy, which Guarino said she wants to do to extend the family's maximum lifetime benefit.

She hopes the state will do more than study the high-risk pool.

"I cannot, at any cost, buy a private insurance policy with our daughter on it," Guarino said.

- Staff writer Joni James contributed to this report.

Highlights of the Legislature's health insurance initiative:

- Expand pilot project statewide to offer bare-bones health insurance policies with high deductibles and a cap on benefits.

- Require health care facilities to publish average costs for certain inpatient and outpatient charges.

- Study whether to reopen the state's high-risk pool.

- Create the Florida Patient Safety Corp. to study medical mistakes and malpractice.