Promoting market-based solutions to expand access to quality health care
AIF Lobby Team Members Assigned to the Area of Health Care:
Bob Asztalos & Leslie Foy

In 2007, AIF created a Health Care Task Force to address ways to halt the growing lack of affordable and accessible health insurance for Florida’s employers and their employees. Following a series of meetings, the Task Forceestablished several principles and ideas the Legislature should consider in crafting solutions to alleviate this problem.

GUIDING PRINCIPLES:

1. Do not create additional regulations or costs in the current health care and health insurance delivery systems;
2. Facilitate access for employees and small business owners to health plans with varying types of benefit packages;
3. Encourage employers to provide health insurance to employees through tax credits or other incentives;
4. Identify the high risk individuals who generate a large amount of the health care costs, and develop programs to address their unique health care needs which would not drive up the cost of health insurance for others;
5. Decrease unnecessary government regulations that increase the cost of insurance and thus drive up the number of uninsured;
6. Increase consumer choice and input into the decision to purchase and utilize health care services; and
7. Decrease the litigious environment in Florida which promotes defensive medicine, shifts precious health care dollars for patients into the courts and thereby increases the cost of care.

As the 2008 Legislature begins their process, we encourage the use of these principles and ideas predicated on the use of market-based solutions to improve the health care delivery system, reduce the cost of health insurance, and decrease the number of uninsured Floridians.

The current budget shortfall, due to the slowdown in the state’s economy, complicates the issue and means there is little or no discretionary money to commit to this problem.  At the same time, this situation has given impetus for finding ways to use market force and greater efficiencies to expand services and decrease costs.

Based on the guiding principles, the following are suggestions which AIF believes will facilitate improvements to the availability and affordability of health insurance:

Health Care Issues

• Support Expanded Health Care Coverage via Market-Based Initiatives -- Many states in the U.S. have begun bold efforts to increase health care coverage to their residents. Florida policymakers should carefully examine all the recent proposals to determine if there are market-based aspects which could be replicated to work within Florida’s unique environment that would increase the affordability and availability of health insurance.

• Support Introduction of More Flexible Benefit Packages -- Employers and individuals should be given the power to build their health care coverage by choosing from plans with varying degrees of benefit packages, free from excessive mandates, so they may decide how much money they are able to allocate toward their health care and which services they need and desire.

• Support Comprehensive Review to Determine Benefit of Health Insurance Mandates -- Florida law contains over 50 mandates on specific benefits and providers that health insurers must include in all the products they offer to Florida consumers. A comprehensive analysis should be conducted to determine whether or not the benefit of current or proposed mandates outweigh the increased cost of health insurance and the increased number of uninsured. A mechanism similar to the Base Realignment and Closing Commission (BRAC) should be created and charged with investigating and allocating costs to each mandate; determining which mandates are beneficial, based upon the cost to consumers, and which are not; and recommending to the Legislature whether each mandate should be retained, modified or repealed.

• Oppose Imposition of All State Mandates on Out-of-State Group Carriers -- Plans which are issued outside the state of Florida are subject to some, but not all, of Florida’s mandated coverage requirements. As a result, out-of-state group plans are more affordable than many of the admitted Florida group and individual plans; and they provide coverage to many self-employed Floridians who could not otherwise afford coverage. Increasing regulation on these out-of-state group plans would inevitably increase the cost of these policies and take away the only manner in which some Floridians can afford coverage.

• Oppose Deregulation of Florida’s Certificate of Need (CON) Process -- The CON regulatory program established in 1973 requires providers to obtain state approval prior to incurring significant capital expenditures or initiating new services. CON was enacted as a response to the increasing costs of state and federal health programs and the concern that the supply of inpatient beds and health care services would exceed demand in many areas of the state, which would result in excess capacity and increased health care costs. Since hospitals are required to GIVE AWAY their product (service) to people who can’t afford to pay in all urgent and emergent circumstances, the CON process ensures the survival of the community and safety net hospitals. In states which have deregulated CON, the proliferation of hospitals has siphoned away the better paying patients from community and safety net hospitals and has left these facilities with the burden of providing low revenue services for the medically underserved, which has strained their ability to sustain their operations. Deregulation of CON and the resultant addition of new facilities would also worsen the current shortage of doctors, nurses, and other health professionals at the state’s existing hospitals.

• Support Existing Caps on Medical Malpractice Non-Economic Damages & Expanded Immunity to Health Care Providers in Certain Emergency Situations -- Even with the reforms enacted in 2003, litigation in the medical and health care arenas continues to be a significant cost driver that encourages defensive medicine, diverts money away from patients and into the legal system, and affects the price of health insurance. The Legislature can impact the rising cost of care by enacting greater medical malpractice reforms.