Gov. Rick Scott's controversial projections about expanding health care for the poor are a sign of the uncertainty behind the looming federal overhaul, conservative lawmakers and health care executives said today.
Scott has been criticized for releasing an analysis this week that predicted adding nearly 900,000 Floridians to Medicaid would cost the state $26 billion over the next 10 years. His Agency for Health Care Administration revised that estimate to $3 billion after complaints.
Sen. Joe Negron, R-Stuart, chairman of a committee guiding the state's health care expansion, backed Scott's initial decision to calculate possible costs without considering contributions from the federal government. There's no guarantee that contribution will last, Negron said at the Florida Health Care Affordability Summit in Orlando.
"I think the governor is reasonable in questioning the cost," Negron said during a panel discussion sponsored by the business advocacy group Associated Industries of Florida.
Regardless of the final costs, several state hospital leaders and health policy experts said Florida must come up with some way to provide insurance for those who are poor enough to qualify for an expanded form of Medicaid. The federal Affordable Care Act requires that all Americans be insured by Jan. 1, 2014.
"I just want to see people in the hospital show up with a (health insurance) card," said Daniel Waldmann, senior vice president of public affairs for the South-Florida's Tenet Healthcare Corp.
Negron questioned the value of handing over Medicaid cards to residents and making them "wards of the state" if they don't want to or can't get to a doctor. Negron backs Scott's proposal that these uninsured residents buy subsidized insurance plans on a privately-run health care exchange.
"I'm leery of people telling other people that don't have something that they need it," he said.
But even leaders who back a private market expansion acknowledged that Medicaid is better than nothing. Hospitals absorb millions in unpaid hospital bills every year, and indirectly pass those costs onto small businesses and people with insurance, said Alan Levine, Florida group president for the Health Management Associate hospital chain, which includes Pasco Regional Medical Center.
"The more people that have coverage, the better it is for the whole system," said Levine, who also served as AHCA administrator for former Florida Gov. Jeb Bush and led health care in Louisiana.
Tenet's Waldmann said while it's right for states to question government control, they also should ask how to address costs that right now are being absorbed into health premiums individuals with private insurance pay. "Both arguments are legitimate," he said.
Today's panel discussion could serve as a preview to Monday's meeting in Tallahassee of the Senate Select Committee on the Patient Protection and Affordable Care Act, which Negron leads.
The group has been asked to make formal recommendations to legislators about Florida's role in Medicaid expansion and health care exchanges, which are designed to provide individuals the opportunity to shop for their own insurance plans.
Negron said the summit taught him that hospitals want all residents to get insurance of some kind, and he was intrigued by an idea that the state could offer incentives to individuals who show improved health and healthy behaviors.
That incentive approach is increasingly popular within private insurance markets and with community health programs, said Jay Wolfson, an associate vice president for Health Law, Policy and Safety at the University of South Florida.
He challenged health leaders and businesses to get individuals vested in their own health reform.
"How can we get people to be increasingly responsible for their behavior?" Wolfson asked.
That's ultimately what this is all about, he said.