Massachusetts Partnership Health Insurance

Florida Health Choices Plan Could Give 'Obamacare' a Boost

Florida Health Choices is scheduled to open in early 2012, nearly four years after lawmakers first approved the plan and two years after Congress passed their own law.

U.S. Sen. Marco Rubio helped create the program when he was state House speaker. An expansion approved this year by lawmakers was applauded by Gov. Rick Scott. Both Florida Republicans want to repeal "Obamacare."

But before the state program can get on its feet, it might be consumed by the federal health care law.

At the center of the federal law are state insurance exchanges, web-based programs where businesses and individuals can search, compare and buy health coverage.

At its most basic, that is Florida Health Choices.

The program was designed to attract small businesses not providing health benefits and to cover some of the 3.8 million Floridians who remain uninsured. Companies and their employees can take advantage of federal incentives and contribute pre-tax dollars to pay premiums.

There are significant differences.

Unlike the federal law, Florida's program is not open to individuals, does not offer any new tax breaks for businesses and does not require insurers to offer minimum health benefits.

But if the federal law is upheld in court, some say Florida Health Choices could become the basis of an insurance exchange envisioned in the federal law.

"It has the potential," said former Sen. Durell Peaden Jr., a Panhandle Republican who serves on the Florida Health Choices board.

Peaden, a retired physician, said the work put into preparing Florida Health Choices would help the state implement the federal law.

"Everyone is pooh-poohing Obamacare and I don't like it, either," Peaden said." But if something is coming down the pike, we will be ahead of it."

Others bristle at any comparison between the state and federal programs.

"We are not related to Obamacare at all," Florida Health Choices chairman Aaron Bean said. Bean, a Fernandina Beach Republican, was the House sponsor of the bill that created the program.

Action For Better Healthcare » Opportunities for accountable care ...

By Joseph Damore and Barbara Gray

 Last year, many in healthcare were abuzz over accountable care organizations (ACOs). This year, many are tearing the concept apart before it ever gets off the ground. 

Healthcare leaders need to realize that there are many ways to explore becoming accountable for care beyond just contracting for shared savings with CMS.

Based on our assessments of “ ACO readiness ” in 90 markets, it is clear there are several populations to target beyond Medicare and here are details on just a few:

Your own employee health plan. The first place to look is in the mirror. Most health systems and large hospitals are self-insured, providing an opportunity to experiment with insured employees. This provides a “learning laboratory” that will help minimize risk when assuming accountability for additional populations.

Self-funded employers. Self-insured employers are ripe for turning to ACOs to provide their care. In one East coast market, a self-funded employer is implementing the Medicare shared savings model for their employee health plan with a handful of health systems.

The employer’s approach is novel. It projected spending on a per-capita basis and made an agreement with partnering health systems that if spending came in under the target in 2011, it would split the savings with them. There is no penalty for falling short of target. 

Health plans/insurers. Shared savings models are not exclusive to self-funded plans. Insurers are beginning to enter into these agreements with health systems as an insurance product. Several throughout the country already have been announced, including Aetna and the Carillion Clinic as well as CIGNA and the Piedmont Medical Group .