By Phillip Milano
Healthcare exchanges, spiraling costs and covering 3.8 million uninsured in Florida were key topics as top names in healthcare, business and government discussed the Affordable Care Act and proposed Medicaid expansion at the JU Public Policy Institute's Healthcare Policy Conference Wednesday Nov. 13.
The timely daylong event, one of the premier forums on healthcare in Florida this year, brought together the Speaker of the Florida House; President of the Florida Senate; nationally renowned healthcare policy experts from Washington, D.C.; and CEO's of hospitals, the insurance industry, and business.
The group presented varying viewpoints, pored over data, summarized studies and debated policy differences before an audience of more than 200 at Jacksonville University’s Terry Concert Hall.
“This is an extraordinary program, and I’m proud of this Institute,” said Steven T. Halverson, CEO of The Haskell Co., who wrapped up the conference with a bold challenge for Florida to find a way to use $51 billion in federal aid to help cover the uninsured in Florida. “We have the ideas and the imagination to solve this crisis. Do we have the resolve? What we’ve seen today is that JU is as good a place as any to start the conversation.”
The conference was organized and moderated by JU PPI Director Rick Mullaney, whose goal for the event was to help “inform, educate and shape healthcare policy in Florida.”
“I hope today is an impetus for a Florida solution to expanding coverage for the uninsured in Florida and helping build consensus on healthcare policy issues,” he said.
JU President Tim Cost welcomed the participants and guests, noting the University’s commitment to advancing quality health care with its programs and new facilities.
“We are investing in the future, with our new College of Health Sciences building as an example … we know that health care in the 21st century is one of the most critically important things we can be discussing,” he said.
The mood during the day shifted from somber to reflective to humorous and back, as presenters offered insights and original research into the challenges that lie ahead for Florida and the nation to offer quality health care to citizens.
Among the highlights:
JU alumnus Will Weatherford, Republican Speaker of the Florida House, who played a lead role in opposing the ACA’s Medicaid expansion in Florida, repeated earlier media statements about his frustration with lack of coverage for Sunshine State residents and problems with Medicaid. It’s estimated nearly four million Floridians, or a fifth of the population, are without insurance.
“I’m not proud that we have so many uninsured,” he said. “And our party hasn’t done a good job nationally of offering alternatives to the Affordable Care Act. But we need a plan … that doesn’t treat the poorest among our citizens differently. We can’t allow the ‘kinda’ poor to be able to pick their own insurance, but the ‘really’ poor to only be allowed Medicaid. That’s creating two Americas, and that’s not fair.”
Florida Senate President Don Gaetz agreed with Weatherford that trusting the federal government to continue for years to pay a sizable portion of the costs for expanding Medicaid in the state was a risky proposition.
He called Medicaid’s growth “metastatic,” rising from a cost of $14 billion a decade ago to $23 billion this year, or 31 percent of the entire state budget.
“Where is this money going to come from? Every three of you out there will be paying for your own costs, plus one person who is on expanded Obamacare. … I predict the ACA will falter and fail to keep its promises, and will have to be redesigned.”
In response to a question from Mullaney on obtaining greater federal government flexibility for Florida and a potential “block grant” or reform approach to Medicaid expansion, both Weatherford and Gaetz said they were open to a “Florida Solution” to expanding coverage for Florida’s uninsured and using the $51 billion in federal funding.
Florida Blue CEO Pat Geraghty addressed media attention over his company’s recent notices sent to 300,000 customers that their insurance plans would be cancelled in January. He stated that Florida Blue had only complied with ACA mandates regarding minimum plan coverage, and that the insurer was working to transition people to more robust plans that meet ACA rules and that may allow them to receive federal subsidies.
He also argued that the state should “not leave 50 billion in federal dollars for Medicaid expansion on the sidelines.”
“We must work to change the system, take the funds, create goals and move from a fee-for-service system to a value-based payment system,” he said.
Ford Koles, Executive Director of The Advisory Board Co., prompted laughter with his opening screenshot of the healthcare.gov website and its message, “The system is down at the moment.”
“This [ACA problems] has been a failure of execution,” he told the audience. “The biggest issue in Florida is the assumption of unending profitability of providers. Sustainable volume has never come back from the beginnings of the downturn in 2007. … Meanwhile, more patients are choosing high-deductible plans … so they have more skin in the game and are price-conscious.”
Joe Antos, a leading healthcare scholar with the American Enterprise Institute in Washington, D.C., addressed the state and federal exchanges, as well as the need to reform Medicaid, with or without expansion.
Halverson, meanwhile, said healthcare in the U.S. was a “profoundly broken” system, consuming nearly 18 percent of U.S. GDP, with costs soaring, little accountability for outcomes, overregulated providers, physicians unprotected and no end in sight.
However, he said, leaving millions uninsured in Florida, who then use emergency rooms for essentially universal free care, creates a $1,000-per-family “hidden tax” when providers are uncompensated for care they deliver.
“We have $51 billion in accessible funds to apply to the problem,” he said. “We need a complete rewrite of health care delivery in Florida. There is opportunity in crisis. I believe this White House needs a win and will be open to intelligent, thoughtful and different ideas. We owe it to ourselves and to the next generation to try. … You need a confluence of disruption to make real change. The ACA has disrupted a system that needed disruption.”
Other speakers and panelists at the event included Russ Armistead, CEO, UF Health; Moody Chisholm, CEO, St. Vincent’s HealthCare; Hugh Greene, CEO, Baptist Health; Jim O’Loughlin, CEO, Memorial Hospital; Dr. William Rupp, CEO, Mayo Clinic in Florida; and Dawn Emerick, CEO, Health Planning Council of Northeast Florida.