The Florida Legislature started work Monday on implementing the Patient Protection and Affordable Care Act.
Lawmakers had delayed taking steps to comply with the 2010 landmark
health law known as Obamacare, betting that a new Congress and a new
president would repeal it. Delay evaporated as an option once President Barack Obama won re-election.
On Monday, special committees in the Florida House and Senate began
working on what many industry representatives and policymakers call a
"sea-level change” in health care policy. Whether and how to implement
provisions of the ACA may be among the most significant decisions
lawmakers make during this spring's legislative session.
Most elements of the ACA, aimed at reducing the number of people
without health insurance, become effective in 2014. Monday a House
Select Committee discussed four decisions the Legislature must make this
year to comply with the law. Rep. Richard Corcoran, R-Lutz and chair of the House Select Committee on the Patient Protection and Affordable Care Act, says the panel will hold eight meetings between now and April.
"We will be diligent, deliberate and transparent in our work,” said
Corcoran, who intends to take public testimony at each meeting.
Lawmakers need to change policies in four areas to implement the
ACA. State health regulations, in some instances, conflict with the
federal law. The health benefit package for state employees differs from
ACA requirements. Whether to set up a state run health exchange and
whether Florida will expand Medicaid coverage to about 900,000 Floridians without health coverage must be decided. A U.S. Supreme Court ruling last year allows states to opt out of the expansion.
"The Affordable Care Act because of its scope and all the regulations
that are created, it’s the largest expansion of the federal government
in my lifetime,” said 46-year-old Rep. Matt Hudson, R-Naples.
"We are making a decision that is going to affect the state of Florida
for decades to come and ... I think it is incumbent upon us to make
sure we have all the information necessary to make a well-founded
Between now and the end of April lawmakers will explore how to bring Florida into compliance with the ACA. Sen. Joe Negron, R-Stuart, chairs the Senate committee on ACA and plans to address regulatory issues next week. Not only does the Office of Insurance Regulation have
no authority to enforce ACA requirements, some of Florida’s
pro-consumer regulations are at odds with the federal mandate. And OIR
is expected to ask for more employees to review an expected flood of
applications for new insurance plans companies want to sell in Florida.
Negron began the Senate’s deliberations on ACA by inviting five
executives to discuss the law’s effect on businesses. The panelists
included representatives of large, medium and small companies.
Businesses can either match ACA requirements or pay a penalty.
Kim Williams, president of Marpan Supply Co. in
Tallahassee, told the committee that the uncertainty surroundingthe
cost of complying with the ACA, the threshold for Medicaid eligibility
and the extent of coverage offered through a health insurance exchange
is paralyzing. He said that currently small business owners don’t know
what options will be open to them and their employees in 2014.
"A lot of small businesses out there are seriously considering that
they are going to have to go out of business because of the convoluted
way this plays out,” Williams sald. "I would say to all of you all that
it is great to sit around and say that you are going to solve this one
day but the best thing that could happen is if we knew the answer
Negron expects to take up expansion during a February meeting.
Medicaid consumes almost a third of the state’s budget. The federal
government will pick up the full cost of the expansion initially and
then 90 percent after 2020. Estimates of the cost to Florida range from
$3 billion to $8 billion over 10 years.
"I want to pursue consideration of an option where there is a premium
subsidy that would come from the federal government that can be used by
a person,” said Negron of an idea he wants to explore. "(It would)
say, hey we’re going to empower you with this subsidy to either go
online to the exchange or to pick from a Medicaid-approved plan.”
Negron said he hopes to have recommendations for the Senate to consider by the second week of the session, which begins March 5.