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Making the Investments Work: Important Benefits and Key Challenges in Implementing Health Reform in Florida

July 9, 2011 Comments off

Making the Investments Work: Important Benefits and Key Challenges in Implementing Health Reform in Florida
Source: Collins Center for Public Policy

This report (PDF) presents key features of the new national health reform law and explores the important potential benefits to Florida along with the main challenges. The report highlights the Medicaid expansion, health insurance exchange, and insurance market reform features of the Affordable Care Act. It also explains how the new benefits are funded and how that will affect Florida taxpayers. A few other important features of the law are briefly explained, such as the requirements placed on individuals to obtain insurance and larger employers to offer it or pay an assessment, and new grant opportunities related to improving health care delivery and financing.

The major conclusions of the report are as follows:

  • Florida has over 4 million uninsured, and the growing number of people without coverageHealth Care Reform Report leads to poor health outcomes; overuse and overcrowding of emergency rooms; a rising burden of uncompensated care provided by hospitals and physicians; reduced productivity and higher costs. The number of uninsured will continue to increase in the absence of reform.
  • State spending on health care has been growing sharply for years, and without major reform, would continue its upward spiral.
  • The Affordable Care Act would significantly reduce the number of uninsured people in Florida, improving the access of many residents to timely preventive health care.
  • Expanding Medicaid will involve new state expenditures estimated at $1.2 billion to $2.5 billion between 2014 and 2019. Each state dollar invested in Medicaid will draw at least ten new federal dollars to the state during this period.
  • By participating in national health reform, the state of Florida will invest money “on the front end” that will generate direct and indirect savings to the community as a whole (including the private sector) that, combined, exceed the new costs.
  • While expanding the number of people with insurance will reduce the uncompensated care burden, it also will place some new pressures on the health care delivery system. Florida will need more physicians, nurses, and other providers to meet the new demand. Medicaid payments need to be adequate to obtain provider participation, including physicians, both primary care and specialist, and dentists.
  • Coverage expansion will depend on effective outreach and enrollment efforts. Investing in community health workers, patient navigators and other outreach workers using new funds provided by the federal government can help to enroll newly eligible populations into Medicaid and provide appropriate follow-up.
  • Florida’s Medicaid program will need to meet the complex medical needs of newly enrolled patients, particularly poor adults without children.
  • Health Insurance Exchanges for individuals and small employers will be required under national reform to provide a broad choice of private insurance plans for moderate- and middle-income people. Participants with incomes up to four times the federal poverty line, or about $88,000 a year of income for a family of four, would receive federally financed subsidies on a sliding scale related to the size of their incomes. This is a major benefit to middle-class people in Florida.
  • Starting up and operating the Exchanges poses a number of implementation and management challenges to which the state must provide timely and careful attention. Florida needs to develop a multi-step plan to prepare for screening applicants to the Exchanges and Medicaid, coordinating a number of state programs, and working with federal agencies on verifications, determining eligibility for subsidies and/or Medicaid enrollment, communicating enrollment information to consumers and health plans, and securely transferring funds.
  • A major source of financing for the new law involves reductions in payment increases for various providers and health plans participating in Medicare. There are, however, no cuts in Medicare benefits under the new law. Also, hospitals, medical device manufacturers, pharmaceutical companies and other health-care providers and plans will experience new assessments under the law. Those costs, however, will be mitigated by the increase in paying patients as a result of the new coverage. People enrolled in Medicare will see the “doughnut hole,” or coverage gap in the middle of their prescription drug coverage, filled over the course of the next decade.
  • National health reform includes many new funding opportunities for states and health-care providers. These include substantial federal support for community health centers. The new law includes many grant opportunities related to improving the way health care is delivered and financed, with the goal of enhancing quality of care and patient safety, along with reducing the growth in total spending.
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