A year later, the good news is that a big spike in the number of uninsured doesn't seem to have materialized, although some insurers report anecdotal increases in the number of small businesses dropping coverage. Meanwhile, filings by big insurers indicate that health insurance rates are stabilizing, at least for the moment. They credit a slowdown in the growth in the number of people spending time in the hospital.
The bad news is that the same broad dynamics continue to rule the healthcare system -- inconsistent standards of care, massive numbers of uninsured people, too many direct and indirect subsidies, soaring pharmaceutical costs, distortions produced by Medicare/Medicaid, lack of accountability for doctors in their practices and for consumers in their lifestyle choices. The nation is still in the very early stages of wrestling with what will become an overhaul of how we provide and pay for healthcare. As Trend reported last year, Floridians like Brian Klepper and his Center for Practical Health Reform are playing important roles in facilitating change.
In the meantime, the trends for employer-based health insurance in Florida are unfolding along one of two lines, depending on the size of the company involved.
Employees of firms with more than 50 workers are beginning to see a rapidly expanding array of choices of deductibles, services and providers. After the premiums jumped on my health plan this past year, I wondered why I couldn't choose a lower-premium, higher-deductible plan that let me assume more of the cost of preventive and routine care but protected me and my family from a big-ticket medical catastrophe. Such plans are now on the market -- big insurers like Humana and Blue Cross now offer plans that cover, for example, the first few hundred dollars of expenses, with the consumer choosing a $1,500 or $2,500 deductible, and major-medical-type insurance picking up again after that.
Along with much more finely tuned choices, the process of selecting a plan is becoming more high-tech and data-driven. Humana offers an online resource that lets consumers use records of their healthcare usage -- number of doctor visits, prescriptions filled, etc. last year -- to answer questions posed by a computer program that then calculates which insurance options may be best in the coming year. Blue Cross will attempt to plug its customers into a number of information plans and resources to help them make good choices about providers and treatment options.
A subtle but intended effect of the "consumer-driven" plans is to educate them about the real cost of healthcare -- consumers will have to adjust the perception, created unintentionally by managed care plans, that a doctor visit actually costs $10 or $20. "The average cost of a pharmaceutical is $100. A C-section costs between $12,000 and $15,000, a natural birth is at least $5,000," says Randy Kammer, vice president of regulatory affairs and public policy for Blue Cross and Blue Shield of Florida. "People don't understand what those costs are."
Meanwhile, the outlook for smaller firms and their employees is still cloudy, but there have been some positive developments. Last year, a committee created by the state's Chief Financial Officer, Tom Gallagher, redesigned the so-called "basic" and "standard" plans the state requires insurance companies competing in the small-group market to offer.
The new plans, which hit the market this month, feature higher deductibles but preserve desirable components like pharmacy and maternity coverage, and they cost less than the old plans. Kammer, the committee's co-chair, says she's concerned -- based on a fax survey conducted through the Florida Chamber -- that employers have unrealistic expectations about the cost of offering basic coverage but expects the revised plans will help make coverage more affordable for many employers -- and employees.
Another glimmer of hope for the uninsured appeared during this year's legislative session as lawmakers revised legislation called Health Flex. The law is aimed at helping provide some level of coverage for the working poor; it allows insurance companies and noninsurers, including local governments and hospitals, to put together low-cost, insurance-like coverage plans free of many of the 48 mandated coverages the state requires of traditional health insurance. Lawmakers expanded the window for creating pilot projects until 2008 and will allow Health Flex plans to be marketed to groups as well as individuals. So far, only two Health Flex plans have been created, both in Miami-Dade County, with fewer than 200 people covered. The changes, it's hoped, will spur the creation of other efforts.
One national effort to watch as developments proceed in Florida is called SimpleCare. A group of doctors in Seattle got a big favorable response -- and turned around a money-losing practice -- when the physicians agreed to cut their fees to patients if the patients would pay at the time of service. Patients and some employers found major medical policies to cover themselves against catastrophic illness; everything else is pay-as-they-go. The doctors have since founded a nonprofit group to manage and expand the SimpleCare network.
Common to all these trends in the evolution of healthcare is the necessity for consumers to take a much more active role in managing both their health and the finances of their healthcare. The days of insurance as an old-fashioned security blanket are ending very rapidly.