Florida Court Declares Balance Billing Out of Bounds

A Florida appeals court recently affirmed that the state’s HMO Act specifically prohibits balance billing by providers, including those not under contract to the HMO. The case was brought by 52 subscribers of an HMO who sought to block a non-contracted provider of anesthesia services from billing them for amounts not paid by their HMO. The case is Riley vs. Florida Health Care Plan.

In Florida, Medicaid Change May Wither

When he was governor of Florida, Jeb Bush pushed through some sweeping changes of Medicaid, a program that needs some reform.

The changes, which were limited by the legislature to just a few counties, have never gained much support. The experiment, in fact, may end next year, reports the Miami Herald.

Florida Governor: Nurses, Come Work Here

Gov. Charlie Crist (R-Fla.) has signed an executive order allowing nurses certified in other states to work in Florida. It’s only a temporary measure, taken in the aftermath of the Haitian earthquake. It’s good to see someone see the importance of measures that might increase the availability of health care, not through increased subsidies and regulations, but through a loosening of regulatory controls. Perhaps this can serve as an inspiration for allowing Floridians to purchase health insurance certified and regulated in other states, rather than be limited to what the Florida state government approves.

Would You Like a California Cash Cow or New York Pork With Your Florida Flim Flam?

California’s recent budget deficits will look bush league relative to the fiscal hurricane that federal health reform will unleash on California and many other states.   The problem stems from the expansion of Medicaid, the program for low-income residents, jointly funded by the federal and state governments.

Most observers anticipate that if President Obama does sign a bill this year, it will look more like the Senate bill (an amendment to H.R. 3590), which would pull millions of Americans into government dependency for their access to medical services via an expansion of Medicaid.

The Congressional Budget Office (CBO) reckons that 15 million more people will enroll in Medicaid if the Senate bill becomes law (p. 8), which is just a whisker less than half the total number of persons the CBO forecasts will be newly insured, 31 million, as a result of the “reform.” This is like the government stating that it will reduce the number of jobless by putting millions more on welfare and classifying them as “employed.”

From 2014 through 2016, the federal government would cover the entire cost of roping these people into Medicaid. By 2019, however, the federal government would pay only about 90 percent of the costs of Medicaid expansion, leaving the states to pick up 10 percent. That’s how it was supposed to work, until we learned about elements in the bill such as the “Cornhusker Kickback.”

Senate Majority Leader Harry Reid bought Senator Ben Nelson’s vote in favor of the bill by promising that Nelson’s state of Nebraska would never have to pay for any of the Medicaid expansion. The federal government or, more properly, the taxpayers of California and 48 other states, would pay for Medicaid expansion in Nebraska. Similar deals for other senators were labeled the “Louisiana Purchase” and the “Florida Flim-Flam.”

Some governors are getting pretty uncomfortable with the way the deal has been hammered out. In a pre-Christmas letter to Speaker Nancy Pelosi, Governor Schwarzenegger charged that the federal plan levied an unfunded mandate on California that would cost the state $4 billion to $5 billion.  But he’s unlikely to get a “California Cash Cow.”

Many states, including California, have long since convinced the federal government to allow them to increase Medicaid eligibility. Of course, this has allowed them to draw down even more federal dollars. (Before the February 2009 “stimulus” bill, the federal government paid for 57 cents of each Medicaid dollar, on average.) Because these states have already bloated their Medicaid programs, they will not enjoy the bailout the federal “reform” offers states that have limited Medicaid enrollment to date.

One of the 24 measurements in the U.S. Index of Health Ownership is the level of Medicaid eligibility. A state scores low if it has recklessly expanded government dependency in this way. In the third edition (2009), California ranks 30th out of 50 states but plenty of states do worse. Consider New York, a lowly 45th in the Index’s measurement of Medicaid eligibility.

“We are, in a sense, being punished for our own charity,” moaned Governor David A. Paterson, in response to the proposed Medicaid funding formula. “Charity” is an interesting noun to describe the Empire State’s approach to Medicaid. Last July, New York State and New York City agreed to pay the federal government $540 to settle allegations from the U.S. Department of Justice that they had submitted false Medicaid claims! A December 26 audit by state Comptroller Thomas DiNapoli accused the state’s health bureaucrats of recently approving $92 million in fraudulent payments.

Wendy Saunders, New York’s Deputy Secretary of Health, now shamelessly suggests a heaping plate of “New York Pork.” She thinks the federal government should throw an extra $30 billion New York’s way over 10 years, above what’s currently in the Senate bill. Unfortunately, in order to convince its stenographers in the media that the “reform” is deficit neutral, the majority took such drastic steps as proposing a luxury tax on tanning salons and cutting about $400 billion from seniors’ Medicare benefits.

All this comes in order to fund a significant expansion of government, a plan supposedly too big to fail. Governors Schwarzenegger and Paterson, and their long-suffering taxpayers will soon learn, however, that the feds are unlikely to find the dollars for more bailouts.

Florida AG on Personal Mandate: It’s a Tax on Living

“It’s a tax on living.”

That’s what Florida’s attorney general, William McCollum, recently said of the personal mandate provision of congressional health legislation. McCollum is joining a list of attorneys general who might challenge the constitutionality of Pelosi-Reid-ObamaCare.

Sen. Bill Nelson’s Florida Flim Flam

The Miami Herald breathlessly asserts that U.S. Senator Bill Nelson has “preserved” Florida’s Medicare benefits.  (Hat tip to John Goodman.)   This is because the “Florida Flim Flam” that he swapped to give Senate Majority Leader Harry Reid his vote in favor of the federal take-over of Americans’ access to medical services will allow Florida’s seniors to keep access to Medicare Advantage plans.

Medicare Advantage allows seniors to use private insurers to give Medicare benefits.  While far from perfect, Medicare Advantage has significant advantages over the traditional, government-monopoly model of Medicare, as I have recently examined.

Here’s an interesting notion: If Medicare Advantage provides superior benefits to traditional Medicare benefits, then the “Florida Flim Flam” will increase the immigration of seniors from other states into Florida.  However, Florida is also Ground Zero for Medicare fraud.

One reasonably presumes that the fraudsters are able to operate more successfully in regions where Medicare beneficiaries are a larger share of the population.  So, Sen. Nelson (FL) may be responsible for a forthcoming increase in Medicare fraud!

State Sovereignty Resolutions: The NY Times Weighs In

A number of state legislatures are considering resolutions affirming their constitutionally-based resistance to the federal government taking over every American’s access to medical services.

According to the New York Times, legislators sponsoring these resolutions are merely carrying water for various corporate interests in the health sector.   Conspiratorially, the NY Times asserts that the idea of state sovereignty over health care popped up at the Goldwater Institute in Arizona, and was then picked up as a theme at the American Legislative Exchange Council (ALEC).  The NY Times asserts that this was because ALEC’s Health & Human Services Task Force is “overseen” by a four-member panel composed of representatives from the Blue Cross/Blue Shield Association, Johnson & Johnson, Bayer, and Hoffmann-La Roche.

Good Grief!  I am a private-sector member of the ALEC HHS Task Force, and I can assure the world that nobody “oversees” it.  It is a lively forum of discussion about model legislation that adheres to principles of limited government.  The push for state-sovereignty resolutions is led by legislators such as Linda Upmeyer (Iowa) and Rep. Nancy Barto (Arizona), supported by various think-tank members, such as Clint Bolick of the Goldwater Institute and myself.  (I testified at a committee hearing in Arizona on that state’s proposed resolution.)  Dr. Eric Novack, an orthopedic surgeon, launched the campaign for state sovereignty over health care.

I would be amazed if the Blue Cross/Blue Shield Association, Johnson & Johnson, Bayer, or Hoffmann-La Roche, cared a hoot about state sovereignty over health care.  But according to the NY Times, appeals to limit federal power over access to medical services can only come from corporate lobbying.

Fraud in Government Programs

Some advocates of government-run (or at least government-paid, which in the end amounts to the same thing) health care say we should have “Medicare for all.”

How about Medicare for thieves?

Fraud in the Medicare program is a big problem, and lax enforcement is one reason why it is so “efficient.” It pays claims without the same sort of rigor that private-sector insurance companies apply.

Here’s one example of the extent of Medicaid fraud: Officials have arrested 30 people in south Florida for defrauding Medicare to the tune of $61 million. That’s over $2 million per person. Not a bad income, though of course a dishonest one.

And then there’s this: “Last week, the HHS Office of Inspector General issued an alarming report that found Medicare paid $520 million to Miami-Dade home healthcare agencies in 2008 for treating diabetic patients — more than the agency spent in the rest of the country combined.”

The “Public Option” in Florida’s Homeowners Insurance

When a unit of government creates a business, the business is going to (surprise!) reveal its political roots.

When lawmakers didn’t want Citizens to compete with private companies, they required it to charge high rates. When lawmakers wanted to give relief to hurricane-addled homeowners, they suppressed its rates.But here’s something to think about the next time politicians or customers debate whether premiums are too high or too low: Citizens has never charged the proper rates to insure homes.

The story is about property insurance, but it holds some lessons for health insurance as well.

Speaking in Defense of Benefits for Politicians

It’s time to do something unusual here–defend the politicians.

Health benefits enjoyed by state employees, including legislators, is coming under scrutiny these days, driven both by the civil service protection that public employees have and the rich benefits contained in their insurance plans.

There’s certainly a populist angle to that criticism, which is reflected in this allegedly straight-up news report from the St. Petersburg Times.

Beth Reinhard and Marc Caputo criticize lawmakers who oppose the particular health reform proposals moving their way through Congress while still getting health insurance on the public’s dime.

Hypocrites!

At least that’s what Reinhard and Caputo imply. But even legislators are employees of the people, and as such, deserve to be compensated for their work. Whether they should be paid $10 a year or $100,000 a year is a matter for debate of course.

Once it’s decided that the legislators will in fact be compensated, the question becomes which forms of payment their compensation will take. It may be in an annual salary, a per-diem allowance, a retirement package, an insurance package, or any combination. As the state’s chief financial officer put it, “When you have employees who pay no premiums, it’s a part of their total compensation package.”

The question for the public should be whether it is paying enough (or too much) in total compensation for its employees. Another fair question, if state employees receive some sort of health benefits plan, is what it will look like: Will it be high-deductible or low-deductible? Will it include co-pays or not? Will it be a defined-benefit plan or a defined-contribution plan?

There’s nothing inherently wrong with a public employee getting paid with a “Cadillac insurance plan,” as long as the cash payments are adjusted to take that into account.