Later, she added: “I am gratified that another two million-plus Floridians will be insured.”
Kutty Chandran, a Coral Springs internist who heads the Broward County Medical Association, said doctors “are confused by the law.” Having more patients with insurance is certainly a plus, but in many cases, that will mean Medicaid, the state-federal insurance for the poor, which has provided notoriously low payments to doctors.
Chandran also said he was concerned that the law could lead to more bureaucratic meddling that “would interfere with the doctor patient-relationship.” If payment is too low, he envisioned doctors not treating Medicaid or Medicare patients. “Polls show that the majority of the people don’t like it,” he said of the law’s requirement that people have insurance, “but the court likes it.”
More upbeat was Elizabeth Etkin-Kramer, a Miami Beach obstetrician-gynecologist who is president of the DadeCounty Medical Association, who said “there are a lot of very good things about the law — especially contraceptives being covered,” along with preventive care. But, she added, “the nitty-gritty of the finances are yet to be seen.”
Florida Blue executive Jon Urbanek said his company is ready for the change: “It’s full speed ahead.” He said some parts of the law clearly benefit consumers — such as preventive screenings without insurance co-pays — but added that Florida Blue was already working to lower costs, increase quality of care and heighten consumer awareness.
He also said the company is preparing to deal with provisions of the act that start in 2014, including rate adjustments that likely mean higher premiums for younger people and the requirement that certain benefits be mandatory in insurance policies — resulting in higher premiums for those who presently have policies with fewer benefits.
The Jackson Health System is also anticipating problems. Brian Dean, vice president of finance, said Miami-Dade’s public hospitals expect they could lose between $100 million and $150 million annually in special federal funding that now goes to support its treatment of the uninsured. Under the healthcare act, the money will go to support consumers being added to Medicaid. “This could have a profound impact,” Dean said.
Another complication: About a third of Jackson’s uninsured patients are undocumented immigrants, and the reform act specifically states that no federal funds will be provided for their care.
Jackson executives have “quite a lot of uncertainty” about how the act will play out, Dean said. One specific uncertainty: Uninsured patients who get Medicaid under the act will be able to choose among many hospitals, and Jackson will be challenged to become more patient friendly to retain those patients.
Sal Barbera, a former hospital executive who now teaches at Florida International University, said the act is “a great start.” But he said he doesn’t think it is strong enough and “healthcare costs will continue to escalate at a rate that is twice or three times inflation. ... Our healthcare system must change from a system that simply pays for service and utilization to one that pays for outcomes and utilization efficiency.”