Michael Garner, president of the Florida Association of Health Plans, said the health plan lobbying group is concerned about the bill’s potential “unintended consequences,” given the broad nature of healthcare reform.
“The industry is in the most transformative period possibly in our history … since Medicare and Medicaid came across in 1965,’’ Garner said. “We are looking at issues with patient care and affordable care, substantial changes with Medicaid in Florida with a state initiative that will change from fee-for-service to managed care.
“There’s so many uncertainties that have been created, especially because of the federal Affordable Care Act, that we’re trying to work through those issues,’’ he said.
Garner said his concern is primarily with the Senate’s version of the bill, which does not provide an exemption for certain health plans and proposes an effective date of July.
The House version of the bill exempts so-called “grandfathered plans,” as defined under the Affordable Care Act, and proposes an effective date of Jan. 1, 2015.
A “grandfathered plan” is a plan that existed on March 23, 2010 — the date the Affordable Care Act was enacted — and that covered at least one person continuously for one year. The designation allows customers to keep the insurance coverage they had before health reform.
Grandfathered plans are not required to provide the same level of benefits and consumer protections mandated for new plans under the federal act, and they are expected to cost significantly less for customers.
So if a grandfathered plan had to cover chemotherapy pills that previously hadn’t been covered, then that new obligation might annul the grandfathered status. And that could mean “substantially” higher costs, Garner said.
Legislators do not share Garner’s concern.
“This isn’t a mandate,’’ Mayfield said. “If an insurance company currently offers cancer treatment, we’re just saying you have to treat the out-of-pocket expense for the pharmaceutical side, the pill, the same as the intravenous side.’’
Benacquisto said legislators have researched the bill’s potential effect on health plans under the federal healthcare act, and they’re not convinced that grandfathered plans would be adversely affected.
“It has not been determined that the implementation of the Patient Protection and Affordable Care Act would conflict with the actions that we’re attempting to take, where people have access to these medications under their insurance policies,’’ Benacquisto said.
“It is a concern that we’ve heard,’’ she added, “but we’ve researched it, and we believe we’re addressing those concerns with the legislation.’’
According to a House legislative analysis of the bill, some health insurers may raise rates to make up for the increased cost of covering chemotherapy pills. But it is unknown how much rates would increase.
Supporters of the bills say coping with a cancer diagnosis is hard enough for patients without saddling them with thousands of dollars in bills every month for medication.
“There are tens of thousands of Floridians like me who are out there, making life and death choices,’’ said Webb, who has told his personal story before state legislative committees.