Several major South Florida healthcare leaders applauded the Supreme Court’s decision Thursday on the Affordable Care Act because they say it will bring more access to the region’s large number of uninsured and allow for providers to get paid for their care.
But doctors leading the Miami-Dade and Broward medical associations said they’re concerned whether physicians will be reimbursed enough under the new legislation. The leader of Florida Blue, the state’s largest health insurer, warned of increased healthcare costs ahead, while Jackson Health System leaders worried about considerable reductions in funding. And individual reactions ranged from calling the ruling a life-saver to decrying the decision as creating rampant socialism.
The stakes are huge for the region’s uninsured — 31.8 percent of Miami-Dade residents, 24 percent in Broward and 32 percent in Monroe County, according to 2010 Census data. The national average is 16.3 percent. Among adults from 18 to 64, the potential effect is even greater: 57 percent of Hialeah residents in that age group are uninsured, 50.4 percent in the City of Miami, 48.5 percent in Deerfield Beach. Even in middle-class Kendall, almost one-third — 31.2 percent — of adults aged 18 to 64 now have no coverage.
Some residents were happy with the ruling because it retained provisions of the law already in force. “I am thrilled,” said Leslie Rosenberg of Hollywood, responding to an inquiry from The Herald. “Last year, our 22-year-old son was diagnosed with a brain tumor just 10 days after graduating from college. Because of Obama’s health law, we’ve been able to keep him on our employers’ insurance policies (despite an extremely high cost) and have him receive outstanding medical care. A year later, he is doing well, and I believe it’s because we were able to have him covered by our policies.”
Al Rothstein, a Fort Lauderdale retiree, decried the act as a move by President Barack Obama “towards socialism,” possibly leading to a Republican backlash in November to kill the act. If that doesn’t happen, the act will lead to “increased healthcare costs and lowered quality of care,” Rothstein said, responding to an inquiry from The Herald.
“This is a big win,” said Donna Shalala, president of the University of Miami who in the 1990s tried and failed to win passage of healthcare reforms when she was secretary of Health and Human Services for the Clinton administration.
“It’s a win not just for those who are uninsured but also for those who do have insurance,” because providers have been shifting the costs of treating the uninsured to those who do have coverage, Shalala said. She called the reform act “a first step toward ending cost-shifting. ... It helps every emergency room across the state.”
Healthcare leaders were braced for the ruling in South Florida, where the large number of uninsured seeking access to healthcare account for $16 billion annually, a larger slice of the region’s revenue than tourism or construction.
When asked how she felt personally, after spending so many years trying to get reforms enacted, Shalala replied: “It’s thrilling, actually.”
Hospitals, now required to treat the uninsured in emergency rooms even though they rarely get paid for such care, appear to be the biggest winners. Linda Quick, president of the South Florida Hospital and Healthcare Association, sent out a one-word email moments after the decision was announced: “Yay!”
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.”
Some efficiencies, however, are being encouraged by the act, including the creation of accountable care organizations in which providers join together to provide coordinated, cheaper care with less repetition. Baptist Health South Florida, Florida Blue and a doctors’ group recently announced the start of one such effort.
On Thursday, Baptist issued a statement that going forward, “the burden is on all hospitals, doctors, insurance companies and healthcare providers to collaborate on improving quality, reducing costs and eliminating waste.”
The act, which runs to more than 2,000 pages, had already left many South Floridians confused. Tony Perez, a South Dade resident and retired military reservist, was enthusiastic about one provision, which allowed parents to keep adult children on their policies up to age 26. Perez had his family on Tricare, the health policy for the military, but Tricare rejected his 24-year-old son, saying the law didn’t apply to that company.
“It seems odd to me,” Perez said. “I don’t really understand the logic here.”
Tricare did not immediately respond to a request for comment.
Corinna√ Olson, an Episcopalian priest in Miami, said in response to a Herald inquiry that she was “very happy” about the Supreme Court ruling. “It will change for some of my family who had troubles getting insurance because of pre-existing conditions.”
She added: “I did pray for this outcome.”