While Florida Attorney General Bill McCollum challenges the legality of the new federal health-care law in the courts, the state's two leading health-care associations are split on the program's medical and fiscal impact.
"The federal health-care law will add millions to a Medicaid system that cannot adequately treat the people who are enrolled now," according to the Florida Medical Association.
Spokeswoman Erin VanSickle said that "while payment for primary care will be increased, unless we increase reimbursement for specialists, the access problem in this sector will get much worse.
"Obviously the state will hardly be in a position to increase specialist pay given the massive increase in enrollment that will result."
The state Agency for Health Care Administration anticipates that most, if not all, of the 4 million currently uninsured Floridians will end up on the state's Medicaid rolls.
With 2.7 million low-income residents already in the system, AHCA Secretary Tom Arnold expects that the current Medicaid budget of $19 billion would rise by at least another $1.2 billion under the federal plan.
The Florida Hospital Association is taking a wait-and-see approach, says its president, Bruce Rueben.
"There will be cuts to hospitals on such things as curbing unnecessary readmissions, but there are also a lot of Floridians who will be covered by health insurance," he said. "We don't really know the net effect yet."
But, Rueben added, there is "no reason to believe that any senior services will be cut."
The only ones taking a hit on Medicare, he said, would be the HMOs that have profited by selling Medicare Advantage policies.
Still, new analyses, including one by the Congressional Budget Office, suggest that young adults who would be required to buy their own insurance will pay an average of 17 percent to 30 percent higher premiums to compensate for the cost of senior health care.
Rueben argues that the primary focus needs to be on reforming the overall heath care delivery system. And he sees signs that could happen under Obamacare.
"Tie the payment method to outcomes instead of volume. This (national health-care reform) is a start."
The FMA, by contrast, warns that the quality of care will suffer under federal rules.
"Florida is already well below national average for number of physicians per population, signaling a current and future physician shortage," VanSickle said. "We fear that this problem will only get worse with the passage of the presidents health-care legislation."
But Rueben, of the hospital association, sees the glass as half full and filling with the federal health program.
"With 32 million more people being insured, there will be ample need for health-care professionals," he said. "The bigger challenge will be in meeting that need."
Rueben is hopeful that the federal program will "eliminate the bureaucratic nonsense" that creates an administrative drag on medical delivery. He said hospitals' back-office overhead has been growing due to ever-increasing insurance paperwork.
"I have as much reason to be optimistic as pessimistic," he said of health-care reform's ability to streamline accounting.
But AHCA is concerned that short-term gain may inflict long-term pain. While the health-care law requires the federal government to pay 100 percent of the cost of new Medicaid enrollees in 2014, reimbursements would ultimately scale down to 90 percent.
Meantime, the new law mandates that Medicaid reimbursements increase to Medicare levels, which are sometimes twice as high.
ACHA said Thursday that its projections of $1.2 billion in annual added Medicaid costs to the state by 2019 do not include expenses related to "administration of new program elements, changes to the federal pharmacy rebate or changes to state disproportionate share allowances."
Businesses are already running their numbers and weighing their options. Instead of furnishing the mandated health coverage, small- and medium-size companies might opt to pay a $2,000-$3,000 fine per worker and let their employees enter an insurance exchange at public expense.
Large corporations are already feeling the squeeze. AT&T announced last week it was taking a $1 billion charge because of reduced tax deductions for drug coverage for retired employees.
The American Benefits Council said the tightened benefits rules will depress corporate profits and discourage hiring.
The White House says its health-care overhaul will save businesses more than $150 billion over the next decade by reducing health-care inflation.
Anticipating a more top-down administrative model with strict rules and central control from Washington, state Rep. Matt Hudson says a "one-size-fits-all" model won't work in Florida.
"Medicaid was unsustainable before. Now it will go from bad to horrendous," said the Republican lawmaker, who opposed the federal program and supports McCollum's lawsuit against Washington.
Hudson, whose district stretches from Pembroke Pines to Naples, said the federal plan -- though it requires the purchase of health insurance -- doesn't address access issues when "so many counties don't even have hospitals and rely on local health departments."
The medical association agrees that more cost-effective, locally based alternatives should be pursued.
"We support the 'medical home' concept to return the focus to patients, cut costs and focus on preventative health. This would allow physicians to treat patients more effectively from the start, as well as helping to prevent inappropriate emergency room visits for basic health-care needs," said Tim Stapleton, executive vice president of the FMA.
SB 2532, by Sen. Durell Peaden, R-Crestview, would establish a pilot project for medical homes, which have been championed by the American Academy of Pediatrics as primary care that is "accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective.
Independent of the health-care agenda in Washington, Hudson is pushing two bills (HB 7183 and HB 1143) aimed at reforming the state Department of Health and the Agency for Health Care Administration.
"We need to bring checks and balances back between the executive and legislative branches," Hudson says. "We have agencies that are seeking grants without legislative approval. What happens when that grant money runs out?"
The Department of Health, which encompasses 11 divisions and employs 17,000 workers, needs a thorough overhaul, he says.
By giving the DOH six months to "redefine and refocus its core mission," Hudson hopes that one positive byproduct will be a more efficient organization that can respond more nimbly when federal health-care edicts start coming down.
But highlighting the ongoing split over the direction of health reform in Florida, Peaden and Hudson are engaging in a duel of their own.
Peaden, a physician who serves as the Senate's health budget chief, dismissed Hudson's House initiatives, saying, You need to leave it alone. Weve got enough problems. You dont need to create any more.
"Theres no efficiencies to be (had)," he said. "Weve got enough problems just getting the money in the right slot right now.
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Contact Kenric Ward at kward@sunshinestatenews.com or (772) 801-5341.
