The Sunshine State’s health care system is one of the worst in the country, according to a new survey from the personal-finance website Wallet Hub.
One Northeast Florida public health expert said that has more to do with state policy than it does with the quality of doctors.
WalletHub looked at three different health care factors: cost, access and outcome. Under its point system, Florida is near the bottom, at 38th best in the nation.
University of North Florida Public Health Chair Jeff Harrison said the study is fair and thorough. He noted the worst marks are in access and costs categories, and he’s looking to Tallahassee for change.
“Certainly the state Legislature can take a lead and can provide the infrastructure and the legislative support to move these forward and they need to,” he said.
Access/Coverage
Harrison said the Legislature could have done a lot more to raise the state’s ranking, especially in the access category. He pointed out that six of the study’s top 10 states have some form of expanded Medicaid.
Since the passage of the federal Affordable Care Act, Florida lawmakers haven't found agreement on expanding Medicaid to higher-income residents. The last attempt to collect federal dollars for expanding state-run insurance was a Senate-supported, private alternative that failed last year after the House rejected it and concluded the legislative session early.
Proponents of the plan said it would help the state deal with the expiration of federal funding for an indigent health care program called the Low Income Pool. But Governor Rick Scott and House Budget Chief Richard Corcoran, R-Land ‘O Lakes, concluded the funding problem could be resolved without drawing on federal dollars, instead the state could pass a package of laws tamping down on health care provider costs.
And Harrison said those measures aren't insignificant.
“These are controversial topics: The ability of other practitioners to practice independently — nurse practitioners, physician’s assistants [and] other individuals — that certainly has to be approved at the state level. And then you get to the issue of telemedicine, and telemedicine didn’t even exist 10 years ago,” he said.
Versions of two bills dealing with those areas of access were passed this year: One measure allows nurse practitioners and physician’s assistants to prescribe some controlled substances, but doesn’t permit them to practice independently of a licensed doctor. The other stops short of setting up a regulatory system for telemedicine and instead creates a taskforce that’ll make recommendations on a way forward.
Cost/Outcomes
WalletHub found that Florida has the second lowest adult insurance rate and the fourth lowest insurance rate for children.
That low insured rate is also a major reason why the Sunshine State ranks 31st in health outcomes. Without coverage, Floridians often seek medical help when conditions are at their worst and most expensive to treat rather than taking advantage of preventive medicine like primary care checkups.
Some opponents of Medicaid expansion disputed that, pointing to studies that showed spikes in emergency room visits by the newly insured, but others — like one UCLA survey — found that spike to be temporary.
UNF Professor Jeff Harrison said if you’re looking for why health care costs are so high in Florida, a good place to start is with the Emergency Medical Treatment and Labor Act.
“EMTALA allows everyone access to an emergency room regardless of your ability to pay … but what that does is it may force portions of the population that don’t have access to an expanded program into hospital emergency rooms, which creates a vicious cycle because you’re treating those individuals in a higher cost environment,” Harrison said.
Last legislative session, Gov. Rick Scott made it a priority to curb what he called hospital “price gouging” by pushing a bill creating an online database of average procedure costs at Florida hospitals. The measure also creates some penalties for hospitals who repeatedly charge a patient above a certain amount of the average rate.
Gov. Scott also signed into law a measure banning the practice of so-called “surprise billing,” which is when a doctor charges a patient for the difference between what their insurer covers and the procedure’s cost.
Insurance companies and health care providers will now have to duke it out in court over disagreements instead of involving the consumer.
Every First Coast hospital and the state Agency for Health Care Administration declined to comment on the implementation of that law.
Bright Spots and Loose Ends
The WalletHub study wasn't all bad. It found Florida is the fourth best in the country at retaining medical residents. That means most of those who study medicine in Florida stay after they graduate.
Harrison said a lot of that has to do with the Legislature’s focus on expanding medical programs.
“They’ve established at least three new medical schools in the past 10 years in the state of Florida, that being said there’s also a growing population,” Harrison said.
Still, that growing population could further strain the state’s health care finances. As WFSU reports, the newest state budget projection could spell trouble for the legislative process in 2017.
According to the estimate from the state Office of Economic and Demographic Research, Medicaid spending will increase, leaving lawmakers with $7.5 million for discretionary projects next year. Although that’s including squirreling away $1 billion in reserves, EDR foresees the state falling into a budget hole in 2018.
All of this is made worse by the fact the federal government’s contribution to the state’s Low Income Pool program for indigent health care is set to expire at the end of this year. That program began with the federal government matching a state contribution of $1 billion, then drew down to $500 million and ended this year with a contribution of just over $300 million. Without those funds, safety net hospitals, local governments and the Legislature will be responsible for covering the cost of health care for the poor.
Reporter Ryan Benk can be reached at rbenk@wjct.org, at (904) 358 6319 or on Twitter @RyanMichaelBenk
