After years of failed attempts to expand Medicaid insurance coverage in Florida, one recently-formed group is pushing for something more — single payer.
Normally that means complete government control of health insurance.
But the drive for a package of constitutional amendments is focusing on a strategy that keeps private insurance intact.
The basic premise of the initiative is to create a sort-of public option for Floridians seeking health insurance. Instead of having the state administer the coverage, a private insurer will said the man behind the plan, Ramon Day.
“I’m a self-described corporate, Wall Street Democrat,” he said.
He said his organization Floridians Advocating Insurance Reform, or FAIR, was dreamt up after asking his friend, doctor Shyam Paryani what he thought needed to be done to stem runaway health care costs and insurance premiums.
“He said a single payer system. I have always been very skeptical, but I said ‘okay, tell me why.” He said ‘well, you can achieve tremendous economies by going to a direct payment system,’” he recalled.
So Day, the self-described capitalist, set out to come up with a way to create a single-payer option that keeps the private insurance market intact.
The plan is to set up a statewide health insurance governing board to choose a single private insurer through a competitive bidding process. That insurer would then be responsible for covering Floridians who opt in. To pay for it, they want to impose a special fee on businesses and individuals and create a trust fund where those fees will be collected.
If that wasn’t enough of a heavy lift already, Day is also calling for a statewide right to health coverage.
He said this would be a hard sell to a legislature that has consistently rejected even expanding Medicaid. So, the only option left is a voter-approved constitutional amendment.
But because amendments have a rule mandating each proposal address a single subject, Day and his colleagues are filing the four proposals separately.
Timothy McLendon with the University of Florida’s Center for Governmental Responsibility said as novel of an approach as this seems to be, it’s been tried before.
“It was pioneered, to my knowledge, back in, I think, 1994,” he said. “It was a package of four amendments that were proposed by the Tax Cap Committee.”
That same year McLendon was part of a group trying to get extra environmental protections and a sugar tax in the constitution. The Florida Supreme Court rejected it because the single amendment “tried to do too much.”
McLendon’s group tried passing three amendments two years later — one that created the sugar tax, another with the protections and a third creating a trust fund for the tax money to go to. However, only two of them passed — the trust fund and the extra protections.
“They need to be careful, and I’m sure that they have this in mind, that all of the pieces of their amendment would be functional on their own. And I suppose they also have to think that if they got one or two of the four, it would still be some incremental advance towards their goal, I suppose,” he said.
McLendon said since his sugar tax didn’t pass, the trust fund’s yearly allocation is up to lawmakers, who may not be as supportive of his initiative.
Exactly how FAIR will word their ballot language is still being decided, according to Day. The group has three years to solicit the required citizen signatures, get Supreme Court approval and push forward with a campaign to get it passed at the ballot box.
Ryan Benk can be reached at rbenk@wjct.org, 904-358-6319 or on Twitter at @RyanMichaelBenk.
