The Affordable Care Act was all about access to health care, so that issue is resolved, right?
Access to health care is the third of five pillars the Blueprint details in its high-level plan to deliver better quality care and value to patients and improve the health status of Florida residents. (You can read previous articles on health care quality (pillar one) and health care costs (pillar two).
The two essential components to access to care are: 1) the ability to pay; and 2) the availability of health care services. On the affordability front, more than 40 percent of the uninsured in Florida are employees of firms with fewer than 10 employees. That may be because nationwide, the health insurance premiums of small businesses more than doubled between 1999 and 2009.
As of 2011, 48.6 million Americans, or 15.7 percent of the population, were uninsured. In Florida, 20 percent of the population is uninsured. The uninsured often wind up consuming more-expensive services in more-expensive settings. Ultimately, taxpayers and those who purchase private insurance pay this cost.
The value of health insurance is predicated on the availability of health care services, and current trends regarding the supply of primary care physicians add up to a brewing crisis. There is a shortage of primary care services in the U.S., and this problem is more severe in Florida.
A 2007 survey of fourth-year medical students indicated that only seven percent planned careers in adult primary care. The widening income gap between primary care physicians and specialists is driving these trends. And we cannot rely on the current supply and pipeline of non-physician primary care clinicians to address this shortage, according to the Blueprint.
The Blueprint for a Healthier Florida 2013 offers these six solutions:
1. Aggressive outreach to those who are eligible for public programs but are not enrolled. It was estimated that approximately 72 percent of uninsured children in Florida were eligible in 2007 for free or subsidized KidCare coverage.
2. Increase income eligibility limit for Medicaid for the entire adult population. In Florida, more than 27 percent of the uninsured have incomes less than 100 percent of the Federal Poverty Limit (FPL). Another 22.7 percent of the uninsured have incomes between 100 and 150 percent of FPL.
3. Establish appropriate reimbursement levels in the Medicaid program. Medicaid historically has reimbursed providers less than Medicare, leading to reduced access among the Medicaid population.
4. Guaranteed issue and the elimination of pre-existing conditions combined with an adequate individual mandate are essential to sustainable universal coverage. Program sustainability requires inclusion of healthy people in the health insurance pool. As such, an individual mandate should be enacted at the state level.
5. Provide incentives to small employers to offer employer-sponsored coverage. The most efficient method of distributing access to coverage is through employers.
6. Provide incentives to expand the capacity of the primary care workforce and bolster the pipeline of primary care physicians and advanced non-physician practitioners. We must increase the number of providers who have strong connections to minority and rural communities, as they are likely to practice there after training.
We’ll be covering the last three pillars of Florida Blue’s comprehensive health care transformation plan in future articles.
This information is for illustrative purposes only and is being provided to help increase understanding of the impacts of some of the provisions of the Affordable Care Act (ACA). It does not attempt to cover all of the law’s provisions and is not intended as tax or legal advice.