In the wake of the Massachusetts health reform and California’s recent attempt at an overhaul, more states are jumping on the bandwagon to “cover the uninsured.” That can be a tricky matter, like health reform in general.
Gov. Charlie Crist’s 2008-09 budget includes a few costly reforms including expanded coverage for uninsured Floridians. This has already summoned skepticism from Republican legislators who want real spending cuts instead of spending “shifts” for new projects.
His “Cover Florida Health Care Access Program” is a $64 million, three-year pilot program that would attempt to provide primary care, prescription drugs, access to specialists, and chronic disease management for Florida’s uninsured. Another $60 million in the governor’s proposal would enroll 46,000 more children into the state’s KidCare program, which provides low-cost health insurance for children whose families are stuck in the “income gap,” earning too much to enroll in Medicaid, but unable to afford private health coverage.
Unfortunately, the Sunshine State faces a deficit of $2 billion. Gov. Crist seems to understand, however, that funding doesn’t fall from the clear Florida sky. He won’t raise taxes for his new proposals, but he does intend to cut some $230 million in spending and make some large funding transfers from existing reserves.
In this time of economic volatility, Florida legislators are still wary that financial estimates could weaken, that gambling proceeds are not reliable, and that tax collections are on the decline. Republican lawmakers are particularly committed to real, structural spending cuts rather than shifting money from existing state funds for new policy plans.
The governor’s plan may take some heat from these cautious legislators, expected to vote on a budget in May. But the governor should be tentatively applauded for proposing bold solutions for the state’s uninsured, without the mandates or tax increases that condemned Gov. Arnold Schwarzenegger’s plan in California and are hurting Massachusetts with potentially huge taxation and more government spending in the near future. In health care, Gov. Crist has embraced incremental yet practical health reforms that wouldn’t shove the state budget into “bold” red.
The Florida governor has talked about modifying state laws to allow businesses to join together and leverage their buying power to provide cheaper insurance for their employees. He wants to allow insurers to sell a broader variety of low-cost health policies with flexible insurance benefits molded to specific patients’ health needs.
Another good idea the governor outlined in his recent budget is to reduce the “red tape” that restricts the construction of new health facilities.
He wants to repeal the certificate-of-need law for acute-care hospitals. This will promote more competition among hospitals and freedom to offer a wider variety of low-cost services to Floridians. He would also encourage patients to use health clinics instead of flooding emergency rooms by extending clinic service hours to nights and weekends. These are good moves, but there is one place where Gov. Crist is misguided.
He says he believes in improving the quality of care through innovation, but supports the piracy of drugs from Canada. Foreign countries often benefit from our R&D and then price-control our products for their own citizens. Meanwhile, it costs between $800 million and $1 billion to bring a new drug to market here in the United States. When Americans then purchase valuable drugs with these foreign price reductions, it hurts American medical innovation.
Nevertheless, avoiding tax increases and lifting barriers to competition in health care are certainly the right way to approach reform. The best way to make it more likely that patients will undertake appropriate preventive care is to give them health care dollars to spend — not just move government contracts from hospitals to managed-care companies.
Former Gov. Jeb Bush made a good start with his pilot project to give Medicaid patients Health Opportunity Accounts. Gov. Crist would do well to use that as a model as he negotiates with the legislature.
Diana M. Ernst is a health care policy fellow at the California-based Pacific Research Institute.
