If you thought that the state of Florida had seen the last of the controversial health care proposal known as CorcoranCare, you’re probably not alone. That proposed change to Florida health care delivery was initially presented by former Republican House Speaker Richard Corcoran nearly half a decade ago, and involved the creation of a private prepaid system to fund the use of primary care physicians, while directing money received for Medicaid use into a subsidy program to help low-income residents purchase private insurance. Now, with the Congress debating the repeal of the Affordable Care Act, some Florida lawmakers are returning to the Corcoran proposal as a solution for the state’s needs.
The CorcoranCare Expansion Proposal
Florida residents who remember the legislature’s attempt in 2013 to expand Medicaid in the state probably also remember at least some details about the debate back then. The expansion plan under debate was drafted by Corcoran, and put on a fast track. Known as HB 7169, CorcoranCare proved to be as divisive in the Florida legislature as Obamacare was at the federal level. The parties divided along partisan lines, with Democrats in opposition and Republicans backing the measure. Readers will no doubt recall that the opposite dynamic occurred during the Affordable Care Act’s passage, and that law passed with only Democratic Party votes.
Two years later, the bill still hadn’t obtained passage, and the measure was scuttled by Republicans in the Florida House. At that point, Medicaid expansion in the state of Florida was blocked for the immediate future. Corcoran himself helped to lead the effort to shut down the legislative process and stop expansion altogether.
While the bill’s detractors will probably dig in their heels again, there are many things to like about the proposal. One of the most important positive features is its emphasis on promoting free market health care solutions rather than just forcing people to obtain health insurance coverage. To understand why that’s important, it’s critical to understand the history of the health care debate and how we got to this point.
A Focus on Costs
Hardly anyone seems to remember that the desire for health care changes in recent decades has been largely motivated by the need to do something about rising costs. It was not, after all, a lack of insurance that most directly impacted most Americans prior to the passage of the ACA. The problem was that health care in the United States increased in cost to the point where people couldn’t afford to cover those costs on their own. And, as you might expect, those rising costs had a direct impact on the cost of insurance as well – leaving millions unable to pay the premiums for health care insurance policies.
The ACA did nothing to address the underlying problems, which is why premium costs have risen so dramatically even after its passage. As long as health care costs continue to increase, insurance premiums will as well. And that’s a recipe for disaster, no matter how you spin it. If anything, the ACA demonstrated a complete lack of imagination, since it merely doubled down on the existing system, without offering the types of structural changes needed to change the current price and care delivery trajectory.
By forcing people to either purchase expensive insurance policies or sign up for government-financed health care in the form of Medicaid, Obamacare exacerbated the problem. It added hundreds of billions of dollars to the costs associated with the Medicaid program, caused millions of Americans to lose insurance policies that were suddenly deemed inadequate by the new law, and trapped millions of others in exchanges that offered no reasonable price options. Meanwhile, health care costs – and insurance premiums – continued to rise.
The proponents of CorcoranCare argue that this will all lead to disaster for the state budget. It’s hard to dismiss that argument as meritless, since it’s difficult to imagine how government at either the state or federal level can continue to spend tens and hundreds of billions of dollars on ever-rising health care costs without eventually facing some harsh budget realities.
Change won’t come easily, however, as powerful forces continue to be arrayed against the new proposal. Some are even arguing against the effort to repeal the certificates of need that currently limit the number of health care facilities that can be in any given area. Hospitals, nursing homes, and other special interest groups argue that repeal of that limitation will result in danger for patients and increased costs. Naturally, there are those who wonder how increased competition will drive up prices – especially when the opposite occurs in every other area of economic endeavor.
There are a host of measures included in the bill, and these will be debated in the weeks to come. Some measures seem to be based on common sense ideas like transparency and full disclosure – such as the provision that would have medical providers list prices for the procedures they perform. Others include different payment and insurance options, including health savings accounts, reimbursement plans, and flexible spending options. There’s even a proposal to provide more autonomy for advanced practice registered nurses. That one has received vehement opposition from the leading doctor’s lobby.
The stated goal is to provide a new way to deliver health care to Floridians, enabling care to be customer-driven in the same way that other industries operate, to provide expanded choices and more informed consent from patients about the type of care options they choose. According to its Republican supporters, the proposed law would ensure that all health care options in the state are wedded to a competitive private marketplace. That includes Medicaid assistance.
The Debate Continues
As the debate continues, the estate planning and elder law attorneys at Kulas & Crawford, Medicaid & Estate Planning Attorneys will continue to monitor developments to ensure that we stay on top of our clients’ needs. Throughout that process, we’ll continue to be here to provide you with the estate and Medicaid planning assistance you need to safeguard your future and your family’s interests. To learn more about how an effective estate plan can help to better protect your loved ones’ future, contact us online or call us today at (772) 398-0720.