While Gov. Rick Scott and the Florida Senate have put forward Medicaid expansion plans that attempt to cover 1 million uninsured residents through private insurance, Florida House Republicans responded with Florida Health Choices Plus?not so much a proposal for reducing the state's high uninsured rate, but rather a 46-page treatise on why private insurance is better than Medicaid.

But Florida Health Choices Plus leaves hundreds of thousands of people in the state without Medicaid or private insurance. It's like saying that steak is better than hamburger, but if you pay me $25 a month, I?ll give you cat food.

The debate underway in Florida now is not between Medicaid and private insurance. Gov. Scott's acceptance of Medicaid eligibility expansion in February came tied with a waiver from the Centers for Medicare & Medicaid Services to expand Florida's mandatory managed Medicaid program statewide. When the House report repeatedly argues that private insurance is better than Medicaid, they are actually offering reasons to support the Scott Plan, or the compromise Negron Plan from the Senate.

Instead, the House proposal is based on a false dichotomy between Medicaid and private insurance, noting differences in access to care and mortality rates. The House proposal states that ?clinics in Jacksonville were more willing to see a patient offering to pay just $20 than they were to see a Medicaid patient,? ignoring the fact that Medicaid in Jacksonville is already privatized through the mandatory managed Medicaid pilot.

Either the Scott Plan or the Negron Plan would move about 1 million new Medicaid beneficiaries into private managed care, but the House's Florida Health Choices Plus optimistically projects to enroll only 115,700. Realistically, far fewer would enroll.

Florida Health Choices Plus offers the poorest working parents in the state high-deductible insurance for $25 a month. People living under the poverty line would be hard-pressed to pay that much for quality health insurance. The coverage under the House plan will likely be minimal and come with a $7,500 deductible, about a third of a participating family's income (The Florida Current). The young and healthy will simply not enroll, while older and/or sicker participants might be better off uninsured, relying on the kindness of charity care. Simply put, Florida Health Choices is not designed to attract low-income uninsured residents, but primary voters.

Health insurers were eagerly anticipating the Scott Plan, with millions of potential customers getting no-premium insurance subsidized by the federal government. But what insurers will compete for a non-proven marketplace that might serve a hundred thousand?probably far less? The House report gives a clue, touting Charter Health Plan, a product offered by safety-net Sarasota Memorial Hospital. Tax-supported safety-net hospitals and federally qualified health centers may be the only healthcare organizations willing to participate?hardly the vibrant private marketplace envisioned by the House.

If Florida Health Choices Plus does enroll 115,700 people, it will cost the state $237 million, which would actually cost more than the plans to cover 1 million uninsured through Obamacare, according to some estimates. But few people would actually enroll in the plan, sending the proposal to the heap of other Florida non-starters. So it is appropriate that the framework and namesake for the proposal should be Florida Health Choices.

Florida Health Choices was started in 2008, championed by then-Speaker of the House Marco Rubio as a free-market health insurance exchange for individuals and small businesses. I?ve been tracking Florida Health Choices since 2011, and there is a consistent pattern: the exchange promises to start enrolling members by a date certain, but when that time comes around, officials claim that the program has been postponed by a few months. Most recently, the exchange was supposed to open for business in January 2013, but the opening has been pushed back to May.

Florida Health Choices Plus is designed to operate in the same way, existing in name only. On Monday, the House Select Committee on PPACA voted to move Florida Health Choices Plus to the chamber's Appropriations Committee. The Senate's Negron Plan has received the approval of Gov. Scott. It is becoming increasingly unlikely that these two proposals, reflecting diametrically opposed views on the uninsured, will be resolved by the end of the session on May 3.

Follow Mark Cherry on Twitter @MarkCherryHLI

Follow Mark Cherry on Twitter @MarkCherryHLI

 

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