Daniel Chang, The Miami Herald, Author at �鶹Ů�� Health News

Could Medicaid Have Helped Miami Man Avoid Amputation?

Daniel Chang, The Miami Herald — Tue, 02 Jun 2015 13:23:40 +0000

The ulcer on Vincent Adderly’s right foot started as a small lesion on the tip of his big toe — a minor injury for many but a serious medical risk for a diabetic.

For Adderly, 46 and uninsured, the lesion meant trips to the emergency room and hours-long waits for a doctor to scrape the wound, bandage it and send him home with a prescription for antibiotics that Adderly said he could not afford.

But two trips to the ER later, the foot ulcer hadn’t healed and had become more painful. In late May, he went to a different ER. This time, doctors at Memorial Hospital West in Pembroke Pines gave him a grim choice: have the toe partially amputated to prevent a bone infection from spreading, or treat the wound with extended antibiotic therapy and hope for the best.

Adderly chose the amputation, a decision that put him on the front lines of a fight raging in Tallahassee this week over Medicaid expansion. If Medicaid were expanded in Florida — as provided for in the Affordable Care Act, but opposed by many Republicans — Adderly would likely qualify. And if he’d had the regular medical care Medicaid can provide, he and some of his doctors believe he might have avoided the amputation.

Vincent Adderly, 46, of Miami Gardens fills out forms in the medical records office at Memorial Hospital West in Pembroke Pines, Fla. on May 28, 2015. He is uninsured and diabetic and was at the hospital following his week- long hospitalization there. Part of the big toe on Adderly’s right foot had to be amputated. (Photo by Marsha Halper/Miami Herald)

“I’m evidence of time wasted,” said Adderly, who falls into a healthcare no-man’s-land that policy analysts call the . “This could have been avoided.”

Unemployed since 2008, the Miami Gardens man said chronic back pain from a car accident and spinal fusion, along with diabetes-related complications, have left him unable to work. He earns no income and does not qualify for financial aid to buy health insurance under the ACA, or Obamacare. Because he has no dependent children and is not legally disabled, Adderly also is ineligible for Medicaid in Florida — one of that have not adopted an expansion plan.

Adderly is among Florida adults, including about 140,000 in Miami-Dade and 80,000 in Broward, who would be newly eligible for Medicaid if the state were to adopt an expansion plan, according to the Urban Institute, a health policy research nonprofit group.

Caught in the coverage gap, Adderly said he has applied for Social Security Disability, which would make him eligible for Medicaid. But he also wants to commit his energies to advocating for Medicaid expansion — a choice that Florida’s Legislature has turned down twice already, in 2013 and 2014. The Legislature reconvened Monday in a special, 20-day session to pass a budget. The process broke down this spring over the issue of Medicaid expansion: the Senate offered a plan to help the uninsured that House leaders and Gov. Rick Scott oppose.

“This special session needs to be a session where they address people who have problems, like myself,” said Adderly, who has enrolled in civic engagement courses through a nonprofit group that advocates for Medicaid expansion, Catalyst Miami. “Why should I have to wait on special sessions when it should have been done the first time? If I was afforded the opportunity with Medicaid, or some type of insurance that Obamacare provides, I would have been able to go to a doctor.”

Kissinger Goldman, the emergency room doctor who first saw Adderly at Memorial Hospital West in late May, said there’s plenty of medical evidence that diabetics have better health outcomes when they receive regular care.

“The only way to do that,’’ he said, “is to see a primary doctor who is on top of you, who reminds you to take your medicine, who reminds you to take care of your feet, who reminds you to eat properly.’’

He said that preventive care, the kind emphasized under the ACA, could have helped a patient like Adderly avoid amputation.

“I see what happens when you don’t get preventive care,’’ he said. “You come to me in the emergency room.’’

Florida Rep. Carlos Trujillo, a Miami Republican, said there is no question that Adderly would have benefited from regular visits with a physician.

Trujillo, who opposes healthcare expansion under the ACA, said he also agrees that Adderly would have been better off with Medicaid than being uninsured. But he says those aren’t the questions dividing the Legislature.

“The question we’re debating in Tallahassee,’’ he said, “is whether Medicaid is the solution, and is it the responsibility of the state to offer insurance to individuals who have never been subsidized for insurance? … And if we do, where do we take the money from? Do we take it from education? Do we take it from transportation?

“There is a cost,’’ he said.

Under the ACA, Medicaid expansion was supposed to bridge the gap between the poorest Americans and those who make enough to qualify for government-subsidized plans. But the Supreme Court’s decision to make Medicaid expansion optional meant that Florida and 20 other mostly Republican-led states chose not to expand the state-federal insurance program for the poor.

For states that chose to expand eligibility for Medicaid, the health law requires the federal government to pay 100 percent of the cost of the newly eligible population through 2016, and never less than 90 percent thereafter.

According to advocacy groups and some state legislators, including Sen. Rene Garcia, a Hialeah Republican, Florida would receive in federal funding to expand Medicaid.

Trujillo, however, argues that Florida’s Medicaid costs have grown dramatically over the years, and that the program now accounts for “34 percent” of the state budget. But includes both federal and state dollars. In 2014, that broke down to about $14 billion from the federal government and and about $9.5 billion from the state.

Vincent Adderly, right, a 46-year-old Miami Gardens man who is uninsured and diabetic, walks past an employee at Memorial Hospital West in Pembroke Pines, Fla. on May 28, 2015. (Photo by Marsha Halper/Miami Herald)

Still, Trujillo said, uninsured Floridians such as Adderly need access to healthcare — but not necessarily Medicaid.

“What’s the best way to get him access? For us, it’s fighting — for transparency, for expansion of scope, for reduced costs — so Vincent can buy good, quality, affordable healthcare rather than end up on Medicaid,’’ he said. “Or is the solution to expand Medicaid and put people on these programs that not you or I could tell them if they would have a better outcome? It’s 100 percent speculation.”

For Adderly, though, there is no guesswork about his need for regular medical care. There is only uncertainty about how to get there, and an urgency to act while there’s still a chance in the Legislature.

“I’m feeling concerned,” Adderly said of the chances for Medicaid expansion in Florida. “But I’m even more determined to make this happen in Florida because there’s no more time to waste. … I’m an example of what happens when you wait.”

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Miami Children’s Hospital Part Of A Trend: Revealing Some Price Information

Daniel Chang, The Miami Herald — Sun, 19 Jan 2014 12:05:00 +0000

This story comes from our partner, the

As health insurance companies shift more financial responsibility onto consumers through higher deductibles, co-payments and co-insurance rates, hospital executives are feeling pressure to reveal their most closely-held secret: prices.

Last week, Miami Children’s Hospital became one of the first in South Florida to give consumers more information — but not exactly the prices — they need to estimate their out-of-pocket costs, an increasingly important factor when deciding where to seek medical care.

Hospital executives reduced by 30 percent the theoretical prices on chargemasters, the pricing documents that detail all the related charges a patient runs up for services but not the amounts most people actually pay.

The revised prices, said Tim Birkenstock, chief financial officer, will more accurately reflect what Miami Children’s collects from insurers.

That, in turn, should give consumers a reliable reference to estimate their out-of-pocket costs, which will vary depending on their health plan type, benefits and other factors.

However, the amounts insurers pay to Miami Children’s will not change.

Prices: A Moving Target

Miami Children’s also is in the process of developing fixed prices for about a half-dozen of the hospital’s most common services, such minor dermatological procedures and wound closures, removal of tonsils and circumcisions.

Birkenstock said the changes are part of a broader initiative to educate patients about what services they actually pay for, as opposed to providing a price that may have little relation to their ultimate out-of-pocket costs.

“We need to re-craft how we talk about what we charge,’’ he said, “and we need to do it in a way that people who use our facility understand what they have to pay.’’

Hospital prices can be a moving target, with hospitals in close geographical proximity charging wildly different prices for the same medical procedure, and with insurers paying radically different prices for the same procedure within a hospital.

Medicaid and Medicare, the government health programs for the poor and/or disabled and elderly, pay hospitals rates set by state and federal officials — usually at considerably lower rates than private insurers.

Uninsured patients pay another price altogether, often at a steep discount determined by the hospital.

Even among the insured, different factors can cause in a patient’s out-of-pocket costs for the same procedure in the same hospital.

Factors include insurance plan type and benefit design, overall health, whether the procedure is performed in a hospital or outpatient clinic, and whether the doctor is employed by the hospital or is independent.

Does Posting Prices Actually Help Consumers?

For years, health insurance consumers paid little attention to hospital prices because they didn’t have to share any of the actual costs for care beyond a co-payment or a relatively low deductible, said Suzanne Delbanco, executive director of the , a California-based nonprofit that works with large employers to increase price transparency.

But health insurance has changed dramatically in the last five years, Delbanco said, as employers seek to reduce their costs for employee health benefits, and as insurers create more policies with low monthly premiums but higher out-of-pocket costs.

“Benefit designs have evolved,’’ she said. “Whereas before almost everyone was insulated from the cost of health care, now benefits are being redesigned so consumers have more skin in the game, so they’re encouraged to make more affordable, higher-value decisions.”

“You can’t really ask them to do that,’’ Delbanco added, “if they don’t have information to act on.’’

Delbanco said she was unsure how much Miami Children’s revised prices will help consumers.

“It’s an interesting maneuver,’’ she said, “but I don’t think we have any sense if that resembles reality or not in terms of what people pay.’’

When a patient receives a bill detailing the hospital’s price, those figures are usually divorced from reality.

Insurers don’t pay the chargemaster price unless a member reaches a predetermined catastrophic level of costs. Even then, sometimes the insurer’s costs are capped.

The payment rates insurers negotiate with hospitals can be affected by their members’ usage rates, ages and health status, and other factors, including the hospital’s ability to leverage its size and geographical reach to extract higher reimbursements.

Birkenstock called the pricing methods that some hospitals use “antiquated”, and noted that as insurance evolves so will hospital prices.

Transparency Trend

The movement for price transparency in private and public sectors over the past five years. More insurance companies, including Cigna and UnitedHealth, have created online calculators to help members estimate out-of-pocket costs for a some medical procedures at in-network providers.

And Florida’s Agency for Health Care Administration, which administers the Medicaid program in the state, recently submitted a legislative funding request of $5 million a year to create and maintain a health insurance claims database that will allow state officials to better evaluate health-care spending and usage.

Delbanco said Miami Children’s appears to be positioning itself to better compete in this changing environment where consumers will demand more information to make educated decisions.

“Combining quality with price, helping people understand what’s their best buy, I think that’s something that’s going to be hotly in demand in the near future,’’ she said.

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In Miami, Medicare Comes With White-Glove Treatment

Daniel Chang, The Miami Herald — Tue, 26 Nov 2013 05:50:25 +0000

This story was produced in partnership with the

The scene at Leon Medical Centers’ Healthy Living Facility in Miami on a recent Thursday resembled a cross between a luxury hotel and a theme park.

Doorman Francisco Rojo greets clients outside the lobby of Leon Medical Center (Photo by Patrick Farrell/Miami Herald).

White-gloved doormen wearing porter uniforms ushered elderly patients from white vans into a gleaming lobby with colored terrazzo floors and a bubbling fountain. Greeters in green vests and ear bud radios welcomed the Medicare members and made sure their doctors knew that they’d arrived. Refreshments were proffered: Would they like a cafecito and pastelito for the wait?

And that was just the entranceway. Three more floors of the sprawling center bustled with Leon members meeting with physicians or dentists, taking healthy cooking classes, exercising in the fitness center or learning to use Facebook in a lecture hall.

It’s a one-stop shopping approach for healthcare based on a level of customer service and attention that, members tell the federal government, sets Leon Medical Centers apart in the highly-lucrative and super-competitive world of South Florida’s privately managed Medicare plans, or Medicare Advantage.

As the country grapples with far-reaching challenges in healthcare, companies like Leon are carving out a niche that is increasingly popular with Medicare beneficiaries — and demonstrating improvements in customer satisfaction and medical outcomes that translate into bigger profits.

Enrollment in Medicare Advantage plans has been growing each year over the past decade — from 5.3 million or 13 percent of all seniors on Medicare in 2003, to 13.1 million or 27 percent of all beneficiaries in 2012. And while the number of plans will decrease from 2,564 in 2013 to 2,429 in 2014, those rated “above average” or better are on the rise, from 27 percent this year to 43 percent in 2014.

“It’s always impressed me how Leon treats its patients,” said Nancy Fernandez, 72, of Miami, a Leon member since she began receiving Medicare benefits for a disability in 2003. “I come here because I see how much attention is given to members wherever they are, even in the cafeteria, from the moment you walk in until you leave.”

South Florida seniors like Fernandez are choosing Medicare Advantage for 2014 more than at any other time in the past 20 years, with more than half of all eligible seniors in Miami-Dade and Broward counties enrolling in a managed care plan instead of traditional Medicare.

According to Medicare data for October, of the 405,000 eligible seniors in Miami-Dade, nearly 57 percent or 232,000 are enrolled in a Medicare Advantage plan. In Broward, there are 272,000 eligible seniors, and 51 percent or 140,000 are in managed care.

With open enrollment running through Dec. 7 for plans that begin in January, advertising is in full swing, with TV commercials featuring South Florida celebrities: Salsa singer Willy Chirino pitching for Humana, and local chef Michelle Bernstein and her mother in a spot for AvMed.

For private insurers, the stakes are high: One Medicare Advantage member can deliver two to three times the premium earnings that a younger consumer in the individual market will generate, experts and economists say.

But the rules are changing, too, largely because of the Affordable Care Act, which has cut payments to the program. That’s driven some insurers out of markets and reduced the overall number of plans nationwide — except for South Florida, where seniors can choose from nearly 40 plans in Miami-Dade and 50 in Broward that are all rated average or better by the Center for Medicare and Medicaid Services, which oversees the public health program for seniors and the disabled.

In South Florida, Medicare Advantage plans are particularly popular among Hispanics, who are drawn to culturally sensitive programs that offer Spanish-speaking physicians and provide benefits such as free transportation, health lectures from dieticians, doctors or nurses, and even a game of dominoes in an “”enrichment room.” Other benefits can include optometry services and dental care, which traditional Medicare does not provide.

With so many plans for seniors to choose from, the U.S. Department of Health and Human Services created an annual star rating system that allows consumers to compare plan performance. The star ratings measure 36 areas, including health screenings, chronic condition management and overall satisfaction.

Though ratings are meant to guide consumers, they also represent money to the plans and providers. Medicare Advantage plans with ratings of at least three stars will receive bonus payments next year. In 2015, only plans with four stars or higher will receive quality bonus payments.

Leon Medical Centers Health Plans, administered by health insurance giant Cigna, will be the first Medicare Advantage plan in South Florida to earn a five-star rating next year. The plan, with about 41,000 members, will also be allowed to sign up members all year.

The difference in payments, depending on the number of stars awarded, can add up. In 2014, the monthly rate that the government will pay per Medicare Advantage member in Miami-Dade ranges from $1,262.17 for five-star plans to $1,199.07 for those with 2½ stars, according to CMS. In Broward, rates will range from $957.48 for five-star plans to $909.61 for 2½ stars.

“It probably takes two or three [federal health care insurance] exchange enrollees to equal one Medicare beneficiary,” said Matt Eyles, vice president of Avalere Health, a healthcare consulting company in Washington, D.C. “When you look at where the opportunity is from the health plan perspective, that’s one of the things that’s very attractive and why there’s so much competition.”

Benjamin Leon Jr., founder of Leon Medical Centers, said one of the secrets to the company’s popularity is its ability to offer so many services under one roof. Leon sells only one plan, a Medicare HMO, and operates only in Miami-Dade, with seven medical centers and four Healthy Living Centers, with plans for three more lifestyle centers by 2016.

Medical centers have urgent care facilities, pharmacies and clinical offices staffed with primary care physicians and specialists, everything from podiatrists who clip toenails for diabetic patients to dentists, pulmonologists and dieticians.

With so many providers in one place — most of them salaried employees of the center — Leon says members can shorten the time between primary care physician referral to specialist to diagnosis.

“What takes six to eight weeks,” he said, “we can do in 3 1/2 to four hours.”

But Leon also holds down costs by managing patients within the center’s network of providers. Fewer referrals to outside specialists means bigger savings for Leon, particularly important as Medicare Advantage cuts are phased in. He said the plan has not eliminated any benefits for 2014.

“The combination of having these big centers and doing most of the work ourselves instead of contracting it out,” Leon said, “and the combination of that and being a five-star plan … as the cuts come in, we should be able to sustain the benefits we have by simply being the top organization in town.”

Leon will be the only five-star plan in South Florida next year, but it is not the largest player in the region’s Medicare Advantage industry. That distinction belongs to the Kentucky-based health insurance giant, Humana Inc., which sells plans under the Humana Gold and CarePlus brands, and owns and operates 19 CAC-Florida Medical Centers, with the majority in Miami-Dade. CarePlus and Humana plans, both rated at 4½ stars, have the highest enrollment rates in South Florida, according to CMS. Care Plus plans have 13,000 members in Broward and 27,000 in Miami-Dade; Humana plans have 52,000 members in Broward and 39,000 in Miami-Dade.

Like Leon, CAC centers offer a comprehensive set of medical services in one location. The company also operates healthy lifestyle centers that include gymnasiums and recreational rooms where members play dominos and take cooking classes, said Mark Kent, chief executive of CAC.

“This model, we know, works,” he said. “We know patients gravitate to it. We know patients love it.”

Humana bought CAC in 2005, but the centers have a tradition of managed care in South Florida, dating to 1964, when the first clinic opened in Little Havana under the name Clinica Asociacion Cubana (Cuban Clinical Association) and the monthly charge was $5 for a family.

Kent said CAC, which received the state’s first HMO license in the 1970s, has not forgotten its roots.

“Our core competency,” he said, “is one in which we do very well in an underserved community, lower-income, senior population.”

Bert Valdes, chief operating officer, attributes CAC’s success to the strong relationships its physicians and staff have built with patients. Valdes said when Cubans migrated to South Florida in the 1960s and ’70s, many elderly immigrants found themselves at home with little social interaction and declining health as their children went to school or worked long days.

Seeing the doctor meant coordinating rides followed by time in a doctor’s sterile waiting room. In Cuba, Valdes said, people were accustomed to receiving healthcare at community-oriented primary care centers called policlinicos where patients and medical professionals formed familial bonds.

“Relationships drive a Hispanic’s decision making,” Valdes said at the August opening of a new CAC medical center in Margate. “This is a place where they can come every day and interact with people just like them.”

Managed care is a traditional model of healthcare in Latin America, particularly the Caribbean, said Steven Ullmann, a health policy expert at the University of Miami business school.

“These systems, these methodologies of HMOs, or managed care, are very common in Latin America,” Ullmann said. “So actually, the methodology was imported from Cuba.”

Of the top counties for Medicare Advantage enrollment in Florida, Miami-Dade is number one and Broward is second.

Ullmann said providers like CAC and Leon have taken the waiting room experience and transformed it into an opportunity for seniors to socialize and stay active.

“If you’re ever waiting to see doctor, you’re very stressed sitting there, staring at a wall, maybe a TV,” he said. “It’s a place to wait and stress more. Leon and CAC say, ‘No. This is a gathering place. There’s a café Cubano. There’s a pastelito. Let’s socialize while we’re waiting to see the doctor.'”

Hospitality, they’ve discovered, is good business.

“It’s an environment that’s a very significant draw to people,” Ullmann said of the lifestyle centers. “If you can draw healthy individuals, you get paid $1,000 per person per month to care for them, and they can socially interact and enjoy services without needing much medical attention, you also can profit handsomely.”

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Miami Leads Nation In Medicare Drug Spending

Daniel Chang, The Miami Herald — Wed, 16 Oct 2013 10:54:40 +0000

This story was produced in partnership with the

Elderly Miami residents on Medicare filled more prescriptions for drugs in 2010 than seniors elsewhere in the country, and they were more than twice as likely as residents in Rochester, Minn., to fill at least one prescription for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines.

These are two of the latest findings from the Dartmouth Atlas Project, which on Tuesday released a report on prescription drug use among seniors that showed, once again, Miami has by far the highest healthcare costs in the nation — with the average Medicare patient spending $4,738 on prescription drugs in 2010, more than any other region and well above the national average of $2,968.

Yet while patients in Miami filled more prescriptions (63 per year) and spent more on medications than their peers elsewhere, according to the Dartmouth report, Miami seniors also fared well in comparison to the rest of the nation for their use of effective medications, such as beta blockers to reduce blood pressure and manage irregular heartbeats within seven to 12 months after a heart attack.

About 78 percent of Miami heart attack survivors on Medicare Part D reported filling a prescription for beta blockers, and about 76 percent of diabetic patients aged 65 to 75 filled a prescription for medications known to reduce blood pressure and prevent kidney disease — both rates on par with national averages.

Jeffrey C. Munson, a physician and lead author of the report, said the findings offer important insights for physicians who prescribe drugs and for their patients.

“A lot of it really is demonstrating what kind of care is possible,’’ Munson said, “and I think that a lot of times physicians don’t have a source of feedback to tell them how they’re performing relative to their peers, and there isn’t an easy way for physicians to know what is the national norm and what is the best care possible.’’

Dartmouth’s research is one of the first comprehensive looks at Medicare Part D, the prescription-drug benefit program. Because the program was launched in 2006, there has been little data available for researchers to study the program’s benefits and risks.

Munson said the research suggests that the program has increased access to prescription drug healthcare and benefitted many Medicare patients, including the estimated 42,000 Miamians enrolled in Part D.

The research also shows that the use of both effective and risky drug therapies by Medicare patients varies widely across regions — evidence that location is a key indicator of healthcare cost and quality.

For instance, heart-attack victims living in Ogden, Utah, in 2010 were twice as likely (91.3 percent) to receive a statin prescription to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas (44.3 percent). Statins are widely available, and Dartmouth researchers did not see a dramatic difference in prescription drug prices by region.

“There’s no good reason’’ for the difference in prescription drug treatment by region, he said.

Munson said cost and prescribing variations are not due to some regions having greater numbers of sick individuals, nor is it due to regional differences in the cost of prescription drugs.

He said the variations are more likely due to the regional culture of medical practice — and Miami has a history of high use of healthcare services.

For years, Dartmouth researchers have been analyzing why Miami’s costs are so much higher than elsewhere, even when adjusted for severity of illness and other factors.

Their findings have shown that a major contributor appears to be the large number of physician specialists in the area, a situation that tends to lead to more visits to doctors and more diagnostic tests. The large number of hospital beds in the area may also drive up usage, Dartmouth has found.

But that does not necessarily explain why Miami’s prescription drug use is so high and costly.

Unlike other forms of healthcare, physicians do not get reimbursed directly for prescribing drugs — so there’s no financial incentive for them to over-utilize prescriptions.

“One of the things that’s curious about high-spending regions like Miami or McAllen, Texas, or even Manhattan really speaks to this culture of more aggressive care,’’ Munson said.

He said one clue to Miami’s high use and high costs lies in the findings for use of discretionary medications, or drugs that work well for some individuals but not for others, including antidepressants, dementia medications, and proton pump inhibitors to relieve heartburn.

Regions with high use of such discretionary medications, Munson said, tend to have higher prescription drug costs per Medicare patient.

“What we see,’’ he said, “is that spending is more closely tracking with use of discretionary medications.’’

Elderly Miamians rated well above the national average on the use of discretionary drugs — leading all other regions in the country by some measures.

For example, Medicare patients in Miami are the most likely to fill at least one prescription for an antidepressant, with an average of 30.2 percent filling one. And they were the most likely to fill at least one prescription for a dementia medication, with an average of 17.1 percent.

Munson said patient choice is certainly a factor in Miami’s high use of discretionary medications, but he added that some variation also is due to physician preference and an abundance of consumer advertising designed to persuade patients that they need a particular drug.

However, he said, the report’s findings show that spending more on prescription drugs does not lead to better care.

Nancy Morden, a physician and co-author of the Dartmouth report, said the data should motivate patients to learn more about the treatment they’re receiving.

“One of the most important things consumers can do,’’ she said, “is have these conversations with their prescriber: understand why each medication is prescribed; what’s the goal of the medication; what the risk and benefit tradeoffs are … [and] ask about what you’re not taking that may be indicated for you and your particular disease state.’’

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Sebelius Spends Third Day Touting Health Law In Florida

Daniel Chang, The Miami Herald — Wed, 18 Sep 2013 09:30:09 +0000

This story was produced in partnership with the

As home to nearly four million residents with no health insurance and state legislators opposed to Obamacare, Florida holds a large stake in the outcome of federal healthcare reform, U.S. Health and Human Services Secretary Kathleen Sebelius told students, local health officials and politicians during a visit to Miami Dade College Tuesday.

Sebelius, who spent her third day in a week campaigning for the health law in the Sunshine State, took a few swipes at Florida Republicans for “keeping information from people” and putting them “at great risk’’ when it comes to the Affordable Care Act.

But she said extensive partnerships with hospitals, community health centers, pharmacies, faith groups and nonprofits will help the federal government overcome Florida’s obstacles and spread the word about healthcare reform — especially the phase scheduled to roll out on Oct. 1: the federally-run online exchanges where millions of uninsured Americans will be able to shop for health insurance plans.

Sebelius assured the audience that the online exchanges will be ready on time. She said participating insurance companies all have signed contracts for the plans they intend to sell, and federal officials are now double-checking those plans and rates to ensure their accuracy before posting the information on the healthcare.gov website.

“For the first time ever, beginning in October,’’ she said, “there will be a website available with side-by-side comparisons of plans that will be available in a particular area.’’

During her visit to Miami, Sebelius focused on the impact the health law will have on Hispanics, noting that a higher proportion of Hispanic Americans are uninsured and eligible for health coverage benefits under the law than the rest of the population.

She said about 10 million Hispanic Americans across the country are uninsured and eligible, including almost 580,000 in Florida.

The law already has benefited an estimated 910,000 young Hispanic adults, she said, who have been able to remain on their parents’ health insurance plans under a provision of the law mandating that insurance companies allow the benefits up to age 26.

But the bulk of Sebelius’s address was directed at efforts to inform Florida’s estimated 3.8 million uninsured and eligible residents about the benefits of the health law.

“The single largest challenge is to get information to individuals who may be eligible for benefits but really don’t know anything about the market,’’ she said. “In October, we begin really a six-month education and outreach effort.”

The sign-up period for insurance purchased through the new exchanges will run from Oct. 1 through March 31.

Among the partners helping to spread the word: CVS, Walgreens and RiteAid pharmacies, which Sebelius said will offer brochures in English and Spanish statewide.

Local health groups also are pitching in. Joining Sebelius on a stage at Miami Dade College was Karen Egozi, president of the Epilepsy Foundation of Florida, which has received a $637,000 grant from the federal government to train so-called “navigators,” counselors who will help uninsured Americans in Miami-Dade shop for and enroll in health plans sold on the insurance exchanges.

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Fuzzy Math Behind Florida’s Health Insurance Projections, Group Says

Daniel Chang, The Miami Herald — Thu, 08 Aug 2013 15:20:34 +0000

After the Florida Office of Insurance Regulation released a last week projecting that individual monthly health insurance premiums would rise 30 to 40 percent next year thanks to Obamacare, some critics cried “fuzzy math!”

This week, the Florida Center for Fiscal and Economic Policy, a left-leaning nonprofit research and education group, issued a brief criticizing the OIR’s methodology for calculating rate increases, and panning the agency’s conclusions as providing “no credible comparison of the impact of PPACA on rates whatsoever.”

Moreover, the group said, the official projections are “likely to result in direct harm to consumers.”

Among the problems cited in the preliminary analysis conducted by the Florida Center:

The OIR compared post-Obamacare average premiums for each individual insurer’s plan with a single statewide pre-Obamacare average taken across all insurers in the individual market;
The OIR omitted the impact of premium tax credits for individuals buying health plans on the federally-run insurance exchanges;
The OIR compared “apples to oranges” by failing to factor into its projections the fact that statewide averages for pre-Obamacare premiums included a “wide array of low-value plans” — including plans with extremely limited benefits, such as no prescription drug coverage; and high-deductible plans, where the insured first must pay hefty out-of-pocket costs before the insurer begins to cover services.

As the Florida Center noted, Florida’s individual health insurance market covers about 700,000 people — less than 5 percent of the state population.

That means the OIR’s projections cannot be used to draw any conclusions regarding the impact of Obamacare on those who receive health insurance through their employers, which includes the majority of Floridians.

The Florida Center has not yet published the analysis on its , but sent an issue brief to media on Tuesday afternoon highlighting the findings.

This story is part of a collaboration that includes and Kaiser Health News.

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