The Florida Medical Association and Blue Cross and Blue Shield of Florida are opposing further expansion of Gov. Lawton Chiles' managed competition healthcare system this year.
Executives from the two organizations said they would like to wait at least one year to determine the effectiveness of the state's 11 regional purchasing alliances in containing costs and expanding access to insurance.
Last year, Florida legislators passed Mr. Chiles' managed competition-styled "Healthy Homes" bill. The legislation allowed small businesses with fewer than 50 employees, Medicaid recipients and state employees to combine their purchasing power through 11 community health purchasing alliances, or "Chipas."
In January, Mr. Chiles asked the state Legislature to approve a bill called the "Health Security Program," which would expand Healthy Homes and bring the governor's long-range plan for universal access a step closer to reality.
The measure would provide discounted insurance to 1 million uninsured working residents through the Chipas (Jan. 10, p. 29). The discounts would be available to uninsured residents earning less than $17,425 a year.
Some 2.1 million small business employees are now eligible to seek health insurance through the Chipas. Florida's 1.4 million Medicaid enrollees and 100,000 state employees would be rolled into the Chipas later this year, said a state spokesman.
If Mr. Chiles' program is approved this year, some 4.6 million people could become eligible to join the Chipas, or about 35% of the state's population.
Funding for the new program would come from savings expected by enrolling the uninsured residents in Medicaid health maintenance organizations, the governor contended.
About 190,000 Medicaid recipients were enrolled in Medicaid HMOs in 1993, saving the state an estimated $45 million, a state spokesman said.
However, FMA and Blue Cross executives say they don't believe the program can be administered with current Medicaid funding, which totaled $7 billion last year. The executives also are worried that physician payments and pre miums wouldn't cover the costs of providing the new services. "This is a monster on our hands," said Carl Hoemer, a Blue Cross vice president. "With half the market (in the Chipas), there will be less competition."
Mr. Hoemer said if the Chipas become the dominant buyers of healthcare services, "they will force (provider and insurer groups) to buckle to the Chipa. Some will go out of business." He said Blue Cross will suggest an alternative to providing low-income residents with access to health insurance.
The governor's bill also would increase the size of companies eligible to participate in the Chipas to 150 employees from the current maximum of 50.
Physicians also are concerned that enrolling large numbers of patients into the Chipas and managed-care plans would limit patient choice.
Last month, the 11 Chipas opened bids from 57 insurers. Premiums ranged from 20% below current commercial rates to 20% above, said a spokesman for the state Agency for Health Care Administration.