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From the staff of the Tampa Bay Times

Did Florida lawmakers know what it meant to hand off health plan rate review to feds?

8

August

When Florida lawmakers decided during the 2013 session to hand off review of rates for new health plans for two years to the feds, it's not clear they knew what that meant.

PolitiFact recently rated True a claim from U.S. Rep. Ted Deutch, D-Boca Raton, that Florida stripped the state insurance commissioner’s authority to negotiate or refuse rates for plans on new Obamacare marketplaces.

PolitiFact’s reporting exposed limited understanding of the federal government's role even among legislators who knew the legislation best.

While the state can negotiate or reject rates it decides are out of line, the federal government can merely label the rate "unreasonable," and in extreme cases, disallow a plan's sale on the state's new marketplace.

It can't negotiate for lower rates on behalf of the state. It can't reject rates, even those it says are unreasonable.

Some congressional Democrats and consumer groups argue this leaves Floridians vulnerable to premiums an empowered state insurance commissioner would quash.

Sen. David Simmons, R-Altamonte Springs, who sponsored the legislation that deferred rate review to the federal government, told PolitiFact he's confident the feds have the authority to "protect consumers."

But what about the ability to negotiate for lower rates? To reject rates? To engage in the kind of rate-making that Florida traditionally does?

"I don't know the answer to that question," he said. "I don't think they have the ability, myself. I think they have the ability to fully go ahead … to step in to protect consumers from unjustifiable premiums."

He suggested federal officials might have "multiple other methodologies" for doing that.

“I would hope that they do," he said.

He's partly right. In addition to rejecting plans from marketplaces, a new rule under the Affordable Care Act specifies a percentage of premiums that insurers must spend on care. A truly outrageous rate would eventually result in rebates to consumers. But that's later. At the start, higher premiums could simply scare consumers away from health plans, or force them to overpay.

Meanwhile, Sen. Eleanor Sobel, D-Hollywood, who spoke up on behalf of consumers at committee hearings and made a last-minute vote switch to oppose the law, said details about the limits of federal rate-review authority were "never made clear."

(PolitiFact got its details from a final rule issued in May 2011, available with a few clicks on the U.S. Health and Human Services website.)

During committee hearings, she expressed confidence that the feds would use a wealth of knowledge to "set" rates. No one corrected her.

"I don't recall us going into detail about that," she said.

She said she was too busy pushing for an expansion to Medicaid that legislators ultimately refused.

"I hope that the insurance companies will propose reasonable rates," she said.

[Last modified: Thursday, August 8, 2013 3:00pm]

    

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