Entrepreneur plans new South Florida HMO : JOHN DORSCHNER

While many analysts are concerned about the problems that healthcare reform might create for insurance companies, veteran entrepreneur Miguel “Mike” Fernandez announced Monday he’s starting an ambitious health maintenance organization that he expects to employ 1,000 statewide — and may expand nationally.

“Wherever there is turmoil, there is opportunity,” said Fernandez. “We have a pretty good history in this area.”

Fernandez cited how he invested about $3 million in a Medicaid HMO in 1993 and sold it in 2002 for $185 million to Amerigroup. He paid $28 million a Medicare HMO that became CarePlus, which he sold in 2004 for $450 million to Humana. “A fairly good return.”

Fernandez plans to launch Simply Healthcare Plans in December. The company is filing an application for an HMO license with the state and is preparing paperwork for a Medicaid contract. Next spring, the firm plans on filing for Medicare approval after his noncompete agreement with Humana runs out.

The company will start with offices in South Florida, Tampa and Orlando. Expansion outside the state could come later.

With more than 30 years experience in health insurance, Fernandez said he knows all the problems. “The last time we started, back in 1993, they said the market was overcrowded and rates were going down. I ignored those reasons and proceeded on ahead.

“The same issues are here today: The markets are overcrowded, the rates for Medicare and Medicaid are coming down. And yet if we provide outstanding service to the customers,” he expects to once again be a success.

He noted that this time he’s starting out with far more capital than he did in the 1990s. The HMO is being funded by $100 million from MBF Healthcare Partners, a venture capital firm Fernandez started in 2005. About $80 million will come directly from Fernandez.

CarePlus thrived in conjunction with 12 CAC clinics, in which Fernandez copied the old Cuban model of providing healthcare in a social atmosphere — seniors with cafecitos chatting with each other. Fernandez did not rule out clinics this time around, but the HMO will start without them.

He said that some of his old team will be joining him. Already on board is Peter Jimenez, the chief operating officer of CarePlus.

He said many former staffers have expressed interest in joining his new endeavor. Employees shared about $90 million from the sales of his previous insurance companies.

“Because of our track record, we already have more than 300 resumes on file for a wide variety of jobs.”

The new health plan will join other MBF investments, which include Medical Specialties Distributors, OMNI Home Health Services, Navarro Discount Pharmacies and NutriForce Nutrition.

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We’re struggling — and fleeing Florida

Reflecting hard economic times, census figures released today show that there’s an exodus of people leaving Florida, that a sizable segment of the state’s population lacks health insurance and that many families live in multigenerational households.

The 2008 American Community Survey found that millions of Floridians are without health insurance — the first time the annual survey has asked about health care. The latest numbers come as Congress is engaged in a heated debate over health-care reform.

The survey also tried to gauge, for the first time since the 2000 census, whether home foreclosures and rising unemployment are forcing children, parents and grandparents to live together in the same house. In Florida, there are more than 240,000 multigenerational households.

The latest census figures confirm what state demographers concluded earlier this year: The recession is not only stunting the growth of Florida and Orlando but is also sending people packing for other states.

Moving out

For a second consecutive year, census figures show more people moving out of Florida to other states than moving in from other parts of the country. In Metro Orlando — Orange, Osceola, Seminole and Lake counties — 9,000 more people left Florida than moved in from other states. Lake was the only metro county to gain more people from out of state than it lost. Volusia County also imported more people than it exported.

University of Florida demographer Stan Smith attributed the flow of moving vans leaving the state to the housing crisis and to Florida residents looking for work in other parts of the country.

The 2008 census figures show that Florida grew a paltry 0.4 percent and that Metro Orlando increased just 1.1 percent. Despite people leaving, the population grew because of births and immigrants from other countries. Metro Orlando had 2,054,036 people in 2008, just 22,000 more than in 2007. Before the recession, the area was gaining more than 70,000 people a year.

Hispanics continue to fuel what little growth there is in the Orlando area, accounting for 79 percent of the population increase in 2008. The area’s Hispanic population tends to be younger and to have larger families, but Orlando also continues to draw in new Hispanic residents from overseas and other states.

University of Florida demographers also found a decline in Florida’s growth rate for 2008. But figures they released earlier this year showed it’s likely that Florida actually lost population in 2009 for the first time in 60 years.

Not insured

The 2008 survey found that in Florida, 3.6 million people are not covered by health care — 21 percent of the population. Among working-age Floridians — who do not qualify for Medicare — the statistics are even worse: 27 percent of Floridians between 18 and 64 don’t have health insurance, according to the survey.

Texas led the nation in the percentage of people without health insurance, at 24.1 percent. In Massachusetts — where the state now requires residents to buy health insurance — 4.1 percent of residents were not covered.

Behind the statistics are people such as Joe Reed. An actor, Reed worked at Disney for 12 years until he was laid off in September 2008.

Reed, who’s 54, started to panic. He had undergone gastric bypass surgery a year earlier and required regular blood tests to monitor his health. And because of his history of heart problems and high cholesterol, he was on regular medication.

Before his insurance ran out, he consulted with his doctor, who switched Reed from expensive drugs to generics that he could pick up for $4 at Walmart. For nearly a year, he never visited a doctor and crossed his fingers, hoping nothing would go wrong.

He’s still working sporadically and, in June, thanks to five months of work at the Alabama Shakespeare Festival, he qualified to get insurance from the actors union. Now he’s still looking for work, but grateful to have insurance. “I haven’t had to be hospitalized,” said Reed, who lives in Orlando. “I’m praying I’m going to stay healthy.”

Under one roof

The recession has also sparked a new line of inquiry for the census: how many families are moving in together.

From Yvonne Williams’ standpoint, it’s more common than you may think.

Williams, her husband and three of their kids, ages 12, 15 and 22, live in Orlando, sharing their house with Yvonne’s 70-year-old mother, Carole Riddick. Yvonne Williams knows at least three other families with at least three generations living under the same roof.

In Florida, only 3.4 percent of households are multigenerational. But in Hawaii and California, these living arrangements are much more common. In Hawaii, 7.4 percent of households are multigenerational, while in California, 5 percent of households contain at least three generations. Demographers say those states, like Florida, have large numbers of immigrants, but they also have high real-estate costs that have forced some families to live together.

This is the first year that the American Community Survey has asked about multigenerational families, however, so the numbers can’t be compared to previous years’ surveys.

For the Williamses, the move to a multigenerational household was born of necessity and love. When Riddick’s memory started failing and she couldn’t live alone, the Williams family opened their home to her.

But it’s a financial move as well, because they can combine Riddick’s retirement income with their own incomes to help the family make ends meet.

“It definitely helps to pool the income between all the family members, rather than everybody struggling on their own,” said Yvonne Williams. “And I think in this recession, there’s going to be more of a trend toward that.”

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State’s health insurance program has no clients

Florida Health Choices, pushed as a solution to the state’s high rate of uninsured last year by Republican House leaders, still has no insurers or businesses signed up.

That makes it even less successful than the program created at the same time, Gov. Charlie Crist’s “Cover Florida.” At the end of July it had about 4,130 policies, while recent census data show the number of uninsured Floridians has grown to 3.6 million.

The results so far mean neither Crist nor Marco Rubio, his opponent in the Republican primary for U.S. Senate, can use the state’s efforts on the uninsured as campaign fodder. Rubio pushed the Health Choices plan as House Speaker.

State Sen. Dan Gelber, D-Miami Beach, had predicted the plans wouldn’t accomplish much and called them “cosmetic.”

“Florida has no meaningful response to the crisis of the uninsured, and we’re not even mentioning the under-insured,” Gelber told Health News Florida.

Crist is partly to blame for delays on Health Choices because he was slow to make appointments to the board, says Chairman Aaron Bean, who sponsored the plan last year as House health council leader. Bean also faulted Sunshine Law requirements that require meetings to be advertised so the public can attend, saying that lengthens the process.

He remains hopeful that some health plan can be offered before the end of 2009. “Would I have preferred to have it already be up? Yes,” he said.

The idea was that Florida Health Choices would promise employers a free market where any package of care could be sold by approved providers, including chiropractors, dentists, and other non-traditional sources of insurance. The benefits would be paid for with pre-tax dollars.

But even when the marketplace is running there is no guarantee that insurers will want to participate, says Tallahassee attorney Bruce Platt, who represents health plans before the Office of Insurance Regulation. While they’d be free of the usual state-imposed “mandates” for minimum coverage, he said, the insurers still have to meet other requirements, such as an adequate network and sufficient finances.

Before Florida Health Choices can even worry about attracting insurers it needs a chief executive officer. Board member Becky Cherney of Orlando said a job posting this summer brought 39 applicants from “all over the map.”

Cherney, president and chief executive officer of the Florida Health Care Coalition, is putting together an applicant matrix for the board to review at its Sept. 21 meeting in Orlando.

While Health Choices has had a slow start in Florida, it may play a role in the national reform plan being debated in Congress, Bean predicts. The bill that eventually emerges is expected to include an “exchange” that sets up the common rules regarding plans’ coverage and prices and helps explain them to the public.

“We could be big winners,” Bean said.

Conversely, if Congress changes the current tax incentives that allow for cafeteria-style health plans to be bought with pre-tax dollars, Bean’s project could be smothered in its cradle.

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Bill Cotterell: Open enrollment for state workers begins today

State employees and Florida government retirees have been receiving big, bulky envelopes containing information about their state insurance options. Open enrollment begins today and runs through Oct. 9.

Precisely, the clock runs out at 5:30 p.m. EST, on the second Friday of next month. The People First Service Center likes to run these things with precision.

As President Obama might say — on a completely unrelated health care matter, which you may have heard something about lately — if you like the insurance you’ve got, you don’t have to change. In fact, contented state employees don’t have to do anything during open enrollment in order to keep the insurance coverage they’ve got now.

The same goes for those flexible spending accounts, the pre-tax plans for dependent care or uninsured medical expenses. If nothing has changed in your family status or coverage needs, you can just let it ride.

But if you’ve birthed or adopted an additional kid, or become responsible for elderly relatives (whom the impending national health-rationing death panels will refer to as “shovel-ready projects”), you might not want to toss that big white envelope on the junk mail pile for the next 24 days or so.

And be wary of those “reimbursement accounts.” They can save you 20 percent to 40 percent, depending on your tax bracket, but it’s a “use it or lose it” proposition — actually a pay reduction — so you don’t get back any unspent money at the end of the year.

Even if you haven’t had any family-status changes, it’s a good idea to review your options and make sure addresses and other identifying information are current.

So what’s new?

All Florida counties except Monroe now have at least one HMO for state workers. For Leon, Gadsden, Wakulla and Jefferson counties, the HMO choices are Capital Health Plan, United Healthcare and VISTA. Taylor and Jackson counties have only United Healthcare, while Calhoun, Franklin and Liberty counties have only United and VISTA, according to the benefit guide that accompanies the enrollment information being sent to employees.
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The pre-tax contribution limits on low-premium, high-deductible health savings accounts have been raised to $3,050 for individual coverage and $6,150 for family insurance. State contributions have not changed; $500 for individuals and $1,000 for families.
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Employees will also find some improved enrollment forms and screen messages for easier changes when they go online.

If you’re like me, you don’t like reading directions, gleaning technical data from charts, tables and graphs or punching 1 for this option and 2 for that one. Luckily, the state is having “benefits fairs” for us Luddites.

There’s one today at the Betty Easley conference center at SouthWood and another at the Civic Center on Thursday. More will follow in Macclenny (Northeast Florida State Hospital) and major cities around the state throughout the month.

The benefits fairs are essentially sales events, with competing HMOs and insurance companies that peddle supplemental plans — extra vision, dental, cancer coverage — showcasing their benefits for employees. And, with a supervisor’s approval, time spent learning about insurance options is considered “time worked.”

The Division of State Group Insurance has provided everything you need to know at MyFlorida.com/MyBenefits, where you can compare plans, find providers and get information on insurance companies. Employees can also call the People First Service Center at (866) 663-4735.

The department is asking people to sign up early and avoid the October rush. And, of course, you’ll have to have your People First password to make any online changes during open enrollment.

The pre-tax contribution limits on low-premium, high-deductible health savings accounts have been raised to $3,050 for individual coverage and $6,150 for family insurance. State contributions have not changed; $500 for individuals and $1,000 for families.

Employees will also find some improved enrollment forms and screen messages for easier changes when they go online.

If you’re like me, you don’t like reading directions, gleaning technical data from charts, tables and graphs or punching 1 for this option and 2 for that one. Luckily, the state is having “benefits fairs” for us Luddites.

There’s one today at the Betty Easley conference center at SouthWood and another at the Civic Center on Thursday. More will follow in Macclenny (Northeast Florida State Hospital) and major cities around the state throughout the month.

The benefits fairs are essentially sales events, with competing HMOs and insurance companies that peddle supplemental plans — extra vision, dental, cancer coverage — showcasing their benefits for employees. And, with a supervisor’s approval, time spent learning about insurance options is considered “time worked.”

The Division of State Group Insurance has provided everything you need to know at MyFlorida.com/MyBenefits, where you can compare plans, find providers and get information on insurance companies. Employees can also call the People First Service Center at (866) 663-4735.

The department is asking people to sign up early and avoid the October rush. And, of course, you’ll have to have your People First password to make any online changes during open enrollment.

Quoting and Saving on your health insurance has never been easier…EasyToInsureME

Florida Health Insurance
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Hospital pricing in South Florida confuses and dismays : JOHN DORSCHNER

When Robert Dollar entered Baptist Hospital, he knew precautions had to be taken, because he would be slightly radioactive from taking a tablet intended to rid himself of any remaining cancer cells after having his thyroid removed.

That’s why a hospital worker wrapped the light switches, telephone receiver, door handles and a portion of the floor with plastic sheeting. Charge for the wrapping: $2,518. Total bill for his 45-hour stay: $23,396.30.

Irate when he saw the bill, Dollar wrote to the hospital: “As our nation struggles to understand why it pays almost twice as much per capita for medical care with more failed treatment outcomes — $6,700 per patient here versus $3,400 in the Netherlands . . . the gluttony of a hospital charging $23,396.30 . . . is terribly wrong.”

Dollar was echoing what many policy experts are saying during the present debate about healthcare reform: Costs must be brought down to help cover the uninsured. That’s particularly true in South Florida, where healthcare spending is far higher than in most other areas of the country.

Certainly, Dollar is not alone in his anger.

In Pembroke Pines, Joey Whitt, 15, sprained an ankle and had magnetic resonance imaging at Memorial West. Total cost: $4,906.20, including a family co-pay of $981.24.

In Hollywood, Robert Feibusch went to Memorial Regional to have a battery replaced in his defibrillator. He stayed eight hours. Total bill: $46,584.30. Astounded, Feibusch fired off a letter to President Barack Obama: “Isn’t this a little stupid?”

In fact, hospital administrators acknowledge the pricing system is out of whack. Dollar was “trying to make logic out of something that’s not logical,” says Karen Godfrey, a Baptist Health South Florida vice president. She admits that “it’s very difficult to make sense” of hospital bills.

“From the broader perspective, this is all a matter of cost-shifting,” says Matt Muhart, chief financial officer of Memorial Healthcare System. “When you look at the numbers of uninsured and the lower-paying government insurance, you have to make up the money somewhere to keep your doors open.” That’s why Memorial, Baptist and other hospitals have to bulk up the charges for those who have private insurance.

All three patients who contacted The Miami Herald have insurance that paid most of their charges, but all are concerned about the larger issue of how high healthcare costs are damaging the American economy.

THREE MEN’S TALES

Dollar, 63, says he recently lost his job as a construction superintendent, part of a move in which his employer cut three older men who were costing the small firm a lot in health insurance. He figures the healthcare benefit worked out to 40 percent of his salary.

Dollar entered Baptist about 5 p.m. on a Tuesday and was given a capsule containing 100 milliliters of radioactive I-131 ($12,400), an anti-nausea medication ($79) and 100 milligrams of ducosate sodium, a stool softener (30 cents).

For various staff members handling the radioactive dosage and delivering it to his room, Baptist billed three charges: $1,057, $1,175 and $3,061. The room rate was $1,553 a day.

Because he was radioactive, Dollar says no one entered his room. A tray was left at the door that he fetched himself. A technician occasionally appeared in the doorway and used a gadget to measure his radioactivity. At 2 p.m. Thursday, his radioactivity level had dropped and he was allowed to go home.

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