What do you need to know about health care in Florida?

Healthcare policy in Florida involves the creation and implementation of laws, rules, and regulations for managing the state's healthcare system. The healthcare system consists of services provided by medical professionals to diagnose, treat, and prevent mental and physical illness and injury. The system also encompasses a wide range of related sectors, such as insurance, pharmaceuticals and health information technology.

According to the National Conference of State Legislatures, the 50 state legislatures collectively "make thousands of health policy decisions each year," not including the decisions made by local governments, which often oversee hospitals, and private bodies, such as insurers. These decisions can include budget appropriations, requirements for doctors obtaining their licenses, which services are covered by insurance, how personal health information is managed, and which immunizations children must receive, among many others.^[1]

Healthcare policy affects not only the cost citizens must pay for care, but also their access to care and the quality of care received, which can influence their overall health. A top concern for policymakers is the rising cost of healthcare, which has placed an increasing strain on the disposable income of consumers as well as on state budgets. Other issues in healthcare policy include state Medicaid expansion, health information technology and privacy, uninsured and underinsured portions of the population, a shortage of primary care physicians, and mental healthcare access and coverage.

Background

See also: History of healthcare policy in the United States

In the early years of the United States, healthcare was provided by wives and mothers in the home, with occasional home visits by doctors. Medical colleges were established starting in the late 1700s, providing formal scientific training and licensing to physicians. The role of doctors became more authoritative and pronounced with further advancements in science and the growth of cities, which presented health hazards due to overcrowding, poor sanitation and attendant disease.^[2][3][4]

University of Pennsylvania School of Medicine, the first medical college in the United States

In 1846 a group of physicians formed the American Medical Association (AMA) with the early mission of (and achievement of) state regulation of pharmaceuticals. As medicine grew more professionalized, private health insurance pools were established, and employers and unions began offering some medical benefits to workers. The model of payment known as "fee-for-service," in which doctors are paid for each treatment, test and office visit, emerged.^[2]

Though once housing primarily poor, terminally ill patients, hospitals evolved to more closely resemble the institutions they are today. This was in part due to the development of antiseptics—allowing for more sanitary treatment conditions—and better education of physicians. It was also partly due to their role in the development of employer-sponsored insurance by offering plans for public school teachers, which allowed them to go to hospitals for more routine treatments. The employer-sponsored insurance model spread during World War II, when government wage controls prompted employers to offer health benefits rather than higher salaries in order to attract workers. This model grew more popular after the war when payments by employers toward employee health insurance were made tax-exempt.^[2][5][6]

Throughout the mid-20th century, Congress established federal agencies dedicated to healthcare policy, including the National Institutes of Health and the Centers for Disease Control, the Food and Drug Administration, and the Department of Health and Human Services. The federal government also enacted a number of pieces of healthcare legislation during the second half of the century:

Broward Health Medical Center in Fort Lauderdale, Florida

• Social Security Amendments of 1965, which established Medicare and Medicaid
• Health Maintenance Organization Act of 1973, which promoted prepaid group practice service plans known as health maintenance organizations (HMOs) as an alternative to fee-for-service plans
• Consolidated Omnibus Budget Reconciliation Act of 1985, which allowed employees to continue healthcare coverage if they would otherwise lose it (due to job loss, medical leave, etc.)
• Health Insurance Portability and Accountability Act of 1996, which limited the extent to which insurance companies could exclude people with preexisting conditions
• Patient Protection and Affordable Care Act of 2010, known as Obamacare, which established health insurance exchanges and required all citizens to obtain health insurance

Though there have been steady calls for a national health insurance program since the early 1900s, no such measure has been adopted in the United States.^[2]

Today, the healthcare industry is an immense part of the nation's economy. Healthcare spending amounts to about one-sixth of the nation's gross domestic product and health expenditures account for about one-fourth to one-third of state budgets. Healthcare regulation and policy is complex, with nearly "every aspect of the field ... overseen by one regulatory body or another, and sometimes by several." Such regulations are enforced by federal, state and local governments, and even private organizations. The 2010 passage of Obamacare introduced experimentation and uncertainty into the industry, which will be watched closely over the next several years to gauge the lasting effects of its policies.^[1][7][8][9]

General information

Terms and definitions

Hover over each term to display a definition.

Fee-for-service

Gross domestic product

Gross state product

Managed care

Medical durables

Medical nondurables

National health insurance

Premium

Scheduled drugs

The tables below compare demographic and economic statistics for Florida and surrounding states, since both factors significantly impact healthcare and healthcare policy. Also provided is general information on the insurance coverage of individuals in each state.

Demographics

See also: State population demographics by age and gender

A major concern for the healthcare industry is the shifting demographic makeup of the nation and its states. Different groups of people—such as men and women, for example—tend to use different health services.In particular, persons aged 65 and older comprise an increasing share of the total population, with that share expected to reach 20.2 percent by 2050. This trend has had a part in the increase in demand for healthcare services and the related increase in costs. It will also influence the federal budget, as more and more seniors join Medicare.^[10]

Compared to its neighboring states, Florida had the lowest percentage of individuals 18 years of age and younger. It also had the largest percentage of its population that was age 65 and over.^[11][12][13]

Economic indicators

See also: Economic indicators by state

Florida's GDP increased by 2.7 percent in 2014. Click the image to view a larger version.

Broadly defined, a healthy economy is typically one that has a "stable and strong rate of economic growth" (gross state product, in this case) and low unemployment, among many other factors. The economic health of a state can significantly affect its healthcare costs, insurance coverage, access to care, and citizens' physical and mental health. For instance, during economic downturns, employers may reduce insurance coverage for employees, while those who are laid off may lose coverage altogether. Individuals also tend to spend less on non-urgent care or postpone visits to the doctor when times are hard. These changes in turn may affect the decisions made by policymakers as they react to shifts in the industry. Additionally, a person's socioeconomic status has profound effects on their access to care and the quality of care received.^[14][15][16]

In 2013, compared to its neighboring state, Florida had the largest percentage of residents that earned incomes of at least 400 percent above the federal poverty level. Between 2011 and 2013, the state's median annual household income was $47,106, just below that in Georgia. Florida's unemployment rate in September 2014 was lowest among its neighboring states at 6.1 percent.^{[17][18][19][20]}

Note: Gross state product (GSP) on its own is not necessarily an indicator of economic health; GSP may also be influenced by state population size. Many factors must be looked at together to assess state economic health.

Insurance coverage

See also: Health insurance coverage by source

In general, employers have been the dominant source of health insurance for individuals since the late 1940s and 1950s. This can be at least partially attributed to the income tax exemption granted to employers for payments made toward health insurance for employees. The second major sources of health insurance are the state and federal governments, which jointly provide Medicaid for low-income individuals while the federal government sponsors Medicare for the elderly and disabled.^[21]

In 2013, about 41 percent of residents in Florida were insured through their employers, the smallest percentage among its neighboring states. Florida also had the greatest percentage of uninsured individuals at 19 percent. This was also greater than the national average.^[22]

The 1980s saw a peak in the percentage of people who were receiving health coverage through their employers, with a continuous decline in the rate thereafter. A study by researchers at the University of Minnesota’s State Health Access Data Assistance Center, which was funded by the Robert Wood Johnson Foundation, found that despite the tax exemption, fewer employers are choosing to offer health coverage to their employees, and when it is offered, fewer employees are enrolling.^[21][23]

Employer-sponsored insurance dropped by 12.4 percentage points in Florida from 2000 to 2012. Meanwhile, Florida's uninsured rate increased by 5.2 percentage points, the largest increase among its neighboring states. Click 'show' on the table below to view more comparisons.^[24]

Spending and costs

See also: Total healthcare spending by state

Healthcare spending and costs have become a top priority for both state and federal legislators amid growing concern from consumers and employers. Healthcare spending as a percentage of the national gross domestic product (GDP) increased from 5 percent in 1960 to reach 17.4 percent in 2009, or over one-sixth of the nation's economy, where it remained steady through 2013. Total healthcare spending in both the public and private sectors amounted to $2.9 trillion in 2013. Federal, state and local governments were responsible for about 43 percent of that spending. Projections have shown that if healthcare spending continues to increase at its current rate, it will reach 19.3 percent of GDP in 2023.^{[25][26][27][28]}

The rise in spending has been attributed partially to increased demand, but in large part to the increased price of delivering and receiving care.

Such costs mean less disposable income for consumers, greater expenses to hire new employees for employers, and difficulty writing budgets for lawmakers.^[30][31]

In 2009, the most recent year for which state-level data are available, total healthcare spending nationwide was $2.5 trillion. In Florida, total healthcare spending amounted to $132.5 billion, 18.2 percent of gross state product (GSP). Total spending came out to about $7,156 per person, highest among neighboring states.^[32][33][34]

In Florida, nearly equal parts of healthcare spending went to hospital care and physician/professional services. Average spending trends across the country saw greater spending on hospital care than physician/professional services, making spending in Florida relatively unique.^[35]

Government spending

See also: Florida state budget and finances

Medicaid and Medicare

Medicaid

See also: Medicaid spending in Florida

During fiscal year 2012, combined federal and state spending for Medicaid, was higher in Florida than in its neighboring states, totaling about $17.9 billion. Spending per enrollee amounted to $5,111, above only that in Georgia. The federal government accounted for 56 percent of total Medicaid spending, while the state government was responsible for 44 percent. Between 2000 and 2012, Medicaid spending experienced greater growth in Florida than in neighboring states, increasing by 82 percent, or about 5.1 percent per year. Florida dedicated a larger portion of its 2012 budget to Medicaid than its neighbors, 30.6 percent.^{[36][37][38][39][40]}

Acute care services are those that are typically provided within a short time frame, such as inpatient hospital stays, lab tests and prescription drugs. Long-term care services, on the other hand, are those provided over a long period of time, such as home care and mental health treatment. Disproportionate Share Hospital (DSH) payments are funds given to hospitals that tend to serve more low-income and uninsured patients than other hospitals. Florida spent a greater percentage of its Medicaid funds on acute care than any of its neighboring states. Meanwhile, it spent the smallest portion on payments to DSHs, 2 percent. The remaining 26.6 percent went toward long-term care services.^[41]

In 2010, there were 3,703,388 Florida residents enrolled in Medicaid. The majority of spending, 67 percent, was on the elderly and disabled, who made up 28 percent of Medicaid enrollees. This is typical of most states, since this group of enrollees is "more likely to have complex health care needs that require costly acute and long-term care services," according to the Pew Charitable Trusts. The proportion of these individuals who are enrolled in Medicaid is taken into consideration when lawmakers make appropriations for the program each year.^[42]

Medicare

Medicare is a federal health insurance program for elderly persons over age 65 and younger individuals with certain disabilities. Medicare accounted for 14 percent of the federal budget in 2013. In 2009, the most recent year for which state spending data is available, total federal Medicare spending for enrollees in Florida amounted to $39.1 billion. Per enrollee spending was higher in Florida than in any of its neighboring states, $11,893. This was also greater than the national average.^{[43][44][45][46]}

In 2012, there were 3,527,830 individuals in Florida enrolled in Medicare, or 18.5 percent of the state population. Aged beneficiaries made up 84.8 percent of the total number, while 15.2 percent were disabled.^[47][48][49]

Dual eligibility

Some individuals, such as low-income seniors, are eligible for both Medicare and Medicaid; these individuals are known as dual-eligible beneficiaries. For those enrolled in Medicare who are eligible, enrolling in Medicaid may provide some benefits not covered by Medicare, such as stays longer than 100 days at nursing facilities, prescription drugs, eyeglasses, and hearing aids. Medicaid may also be used to help pay for Medicare premiums. Total Medicaid spending for dual eligibles in Florida amounted to $7.2 billion. Most payments were made toward long-term care.^[50][51]

Prison healthcare

See also: Prison healthcare

In 1976, the United States Supreme Court ruled that adequate healthcare for prisoners is a constitutional right and that the refusal to provide them with such violates the Eighth Amendment prohibiting cruel and unusual punishment. As such, state budget allocations for correctional facilities, like other healthcare expenditures, have continued to grow, especially as the prison population ages. Correctional healthcare spending nationwide totaled $7.7 billion in 2011, or $6,047 per inmate, which The Pew Charitable Trusts estimated to be about one-fifth of total prison spending. This was up from 2007, but down from a peak in 2009 as the average daily prison population decreased. States have experienced fiscal pressure to manage prison healthcare costs without compromising prisoners' right to quality care.^[52]

In Florida, the percentage of inmates age 55 and older rose by about 29 percent, from 7 percent of the prison population to 9 percent. This was a greater increase and total percentage than in any of Florida’s neighboring states. Total prison healthcare spending in Florida was $424.6 million, or $4,670 per inmate, the highest per inmate spending among neighboring states.^[52]

State employees

See also: State employee health plans

State employee health insurance accounts for the second-largest portion of state healthcare spending, behind only Medicaid. The total cost of insurance for state workers was $30.7 billion nationwide in 2013, with $25.1 billion paid for by the states. Premium costs varied widely, with higher premiums found in states such as New Hampshire and Vermont compared to those in states like Arkansas and Mississippi. Part of this variation is due to demographic factors and provider prices, and part may be attributed to differences in health plan "richness," or the cost sharing between the insurer and health plan enrollees, such as deductibles and copayments.^[53]

Several states are experimenting with various cost-containment methods. "Pooled public employee health benefit programs" are one such strategy, which are mergers between state employee health plans and those of other, smaller public employers, such as city governments and school districts. The idea is to save on administrative costs for insurers and leverage the larger pool to negotiate lower premium rates. Evidence of cost savings is mixed, with the smaller public employers reaping most of the benefits. Programs for pooling public employee health plans have been implemented in 31 states; as of December 2014, Florida was one of them. According to the [[National Conference of State Legislatures, Florida allows public school districts to join its health plan.^[54]

Florida is one of 46 states that “self-fund at least one of their employee health care plans,” meaning that rather than purchasing insurance, the state pays health insurance claims with state and employee out-of-pocket insurance contributions while an insurer administers the benefits. As of 2013, there were 24 states offering plans with a $0 deductible; Florida was one of these states, with 55 percent of state employees enrolled in such a plan.^[53][54]

Net state employee health plan expenditures in Florida totaled $1.4 billion in 2013. Net expenditures for state employee health plans dropped by 6 percent in Florida from 2011 to 2013, while nationwide net expenditures fell by 1 percent..^[53]

Note: Due to such variations as demographics, plan richness and provider rates, "higher spending is not necessarily an indication of waste, and lower spending is not necessarily a sign of efficiency."^[53]

Florida’s average state employee health plan premiums for single and family coverage were the highest among neighboring states. The state paid on average 87 percent of the premiums.^[53]

Private insurance

See also: Private health insurance

Premiums

For private insurance, consumers typically either receive coverage through their employer or buy it on their own through the individual market. As healthcare costs have increased, so have insurance premiums. Between 2000 and 2014, insurance premiums for employer-sponsored plans, including state and local government plans, increased 144 percent for single coverage and 161 percent for family coverage. However, the rate of increase has slowed in more recent years. Between 2000 and 2007, premiums grew by 81 percent for single coverage and 88 percent for family coverage. Between 2007 and 2014, the rates of increase were 34.5 percent and 39 percent, respectively.^[55]

Employers have reacted to these costs in a number of ways, one of which has been to shift more responsibility for premium contributions to their employees. The portion of premiums paid by employees for single coverage has increased by four percentage points, from 14 percent to 18 percent, since 2000, and by three percentage points, from 26 percent to 29 percent, for family coverage. Average deductibles for employees have also risen, doubling from $584 to $1,135 between 2006 and 2013.^[55][56]

In Florida's private, employer-based insurance market, average premiums for employer-sponsored coverage amounted to $5,383 for single coverage and $16,070 for family coverage. The single coverage figure was below the national average, while the family coverage figure was roughly equal. Employees contributed about $1,408 per year for single coverage and $5,653 for family coverage. As shown in the bar chart above, premiums in Florida's individual market were greater than in its neighboring states, averaging about $233 per month, or $2,797 per year.^[57][58][59]

In 2013, private sector employers in Florida contributed on average 73.8 percent to single coverage premiums and 64.8 percent to family coverage premiums. Click on the table below to view further details and state comparisons.^[60][61]

Competitiveness

The Henry J. Kaiser Family Foundation measured the competitiveness of the private health insurance market in 2013, using the Herfindahl-Hirschman Index (HHI) as an indicator. The HHI takes into account how much of a market is controlled by each of the companies competing within it (market share) and is expressed in a value between zero and 10,000. The lower the number, the more competitive the market. The analysis was divided into individual, small group and large group insurance markets. The data also includes information on the market share of the largest insurer in each state, as well as the number of insurers with a market share of greater than five percent.^{[62][63][64][65]}

The individual, small group and large group insurance markets were more competitive in Florida than in its neighboring states, with the exception of Georgia. Within the state, the individual market was the most competitive, with the largest insurer holding a market share of 47 percent.^[62][63][64]

Other sectors

Pharmaceuticals

See also: Prescription drug sales by state

In the United States, there are more than 10,000 FDA-approved medicines available for doctors to prescribe or individuals to purchase over-the-counter. A major target of state healthcare cost-containment efforts is the price of these medicines. Prescription drugs generated a total of $259 billion in sales at retail pharmacies nationwide in 2014. Since generic drugs tend to be significantly less expensive than their brand name equivalents, all states allow pharmacists to dispense generics in place of brand name drugs for prescriptions. This practice is required in 13 states, except when a brand name drug is specifically ordered by a physician; this group of states includes Florida.^[66]

Additionally, state Medicaid programs typically take a number of steps to control spending on pharmaceuticals. Most common are establishing preferred drug lists, which are prescription drugs that are automatically covered by the program, and negotiating rebates with manufacturers for both brand name and generic drugs. Florida's Medicaid program utilized both of these strategies.^[67]

In 2014, retail sales of prescription drugs at pharmacies in Florida amounted to $15.6 billion, with about 248.9 million drugs sold. On average, women and individuals over age 65 bought more prescription drugs than men and those under age 65. These totals do not include medications sold over-the-counter.^{[68][69][70][71]}

Monitoring programs

States are also focusing on curbing prescription drug abuse and fraud as a method to contain costs.^[72]

Between 2004 and 2009, there was a documented increase of 98.4 percent in emergency room visits caused by such abuse and misuse of prescription drugs. As an effort to combat the rise in prescription drug abuse and fraud, all but two states have authorized the development of prescription drug databases that can monitor the dispensing of certain controlled substances. These programs have been bolstered by federal grants encouraging their implementation.^[72]

Florida has an operational prescription drug monitoring program that monitors the dispensing of Schedule II, Schedule III and Schedule IV drugs. Information must be reported weekly by pharmacies and practitioners that are authorized to dispense such drugs. These requirements exclude drugs directly administered to patients in hospitals, healthcare facilities, correctional centers and emergency rooms, as well as drugs dispensed for a one-time two-day period. The law does not require patients to be notified of the monitoring program.^[73]

Right to try

Under the current model, access to experimental drugs by terminally ill patients is controlled by the Food and Drug Administration (FDA), which must give its approval after it receives a form from a patient's physician. What are known as "right to try" laws aim to allow such patients to gain access to experimental drugs without the permission of the FDA. As of March 2016, 27 states in total had adopted right-to-try legislation. Florida enacted a right-to-try law in June 2015.^[74][75]

Health information technology

Health information technology (IT) refers to electronic systems that manage, store and transmit health information, such as patient records. The adoption of modernized health IT has been promoted by the federal government as a way to increase quality while decreasing costs. For instance, the American Recovery and Reinvestment Act of 2009 required most health providers to adopt electronic health records by 2015. However, the digitization of health data raises concerns about the privacy of such data, which could be vulnerable to a breach if not properly secured. Since 1996, health IT privacy and security has been governed by the Health Insurance Portability and Accountability Act (HIPAA), which required and set national standards for the confidentiality of patient information "when it is transferred, received, handled, or shared."^[76][77][78]

All-payer claims databases are one form of health IT that a growing number of states are implementing to track healthcare costs. All-payer claims databases are state systems for collecting data from public and private health insurance claims on demographics, types of services and total charges. According to the National Conference of State Legislatures, "the U.S. Department of Health and Human Services plans to build a nationwide all-payer claims database consisting of a representative sample of the population." All-payer claims databases exist in 17 states, while another 17 have demonstrated a "strong interest" in creating one. To view the status of such a program in Florida, click here.^{[79][80][81][82]}

Studies

Citizen health

Each year, the United Health Foundation releases a report titled "America's Health Rankings," which measures the overall health of the citizens in each state. The United Health Foundation is a nonprofit organization that "provides helpful information to support decisions that lead to better health outcomes and healthier communities." Factors taken into account for the report include the percentage of the state population that smokes tobacco, incidents of infectious diseases such as Salmonella, percent of the population uninsured, the number of primary care physicians, and the rate of infant mortality, among others.^[83][84]

In its 2014 report, Florida ranked 32nd in the nation, up from 34th in 2012. According to the report, although the state had a low high school graduation rate and high incidence of Salmonella, there was a low prevalence of smoking and obesity, and drug deaths had declined in the state over the previous two years.^[83]

Florida ranked higher than each of its neighboring states: Mississippi (50th), Georgia (38th) and Alabama (43rd). To read the full report, click here.^[83]

Recent legislation

The following is a list of recent healthcare policy bills that have been introduced in or passed by the Florida state legislature. To learn more about each of these bills, click the bill title. This information is provided by BillTrack50 and LegiScan.

Note: Due to the nature of the sorting process used to generate this list, some results may not be relevant to the topic. If no bills are displayed below, then no legislation pertaining to this topic has been introduced in the legislature recently.

Ballot measures

Voting on Healthcare
Ballot Measures
By state
By year
Not on ballot
Local Measures

See also: Healthcare on the ballot and List of Florida ballot measures

Ballotpedia has tracked the following ballot measures relating to healthcare matters in Florida.

1. Florida Medical Malpractice Protection, Amendment 8 (2004)
2. Florida Patient's Right to Know, Amendment 7 (2004)
3. Florida Healthcare, Amendment 1 (2012)

Recent news

The link below is to the most recent stories in a Google news search for the terms Florida healthcare. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

See also

• 

  Medicaid spending in Florida

 
• 

  Effect of the Affordable Care Act in Florida

 
• 

  U.S. Department of Health and Human Services

External links

• ","Florida Department of Health
• The Henry J. Kaiser Family Foundation
• National Conference of State Legislatures, Health
• Health Affairs

Additional reading

• The Henry J. Kaiser Family Foundation, "Health Care Costs: A Primer"
• Deloitte Center for Health Solutions, "Dig deep: Impacts and implications of rising out-of-pocket health care costs"
• The Pew Charitable Trusts, "State Health Care Spending Project Reports"

  Back to top↑

Footnotes