Florida Health Exchange Profile
Establishing the Exchange
In December 2012, Governor Rick Scott (R) announced that Florida would not be pursuing efforts to implement a state-based health insurance exchange. Governor Scott has been a vocal opponent of federal health reform and the state has refused multiple funding opportunities available through the Affordable Care Act (ACA). Florida was also the lead plaintiff in a lawsuit brought by 26 states seeking to declare parts of federal health reform unconstitutional.
At the same time, Florida has been proceeding with an initiative, Florida Health Choices, to create a new marketplace for small businesses that predates the passage of federal health reform. The initiative, begun in 2008 with the enactment of SB 2534, will include a web portal where employers with 50 or fewer employees and some individuals, such as state retirees, can shop for health plans offered in their county. The state provided a one-time appropriation of $1.5 million for start-up funding, with on-going support provided through a fee of 2% of the premium for every policy sold through the marketplace paid by participating health plans and a $300 annual payment from agents who sell policies through the marketplace. Florida Health Choices has appointed a Board of Directors, hired staff, and appointed two steering committees to advise the Board- one for vendors and another for agents. In May of 2012, Florida Health Choices identified a third party administrator to provide a web portal, online plan selection tools, and a statewide customer contact center. In September 2012, the state began beta testing the web portal. Florida Health Choices does not currently comply with provisions in the ACA, such as providing subsidies to assist eligible low-income individuals with purchasing insurance or mandating that health plans sold through the exchange cover certain health benefits.
In 2011, the Governor signed HB 97/SB 1414, which prohibits coverage of abortions when insurance is purchased through an exchange using state or federal funds, except in cases of rape, incest, or life endangerment of the pregnant woman. The legislation allows health insurance policies to offer separate coverage for abortions not purchased with state or federal funds.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Florida has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Florida- BlueOptions, PPO.
Florida’s Agency for Health Care Administration received a federal Exchange Planning grant of $1 million in 2010, but has since returned the grant.
The federal government will assume full responsibility for running a health insurance exchange in Florida beginning in 2014. To find out what options are available in the State of Florida you can contact us or fill out a quote request for more details.