The rates will be as low as $100 a month for a
healthy 35-year-old man. Of course, they will cost
older and sicker people more, and the Blues will
still reject applicants who are seriously ill.
However, small businesses are guaranteed coverage
if 70 percent of their employees participate and
the companies pay at least half of the premiums.
The deductible is an affordable $250, after
which the Blues will pay 90 percent of in-network
hospital costs and 100 percent of in-network lab
costs. Office visits will cost $50. The plan
covers generic drugs with a $10 copay, and brand
drugs will be available at the Blue’s negotiated
cost. The annual out of pocket limit for an
individual will be $2,500, with a $5 million
lifetime ceiling on insurance payments.
Naturally, the provider network is limited.
About 1,500 primary-care doctors have agreed to
accept the low fees, and 20 community clinics are
also in the network. Among the seven participating
hospitals are three in the Jackson Health
System; Tenet’s Palmetto
General, Hialeah and Coral Gables facilities; and
the Baptist system’s Homestead Hospital.
The county helped shape the health plan’s
benefits and selected Blue Cross Blue Shield in a
bidding process, but taxpayers will not subsidize
the plan.
In January, Florida launched a program offering
low-cost insurance plans to the state’s 3.8
million uninsured people. The average cost of
those plans is $155 a month, but the deductibles
are high. For example, the Blues’ catastrophic
policy carries a $3,000 family deductible. Perhaps
because of that, there have been few takers.
Miami-Dade Blue might be more successful, if only
because of its lower out of pocket costs.
Massachusetts has also offered relatively cheap
insurance to many of its uninsured, who are
required to buy coverage under the state’s 2006
reform law. As of last fall 41% of the 439,000
newly insured people in Massachusetts had bought
health plans subsidized by the state. But while
this approach has helped lower the uninsured rate
to 3 percent, it is endangered by soaring costs
and inadequate access to primary care.
Neither Miami-Dade County nor Florida has
proposed public subsidies for insurance or an
individual mandate. Moreover, the uninsured rate
is far higher in Florida than it was in
Massachusetts before the latter state put its
reforms into effect.
Policymakers in Washington are evaluating the
Massachusetts experience as they continue to pilot
a course toward national reform. But they should
also take a close look at what happens in Miami
during the next several months. While government
subsidies will certainly be required to reach
universal coverage, the willingness of providers
to bend on price might spell the difference
between success and failure.