By Lynn Hatter
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-990061.mp3
Tallahassee, FL – In the upcoming years Florida will face a choice: to comply, or not to comply with the Federal Affordable Care Act. The state is one of 26 fighting the law in a case headed to the Supreme Court. But quietly, Florida has created a few programs that, at first glance, seem to mirror the federal law it's disputing. One of those elements is a health insurance marketplace. As Lynn Hatter reports, some businesses could benefit.
Blossom's flower shop is in Tallahassee's busy downtown.
"I am Lisa Metcalf, director of operations, Blossom's Flowers, Tallahassee's premier florist. And I'm Jessica Parker, Jesica with one "S". and I am the owner."
Metcalf and Parker are former bankers, and they do weddings, funerals, special occasions, birthdays, you name it. Right now, they and their six employees have health coverage through a not-for-profit HMO - but it isn't an easy lift, even for successful entrepreneurs.
Parker: "In the beginning when we first started offering it and we came around to our first couple of renewals I was surprised at the increase annually in our premium. But now it's something that we've come to expect and budget into our budget, that we're going to have an increase every year. And now, 10-percent of our monthly budget goes to health insurance."
Metcalf: "Which, for a small business, is substantial."
Florida Health Choices is aimed at small businesses like Blossom's and is an online portal where they can compare and shop for health insurance plans. Sort of like a Priceline Negotiator for health insurance. It looks an awful lot like the insurance exchanges that the federal health overhaul law says every state must create. But if you call it that, its CEO Rose Naff will quickly correct you.
"I want to be real clear that we are not a health insurance exchange. That's something that's defined in the Affordable Care Act and we don't even come close to meeting that definition. I refer to what we're doing here as a marketplace."
Florida Health Choices predates the federal Affordable Care Act by two years and would be only for businesses with fewer than 50 employees. And unlike the exchanges other states are working on now to comply with the health law, it has no subsidies to help anyone buy insurance, and the plans it offers don't have to guarantee a minimum level of coverage for consumers. Naff says that is by design.
"This is a voluntary market place. They don't have to come and offer their products and services , and also its voluntary for employers and their employees. So how do we make it easy for them? It's voluntary for agents. So, what does it take for those three groups to collectively decide they want to do business through this model?
The health insurance industry is still trying to find an answer to that question. Florida Health Choices wouldn't qualify as a federal exchange, and people like Florida Association of Insurance Agents President Jeff Grady are wondering, what's the point?
"It's uh, it's kind of funny. It meets the theme of a state-based exchange, but not the one the feds are talking about. And I think some in the industry scratch their heads and wonder how effective this will be. I don't think they're opposed to it necessarily."
Grady says if the state's marketplace helps streamline the process for employers it's a good thing, but if the competition doesn't drive down costs, it wouldn't help businesses like Blossom's.
"There's nothing in these initial views of the proposal, that changes the affordability equation, it doesn't change any of the players in whose doing what and what they're providing."
The Florida marketplace was supposed to open for business this past summer but has now been delayed until early next year. It's also still looking for insurance companies to join. Meanwhile, no model for a federal exchange has emerged yet. If Florida doesn't have an exchange in place that meets the federal rules by January of 2013, the federal government can set up a separate exchange in the state. Health Choices CEO Rose Naff says if that happens, Health Choices will still have a place.
"If there were to be a federal exchange in Florida, there is still going to be a private insurance market. And there are still going to be a lot of underwriting components to that and I think there's a lot of evolution under way. I think we're doing something exciting today and not waiting for someone else to tell us how to do what's right for Florida."
For florists Metcalf and Parker, what the insurance marketplace is called is less important than what it does for their business.
"Just because an exchange may be created, if the insurance companies involved in that exchange aren't beneficial, affordable and have the adequate coverage to be beneficial to us and our employees, then the whole thing will be futile."
***This story was produced as part of "Health Care in the States," a special project of WFSU, NPR and Kaiser Health News.***