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

Published December 8th, 2022 by Timothy McGuire

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 insurancepharmaceuticals 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 privacyuninsured 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

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]

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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

Healthcare Policy Logo on Ballotpedia.png


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]

[hide]Age and gender demographics, 2013
StateTotal residentsChildren 0-18Adults 19-6465+MaleFemale
Florida19,379,40022%61%17%48%52%
Alabama4,755,20025%60%15%48%52%
Georgia9,787,10027%60%13%48%52%
Mississippi2,920,00027%60%13%48%52%
United States313,395,40025%61%14%49%51%
SourceThe Henry J. Kaiser Family Foundation, "State Health Facts"

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.

[hide]Various economic indicators by state
StateDistribution of population by FPL* (2013)Median annual incomeUnemployment rateTotal GSP (2013)
Under 100%100-199%200-399%400%+Sept. 2013Sept. 2014
Florida15%20%32%32%$47,1066.9%6.1%$800,492
Alabama17%22%33%28%$43,3306.4%6.6%$193,566
Georgia16%21%32%31%$47,7538%7.9%$454,532
Mississippi23%20%29%28%$40,3388.4%7.7%$105,163
United States15%19%30%36%$52,0477.2%5.9%$16,701,415
* Federal Poverty Level. "The U.S. Census Bureau's poverty threshold for a family with two adults and one child was $18,751 in 2013. This is the official measurement of poverty used by the Federal Government."
Median annual household income, 2011-2013.
In millions of current dollars. "Gross State Product is a measurement of a state's output; it is the sum of value added from all industries in the state."
SourceThe Henry J. Kaiser Family Foundation, "State Health Facts"

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]

[hide]Health insurance coverage by source, 2013
StateEmployerOther privateMedicaidMedicareOther publicUninsured
Florida41%5%14%17%3%19%
Alabama43%5%17%18%N/A16%
Georgia47%6%13%14%4%16%
Mississippi43%5%19%17%3%14%
United States48%6%16%15%2%13%
SourceThe Henry J. Kaiser Family Foundation, "State Health Facts"

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]

[show]Change in health insurance coverage by source, 2000-2012
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Spending and costs

See also: Total healthcare spending by state
Florida healthcare spending GSP.png

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.

Between January 1988 and January 2009, the consumer price index (CPI) rose 82 percent, while the medical component of CPI rose 175 percent.[29]

—National Conference of State Legislatures

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 Floridatotal 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]

[hide]Total healthcare spending*, 2009
StateTotal health spending (in millions)Percent of GSPHealth spending per capitaAvg. annual percent growth
Florida$132,46318.24%$7,1566.9%
Alabama$29,52417.92%$6,2725.9%
Georgia$53,65513.71%$5,4676.6%
Mississippi$19,38421.03%$6,5717%
United States$2,505,80017.4%$8,1756.8%
* "Total Health Spending includes spending for all privately and publicly funded personal health care services and products (hospital care, physician services, nursing home care, prescription drugs, etc.) by state of residence. Hospital spending is included and reflects the total net revenue (gross charges less contractual adjustments, bad debts, and charity care)."
1991–2009
Data come directly from the Centers for Medicare and Medicaid Services, "NHE Summary including share of GDP, CY 1960-2013"
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"


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]

FL-US healthcare spending by service.png
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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]

[hide]Medicaid spending, fiscal year 2012
StateTotal spending*Per enrollee*Total growthCompound annual growth rateFederal share*State share*Percent of state budget
Florida$17,906,910,735$5,11182%5.1%56%44%30.6%
Alabama$5,027,020,046$4,84747%3.2%69%31%23.3%
Georgia$8,525,953,526$6,52453%3.6%66%34%21.5%
Mississippi$4,465,933,337$6,49976%4.8%74%26%23.4%
United States$415,154,234,831$6,83363%4.1%57%43%N/A
* "Expenditures do not include administrative costs, accounting adjustments, or the U.S. Territories."
Includes both state and federal expenditures.
2000–2012. Includes payments for services, administrative expenses, and DSH payments.

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]

FL Medicaid spending by service 2012.png

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]

[hide]Distribution of Medicaid enrollment and payments, 2010
StateEnrollment ratesPayment for services
TotalElderly and disabled individualsParents and childrenTotal (in billions)Elderly and disabled individualsParents and children
Florida3,703,38828%72%$16.467%33%
Alabama1,015,57633%67%$4.260%40%
Georgia1,869,62225%75%$7.359%41%
Mississippi772,14133%67%$0.966%34%
United States66,390,64224%76%$369.364%36%
Source: The Pew Charitable Trusts, "State Health Care Spending on Medicaid"

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]

[hide]Medicare spending and growth, 2009
StateTotal (in millions)Average annual growth rate*Per enrolleeAverage annual growth rate*
Florida$39,1198.6%$11,8936.7%
Alabama$8,0427.9%$9,7185.9%
Georgia$11,7438.6%$9,8365.8%
Mississippi$5,2058.5%$10,6676.9%
United States$471,2608.0%$10,3626.4%
* 1991–2009
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"

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]

[hide]Medicare beneficiaries, 2012
StateNumberPercent of populationEligibility category
AgedDisabled
Florida3,527,83018.5%84.8%15.2%
Alabama881,68618.4%72.7%27.3%
Georgia1,318,73313.4%78.4%21.6%
Mississippi516,80917.4%72.6%27.4%
United States49,435,61016.0%81.4%18.6%
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"

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]

[hide]Medicaid spending for dual eligibles by service, fiscal year 2011 (in millions)
StateMedicare premiumsAcute carePrescribed drugsLong-term careTotal
Florida$1,122$1,927$87$4,054$7,190
Alabama$250$245$13$1,125$1,633
Georgia$295$366$26$1,596$2,283
Mississippi$201$377$9$1,014$1,602
United States$13,489$40,190$1,462$91,765$146,906
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"
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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]

The manner in which states manage prison health care services that meet these legal requirements affects not only inmates' health, but also the public's health and safety and taxpayers' total corrections bill.[29]

—The Pew Charitable Trusts

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]

[hide]State spending on prison healthcare
StateCategory20072008200920102011Percent change
FloridaTotal spending*$409,646$443,595$416,244$427,795$424,5924%
Daily prison population83,96587,03590,41791,57490,9278%
Per inmate spending$4,879$5,097$4,604$4,672$4,670-4%
Percent of inmates age 55+7%7%7%8%9%29%
AlabamaTotal spending*$89,057$92,465$94,206$96,215$97,2669%
Daily prison population28,76025,52326,17925,84125,806-10%
Per inmate spending$3,097$3,623$3,599$3,723$3,76922%
Percent of inmates age 55+6.3%6.7%6.7%7.2%7.9%25%
GeorgiaTotal spending*$206,094$229,106$215,069$207,282$208,1031%
Daily prison population53,86454,62954,76753,70451,794-4%
Per inmate spending$3,826$4,194$3,927$3,860$4,0185%
Percent of inmates age 55+6.3%6.8%6.9%7.5%7.9%26%
MississippiTotal spending*$57,775$66,743$66,262$69,299$64,57512%
Daily prison population19,82420,55320,78819,81219,305-3%
Per inmate spending$2,914$3,247$3,188$3,498$3,34515%
Percent of inmates age 55+6%5%5%6%6%0%
* In thousands.
Source: The Pew Charitable Trusts, "State Prison Health Care Spending"

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]

Healthcare policy blood pressure.jpg

State health plans were generally "rich," paying on average 92 percent of the typical enrollees’ health care costs. By way of context, these plans would be designated "platinum" plans within the new health insurance marketplaces.[29]

—The Pew Charitable Trusts

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]

[hide]State employee health plan spending (in thousands)
StateTotal state expenditures (gross)ChangeTotal state expenditures (net)Change
2011201320112013
Florida$1,709,924$1,600,160-6%$1,483,773$1,388,552-6%
Alabama$319,012$299,038-6%$244,199$222,317-9%
Georgia$562,834$596,4376%$432,056$432,7250%
Mississippi$323,775$315,057-3%$251,250$243,504-3%
United States$30,311,259$30,692,1471%$25,263,863$25,071,413-1%
Note: "Gross expenditures include employer and employee premium contributions. Net expenditures include only employer premium contributions. All spending figures are in 2013 dollars."
Source: The Pew Charitable Trusts, "State Employee Health Plan Spending"

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]

[hide]Average state employee health plan monthly premiums, 2013
StateSingleFamilyEmployer contribution percentageEmployee contribution percentage
Total premiumEmployer contributionEmployee contributionTotal premiumEmployer contributionEmployee contribution
Florida$549$500$50$1,242$1,063$17987%13%
Alabama$383$298$85$1,038$763$27574%26%
Georgia$518$395$122$1,171$833$33873%27%
Mississippi$391$356$35$729$356$37377%23%
United States$570$502$68$1,233$1,004$23084%16%
Note: "Due to rounding, the sum of employer and employee contributions may differ from total premium."
Source: The Pew Charitable Trusts, "State Employee Health Plan Spending"
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Private insurance

FL individual insurance premiums.png
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]

[hide]Average annual premiums for private employer-based insurance, 2013
StateSingleFamily
Employee contributionEmployer contributionTotalEmployee contributionEmployer contributionTotal
Florida$1,408$3,975$5,383$5,653$10,417$16,070
Alabama$1,379$3,825$5,204$3,791$9,686$13,477
Georgia$1,219$4,155$5,374$4,435$10,327$14,762
Mississippi$1,097$3,864$4,961$4,376$9,677$14,053
United States$1,170$4,401$5,571$4,421$11,608$16,029
Note: "Figures may not sum exactly due to rounding."
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"

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]

[show]Average annual premiums for private employer-based insurance, 2013 (percents)

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]

[hide]Health insurance market competition, 2013
StateIndividualSmall groupLarge group
HHI*Market share of largest insurerInsurers with >5% market shareHHI*Market share of largest insurerInsurers with >5% market shareHHI*Market share of largest insurerInsurers with >5% market share
Florida2,73147%52,80435%53,18251%5
Alabama8,25091%29,48397%18,37591%1
Georgia2,46536%32,27828%42,51242%5
Mississippi4,09260%37,32985%26,94482%2
United States3,88855%33,84157%44,03857%4
* "The Herfindahl-Hirschman Index (HHI) is a measure of how evenly market share is distributed across insurers in the market. HHI values range from 0 to 10,000, with an HHI closer to zero indicating a more competitive market and closer to 10,000 indicating a less competitive market. An HHI index below 1,000 generally indicates a highly competitive market; an HHI between 1,000 and 1,500 indicates an unconcentrated market; a score between 1,500 and 2,500 indicates moderate concentration; and a value above 2,500 indicates a highly concentrated (uncompetitive) market."
Source: The Henry J. Kaiser Family Foundation, "State Health Facts"
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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]

[hide]Prescription drugs filled at retail pharmacies, 2014
StateTotal sales for retail Rx drugsTotal number retail Rx drugsNumber per capita by ageNumber per capita by gender
Ages 0-18Ages 19-64Ages 65+MaleFemale
Florida$15,583,530,624248,850,2794.111.825.910.814.6
Alabama$5,166,108,99084,280,1505.617.636.114.320.5
Georgia$7,963,555,676126,152,4364.112.532.210.315.
Mississippi$2,907,188,31252,221,6756.717.239.14.120.8
United States$259,092,876,2854,002,661,7504.112.627.910.414.9
Note: "These totals include prescriptions filled at pharmacies only and a small portion of over-the-counter medications and repackagers and exclude those filled by mail order."
SourceThe Henry J. Kaiser Family Foundation, "State Health Facts"

Monitoring programs

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

According to the Coalition Against Insurance Fraud, prescription drug misuse, abuse and fraud cost private health insurers almost $25 billion a year.[29]

—National Conference of State Legislatures
US Army 52156 VA warns veterans of telephone prescription scam.jpg

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

The HHS on the HIPAA Privacy Rule

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]

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Studies

Citizen health

Healthcare policy jogging.jpg

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.

Healthcare legislation in Florida
  • An act relating to health insurance cost sharing; creating s. 627.6383, F.S.; defining the term “cost sharing requirement”; requiring specified individual health insurers and their pharmacy benefit managers to apply payments by or on behalf...
    11/22/2022: Filed
  • An act relating to pharmacies and pharmacy benefit managers; transferring, renumbering, and amending s. 465.1885, F.S.; revising the entities conducting pharmacy audits to which certain requirements and restrictions apply; authorizing audited...
    06/09/2022: Signed by Officers and presented to Governor
  • Specifying the responsibilities of regional counsels regarding witness coordination; removing the requirement that regional counsel employees be governed by Justice Administrative Commission classification and salary and benefits plans; providing...
    06/09/2022: Signed by Officers and presented to Governor
  • Authorizing the Department of State to electronically receive service of process under ch. 48, F.S.; revising procedures for service on partnerships, limited liability partnerships, and limited partnerships; requiring designation of registered...
    06/08/2022: Signed by Officers and presented to Governor
  • An act relating to the state group insurance program; amending s. 110.123, F.S.; providing and revising definitions; authorizing eligible former employees to participate in the state group insurance program; removing certain benefit levels for...
    06/03/2022: Chapter No. 2022-160
  • Providing an appropriation to the Board of Directors of the H. Lee Moffitt Cancer Center and Research Institute for a specified purpose; authorizing pharmacists and wholesalers employed by or under contract with forensic facilities managed by...
    06/03/2022: Chapter No. 2022-150
  • An act relating to the Appropriations Project titled Encore Healthcare - Medicaid Respiratory Disease Management Pilot Program; providing an appropriation; providing an effective date.
    06/02/2022: Vetoed by Governor; See HB 5001 (line item 189)
  • An act relating to Department of Financial Services; repealing s. 17.0315, F.S., relating to the financial and cash management system and task force; amending s. 48.151, F.S.; providing an exception to service of process on public entities under...
    05/26/2022: Chapter No. 2022-138
  • An act relating to mental health of students; amending s. 394.463, F.S.; revising data the Department of Children and Families is required to analyze when creating its annual report on the initiation of certain involuntary examinations; amending...
    05/19/2022: Chapter No. 2022-126
  • An act relating to step-therapy protocols; amending s. 627.42393, F.S.; revising the circumstances under which step-therapy protocols may not be required; defining terms; requiring health insurers to publish on their websites and provide to...
    04/08/2022: Chapter No. 2022-47
  • An act relating to nursing homes; amending s. 400.021, F.S.; revising a definition; amending s. 400.23, F.S.; providing definitions; specifying functions that do not constitute direct care staffing hours for purposes of required nursing home...
    04/08/2022: Chapter No. 2022-61
  • Requiring hospitals and other state-licensed birthing facilities to test for congenital cytomegalovirus in newborns within a specified timeframe under certain circumstances; revising the timeframe in which health care providers attending home...
    04/08/2022: Chapter No. 2022-25
  • Authorizing the approval of drug products or certain medication prescribed for the treatment of schizophrenia or schizotypal or delusional disorders for Medicaid recipients who have not met the step-therapy prior authorization criteria, when...
    04/08/2022: Chapter No. 2022-27
  • Authorizing certified paramedics to perform basic life support services, advanced life support services, and additional health care services to acute care at-home patients in nonemergent community settings under certain circumstances; providing...
    04/08/2022: Chapter No. 2022-35
  • Authorizing emergency contact information to be released to certain entities; revising the conditions under which a patient's communication with persons outside of a receiving facility may be restricted; requiring a receiving facility to notify...
    04/08/2022: Chapter No. 2022-36
  • Authorizing the Agency for Health Care Administration to pay for donor human milk bank services as an optional Medicaid service if certain conditions are met; authorizing the agency to seek federal approval; adding donor human milk bank services...
    04/08/2022: Chapter No. 2022-40
  • Providing that the use of peer specialists is an essential element of a coordinated system of care in recovery from a substance use disorder or mental illness; revising background screening requirements for certain peer specialists; requiring...
    03/11/2022: Chapter No. 2022-13
  • Requiring the court to prioritize certain forms of alimony; authorizing the court to grant permanent alimony only if both parties enter into such agreement; revising factors that the court must consider in determining the proper type and amount...
    03/09/2022: Ordered enrolled
  • Creating the "Ramping up Education of Alzheimer's Disease and Dementia for You (READY) Act"; requiring the Department of Health, in collaboration with the Department of Elderly Affairs and the Alzheimer's Association, to develop and disseminate...
    03/07/2022: Ordered enrolled

Ballot measures

Voting on Healthcare
Health care.jpg
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

External links

Additional reading

Footnotes

  1. ↑ Jump up to:1.0 1.1 National Conference of State Legislatures, "Health," accessed July 8, 2015
  2. ↑ Jump up to:2.0 2.1 2.2 2.3 Fillmore, R., Florida Science Communications, Inc., "The Evolution of the U.S. Healthcare System," accessed July 8, 2015
  3. History, "George Waring," accessed July 27, 2015
  4. University of Houston: Digital History, "The Growth of Cities," accessed July 27, 2015
  5. NPR, "Accidents Of History Created U.S. Health System," October 22, 2009
  6. The Economist, "The insured and the unsure," January 26, 2013
  7. NPR, "Health Care In America: Follow The Money," March 19, 2012
  8. National Center for Biotechnology Information, "Why Is Health Care Regulation So Complex?" October 2008
  9. Center on Education and the Workforce, "Healthcare," June 2012
  10. Ensocare, "How Demographics Impact Health-care Delivery," accessed July 10, 2015
  11. The Henry J. Kaiser Family Foundation, "Total Number of Residents," accessed July 17, 2015
  12. Henry J. Kaiser Family Foundation, "Population Distribution by Age," accessed July 17, 2015
  13. Henry J. Kaiser Family Foundation, "Population Distribution by Gender," accessed July 17, 2015
  14. Academy Health, "Impact of the Economy on Health Care," August 2009
  15. The Conversation, "Budget explainer: What do key economic indicators tell us about the state of the economy?" May 6, 2015
  16. Health Affairs, "Socioeconomic Disparities In Health: Pathways And Policies," accessed July 13, 2015
  17. The Henry J. Kaiser Family Foundation, "Distribution of Total Population by Federal Poverty Level," accessed July 17, 2015
  18. The Henry J. Kaiser Family Foundation, "Median Annual Household Income," accessed July 17, 2015
  19. The Henry J. Kaiser Family Foundation, "Unemployment Rate (Seasonally Adjusted)," accessed July 17, 2015
  20. The Henry J. Kaiser Family Foundation, "Total Gross State Product (GSP) (millions of current dollars)," accessed July 17, 2015
  21. ↑ Jump up to:21.0 21.1 Health Affairs, "Employment-Based Health Insurance: Past, Present, And Future," November 2006
  22. The Henry J. Kaiser Family Foundation, "Health Insurance Coverage of the Total Population," accessed July 23, 2015
  23. Robert Wood Johnson Foundation, "State-Level Trends in Employer-Sponsored Health Insurance," January 29, 2015
  24. The Pew Charitable Trusts, "State Health Care Spending on Medicaid," July 2014
  25. Centers for Medicare and Medicaid Services, "National Health Expenditures 2013 Highlights," accessed July 28, 2015
  26. Health Affairs, "National Health Spending In 2013: Growth Slows, Remains In Step With The Overall Economy," December 2014
  27. Health Affairs, "National Health Expenditure Projections, 2013–23: Faster Growth Expected With Expanded Coverage And Improving Economy," September 2014
  28. Peterson-Kaiser Health System Tracker, "Health Spending Explorer," accessed July 28, 2015
  29. ↑ Jump up to:29.0 29.1 29.2 29.3 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
  30. Health Affairs, "The Rise In Health Care Spending And What To Do About It," November 2005
  31. National Conference of State Legislatures, "Equalizing Health Provider Rates," June 2010
  32. The Henry J. Kaiser Family Foundation, "Health Care Expenditures by State of Residence (in millions)," accessed July 17, 2015
  33. The Henry J. Kaiser Family Foundation, "Health Care Expenditures per Capita by State of Residence," accessed July 17, 2015
  34. The Henry J. Kaiser Family Foundation, "Average Annual Percent Growth in Health Care Expenditures by State of Residence," accessed July 17, 2015
  35. The Henry J. Kaiser Family Foundation, "Distribution of Health Care Expenditures by Service by State of Residence (in millions)," accessed August 27, 2015
  36. The Henry J. Kaiser Family Foundation, "Total Medicaid Spending," accessed July 17, 2015
  37. Medicaid and CHIP Payment and Access Commission, "Medicaid Benefit Spending per Full-Year Equivalent Enrollee by State and Eligibility Group, FY 2012," accessed September 14, 2015
  38. The Pew Charitable Trusts, "State Health Care Spending on Medicaid" Table B.1, accessed July 17, 2015
  39. The Henry J. Kaiser Family Foundation, "Federal and State Share of Medicaid Spending," accessed July 17, 2015
  40. National Association of State Budget Officers, "State Expenditure Report: Examining Fiscal 2011-2013 State Spending: Table 5," accessed July 17, 2015
  41. The Henry J. Kaiser Family Foundation, "Distribution of Medicaid Spending by Service," accessed July 17, 2015
  42. The Pew Charitable Trusts, "State Health Care Spending on Medicaid," July 2014
  43. The Henry J. Kaiser Family Foundation, "Total Medicare Spending by State (in millions)," accessed July 17, 2015
  44. The Henry J. Kaiser Family Foundation, "Average Annual Percent Growth in Medicare Spending, by State," accessed July 17, 2015
  45. The Henry J. Kaiser Family Foundation, "Medicare Spending Per Enrollee, by State," accessed July 17, 2015
  46. The Henry J. Kaiser Family Foundation, "Average Annual Percent Growth in Medicare Spending per Enrollee, by State," accessed July 17, 2015
  47. The Henry J. Kaiser Family Foundation, "Total Number of Medicare Beneficiaries," accessed July 17, 2015
  48. The Henry J. Kaiser Family Foundation, "Medicare Beneficiaries as a Percent of Total Population," accessed July 17, 2015
  49. The Henry J. Kaiser Family Foundation, "Distribution of Medicare Beneficiaries by Eligibility Category," accessed July 17, 2015
  50. Medicaid.gov, "Seniors & Medicare and Medicaid Enrollees," accessed July 16, 2015
  51. The Henry J. Kaiser Family Foundation, "Distribution of Medicaid Spending for Dual Eligibles by Service (in Millions)," accessed July 17, 2015
  52. ↑ Jump up to:52.0 52.1 The Pew Charitable Trusts, "State Prison Health Care Spending," July 2014
  53. ↑ Jump up to:53.0 53.1 53.2 53.3 53.4 The Pew Charitable Trusts, "State Employee Health Plan Spending," August 2014
  54. ↑ Jump up to:54.0 54.1 National Conference of State Legislatures, "State Employee Health Benefits," accessed July 20, 2015
  55. ↑ Jump up to:55.0 55.1 The Henry J. Kaiser Family Foundation, "Employee Health Benefits: 2014 Annual Survey," accessed July 24, 2015
  56. The Henry J. Kaiser Family Foundation, "FAQ: How Employer-Sponsored Health Insurance Is Changing," September 17, 2013
  57. The Henry J. Kaiser Family Foundation, "Average Single Premium per Enrolled Employee For Employer-Based Health Insurance," accessed July 24, 2015
  58. The Henry J. Kaiser Family Foundation, "Average Family Premium per Enrolled Employee For Employer-Based Health Insurance," accessed July 24, 2015
  59. The Henry J. Kaiser Family Foundation, "Average Monthly Premiums Per Person in the Individual Market," accessed July 24, 2015
  60. The Henry J. Kaiser Family Foundation, "Average Single Premium per Enrolled Employee For Employer-Based Health Insurance," accessed July 17, 2015
  61. The Henry J. Kaiser Family Foundation, "Average Family Premium per Enrolled Employee For Employer-Based Health Insurance," accessed July 17, 2015
  62. ↑ Jump up to:62.0 62.1 The Henry J. Kaiser Family Foundation, "Individual Insurance Market Competition," accessed July 24, 2015
  63. ↑ Jump up to:63.0 63.1 The Henry J. Kaiser Family Foundation, "Small Group Insurance Market Competition," accessed July 24, 2015
  64. ↑ Jump up to:64.0 64.1 The Henry J. Kaiser Family Foundation, "Large Group Insurance Market Competition," accessed July 24, 2015
  65. Investopedia, "Herfindahl-Hirschman Index - HHI," accessed August 6, 2015
  66. National Conference of State Legislatures, "Use of Generic Prescription Drugs and Brand-Name Discounts," June 2010
  67. National Conference of State Legislatures, "Prescription Drug Agreements and Volume Purchasing," June 2010
  68. The Henry J. Kaiser Family Foundation, "Total Retail Sales for Prescription Drugs Filled at Pharmacies," accessed July 21, 2015
  69. The Henry J. Kaiser Family Foundation, "Total Number of Retail Prescription Drugs Filled at Pharmacies," accessed July 21, 2015
  70. The Henry J. Kaiser Family Foundation, "Retail Prescription Drugs Filled at Pharmacies (Annual per Capita by Age)," accessed July 21, 2015
  71. The Henry J. Kaiser Family Foundation, "Retail Prescription Drugs Filled at Pharmacies (Annual per Capita by Gender)," accessed July 21, 2015
  72. ↑ Jump up to:72.0 72.1 National Conference of State Legislatures, "The Burden of Prescription Drug Overdoses on Medicaid," January 2012
  73. National Alliance for Model State Drug Laws, "Prescription Monitoring Program State Profiles – Florida," accessed July 21, 2015
  74. National Conference of State Legislatures, "'Right to Try' Experimental Prescription Drugs State Laws and Legislation for 2014 & 2015," March 31, 2015
  75. Right to Try, "Right to Try in Your State," accessed April 10, 2017
  76. California Department of Health Care Services, "Health Insurance Portability and Accountability Act," accessed August 4, 2015
  77. U.S. Department of Health and Human Services, "Health Information Technology," accessed August 8, 2015
  78. U.S. Department of Health and Human Services, "Health Information Technology," accessed August 4, 2015
  79. The Commonwealth Fund, "All-Payer Claims Databases: State Initiatives to Improve Health Care Transparency," September 2010
  80. Governing, "More States Create All-Payer Claims Databases," February 4, 2014
  81. APCD Council, "Frequently Asked Questions," accessed August 4, 2015
  82. National Conference of State Legislatures, "Collecting Health Data: All-Payer Claims Databases," May 2010
  83. ↑ Jump up to:83.0 83.1 83.2 United Health Foundation, "America's Health Rankings," December 2014
  84. United Health Foundation, "About the United Health Foundation," accessed July 27, 2015
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