Public Policy Directly Affects Local Government Area

¶ … public policy directly affects local government area organization located. You select a policy affects,, local government area work located. (I work Orlando, Fl). The private sector affected federal, state, local policies.

Public policy: Healthcare in Orlando, Florida

Public policy is a government's attempt to address a problem that affects the public or to improve citizens' lives through legislation. One example of public policy on a federal level is that of the government's efforts to reform both government-sponsored and private healthcare insurance and to curtail spiraling healthcare costs. On a state level, Florida has made an aggressive attempt to reform healthcare. The focus of the proposed Florida program to reform Medicaid, the government insurance program for low-income residents, has been to force healthcare entities to limit care by setting spending caps, increasing the emphasis on personal responsibility, and charging patients fees for procedures to reduce the use of services.

Medicaid is partially funded by the federal government, but states set requirements for eligibility, based upon micro-level conditions of how 'poverty' is defined, although all states must cover workers who fall below the federal definition of the poverty threshold ($22,050 for a family of four) in some form. Because reimbursement costs for physicians are low, and the program has a history of under-funding, efforts to reform the program have been ongoing. Recently, the Florida Senate introduced a bill to shift the state's 2.9 million Medicaid recipients to HMO-like health plans, "charging for doctor and hospital visits, and banning illegal immigrants from getting care through the rapidly growing program" (Deslatte, 2011).

Some populations would be excluded from mandatory enrollment in the HMOs, including the developmentally disabled; nursing home residents; women eligible only for family planning services, breast or cervical cancer services; and sick children" (Deslatte, 2011). HMOs (Health Management Organizations) are thought to be more cost-efficient than insurance companies that pay per service, because the HMOs exercise more discretion in limiting procedures deemed to be inessential for the policyholder. In contrast to Florida's efforts to contract enrollment levels overall in the state and reduce procedures performed (including preventative screening procedures), the federal healthcare legislation passed by the Obama Administration would expand the eligibility of many currently ineligible members of the working poor for Medicaid.

The principle of the proposed Florida policy is to introduce accountability to the Medicaid program and save money -- according to policy analysts an estimated $1 billion per year. The bill places a strong emphasis on personal responsibility in healthcare, requiring some beneficiaries to take smoking-cessation or weight-loss classes. To increase the incentive for physicians to take Medicaid patients, doctors would be reimbursed at "100-percent of the rate paid by the Medicare program for seniors, which is roughly double what they get now. In addition, doctors would be shielded from malpractice liability" (Deslatte, 2011). High-cost recipients of Medicaid would have their coverage limited, "including transplant recipients, with high medical costs whose income exceeds eligibility limits -- to only physician services" and the bill would charge state Medicaid recipients whose income exceeds the federal poverty level fees to cover their children (Deslatte, 2011).

Amongst "for-profit health-maintenance organizations, physician networks or other managed-care organizations would be paid capped dollar amounts to treat people, theoretically containing costs in a program that has swelled to cover 2.9 million people and is projected to cost $22 billion next year" (Deslatte 2011). This would create a strong incentive to contain costs to recipients by denying them coverage. Procedures, including preventative care procedures deemed unnecessary would be sharply contained. Additionally, both Senate and House versions of the Florida healthcare bill 'carve up' Florida into different regions, "requiring managed-care companies to 'bid' on serving patients in the entire region. The Senate plan breaks the state into 19 regions, giving managed-care organizations more flexibility to target more lucrative populations" (Deslatte 2011).

If the bill is passed, almost all Florida recipients are likely to see a change in how their healthcare is covered, regardless of where they live. The bill marks a new shift most fundamentally in terms of how 'personal responsibility' is viewed when disseminating care. While the idea of personal responsibility may seem like a good one to contain costs, it can also result in individuals being 'blamed' for their illnesses. Not all illnesses are lifestyle-related. Aging, genetics, occupational stressors, and other factors can also impact one's healthcare status. The bill would set a precedent for making the monitoring of personal behaviors a condition for Medicaid coverage but other insurers might follow Florida's lead.