Florida lawmakers highlight KidCare expansion and new PBM regulations as key legislative wins
Lawmakers applauded the recent passage of bills that expand the number of children covered under Florida KidCare and regulate the business practices of pharmacy benefit managers (PBMs) during the 2023 Florida State of Reform Health Policy Conference.
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Rep. Robin Bartleman (D-Weston), ranking member of the Healthcare Regulation Subcommittee, said the most significant bill she sponsored that was passed this session was House Bill 121. The bill increases the income eligibility threshold for coverage through the KidCare program, and requires that premiums for certain enrollees be based on a tiered system of uniform premiums.
“It’s for the working people in Florida,” Bartleman said. “Sometimes, behind the scenes, people don’t want to give handouts. These are not the people that are sitting at home doing nothing, just living off the government. These people are working two or three jobs.”
HB 121 allows children living in families earning 300% of the federal poverty level (FPL) to qualify for KidCare coverage. Bartleman said she met with staff from Broward County Public Schools, which employs more than 34,000 people, while working on the bill.
“I would meet regularly with teacher’s aides, bus drivers, cafeteria staff, (and) teachers, and they could not afford dependent coverage,” she said. “And there was nothing we could do to reduce those rates. And many of them were just above that 200% FPL to qualify for KidCare. I (wanted) to increase eligibility for working families.”
Bartleman tried to pass legislation to increase the qualifying FPL threshold for KidCare during the past three legislative sessions, with her first proposal including families that earn 250% of the FPL. After that proposal failed to move through the legislature, she worked with other lawmakers to determine the eligible FPL threshold needed to be raised to 300%.
“We did a comprehensive bill,” Bartleman said. “We believe no family should have to choose between economic prosperity and the health of their children. And people don’t grasp how important that is. If you take a 50-cent an hour raise, and you get knocked off of KidCare, you will basically have no health insurance for your children. When you get that 50-cent raise, and you get knocked off, you have to go to the full-pay program. So your raise doesn’t even cover half of those insurance costs.”
During the three-year process it took to expand KidCare coverage, Bartleman said she learned two important things in the legislative process: always seek bipartisan support, and take time to meet with legislative staff.
“Bipartisan support is always the best,” she said. “Meeting with policy staff is one of the smartest things you can do. Because if they believe in your concept, they’re going to write a bill that can move.”
The KidCare expansion achieved through HB 121 will impact 77,000 children in its first year, Bartleman said.
“Families will be able to economically prosper,” she said. “We’re talking about mental health, dental health, physical health. That’s all covered under KidCare. As they make more money, they will pay more in their premiums. And when they get to the end of that fiscal cliff, they’re ready to assume total costs. And that’s the goal.”
Rep. Linda Chaney (R-St. Pete Beach), vice chair of the Rules Committee and a member of the Healthcare Regulation Subcommittee, said the passage of House Bill 1509 was the highlight of her legislative session. The bill initiates several steps to regulate the business practices of PBMs.
“My PBM bill is the most comprehensive reform of PBMs in the country,” Chaney said. “There are a number of states that have done pieces of this bill, but we put it all together.”
The bill will require drug manufacturers to notify the Department of Business and Professional Regulation of planned drug price increases, and make that information available to the public. It also prevents PBMs from requiring patients to receive prescriptions by mail.
“It puts an end to mandatory mail-order,” Chaney said. “Mandatory mail-order takes your pharmacist out of the loop. People see their pharmacist, on average, 12 times a year. So your pharmacist is on the frontline of your healthcare. And mail-order took your connection to that healthcare out of the loop. So we no longer have mandatory mail-order. You can opt in if you choose.”
HB 1509 also requires PBMs to identify ownership affiliations, and provides requirements for contracts between PBMs and pharmacies.
“We also are requiring rebates to pass through 100% to the plan for the sole purpose of reducing premiums and copays,” Chaney said. “So that’s become transparent.”
Lawmakers were also asked if any initiatives that did not receive a green light during the last session should be revisited in the future. Bartleman said she hopes the legislature considers Medicaid expansion in the future. Florida is one of only 10 states that has not expanded its Medicaid program under the Affordable Care Act to adults ages 19-64 with income under 138% of the federal poverty level.
“We have to figure out how we’re going to do that,” Bartleman said. “We’re leaving billions of dollars on the table.”