Florida’s behind-closed-doors health care dealings are a slight to public servants and their families
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The state chose big, out-of-state companies to manage state health plans.

When the Department of Management Services announced the companies being awarded contracts for state health plans, it shut out two providers, including one of Florida’s oldest and longest-serving not-for-profit plans.

The decision tapped big out-of-state companies to manage benefits for workers who specifically serve Florida, those working in state government jobs, instead of choosing companies that have a proven track record in the state.

To make matters worse, they did it largely in secret.

AvMed, a company with Florida roots that’s been around for 50 years currently serves about 250,000 Floridians, was completely shut out of three-year contracts awarded to administer health-maintenance organization (HMO) and preferred-provider organization (PPO) plans for state workers, their dependents and retirees.

Aetna was awarded some HMO services, though not all it sought, and wasn’t chosen at all for a PPO contract.

Both companies are suing.

Set aside for a moment the problems that can inherently arise from being sued, Florida state employees may now be forced to change their health insurance provider.

While Aetna’s argument — that the state should have chosen them, not Florida Blue, for PPO services because it has a better network of health providers — is compelling, AvMed’s argument is the most troubling.

Its lawsuit, filed in June in Leon County, alleges negotiations violated open meetings laws by holding some discussions in private. It seeks to prevent the state from moving forward with its HMO contract decisions.

In its lawsuit, AvMed said it has provided HMO services to state employees for four decades and, as of Jan. 1, it provided managed care for about 50,000 state employees, retirees and their dependents. Yet it was denied contracts in any of the six regions sought.

The HMO and PPO awards instead went to large conglomerates, Aetna included. Such companies are accountable to just one source: shareholders. Their commitment to Floridians is not guaranteed and any perceived value they may offer may not compensate for what is lost in customer care.

AvMed, for example, has received the highest overall rating of any commercial statewide Florida health plan in the Consumer Assessment of Health Plans Study.

Further, awarding contracts to shareholder-driven companies — UnitedHealthCare and CVS/Aetna each brought in more than $320 billion in revenue last year — fosters less accountability and erodes competition in the health plan marketplace.

And the awarded companies have track records to prove potential trouble. Aetna is facing a lawsuit from Kraft Heinz over its alleged mishandling of sensitive data and accusations that it improperly paid claims. Those weren’t the only troubling claims. The lawsuit also alleges Aetna breached its fiduciary responsibility and used clients’ money to pay company claims costs.

Aetna was also accused in 2021 of illegally securing a Medicaid contract in Pennsylvania for misrepresenting the number of pediatric providers in its network.

United likewise faced a class action suit in California in 2014 alleging it misrepresented its health care provider network in advertising materials.

But instead of due process, the state quietly moved forward with contracts for Florida Blue for the statewide PPO contract; Aetna in four of the nine HMO regions; United in four regions; and Capital Health Plan in the ninth, which includes Tallahassee and surrounding counties.

State workers deserve better than big box health care. And at the very least, they deserve the benefit of transparent discussions about their health care access.

Peter Schorsch

Peter Schorsch is the President of Extensive Enterprises Media and is the publisher of FloridaPolitics.com, INFLUENCE Magazine, and Sunburn, the morning read of what’s hot in Florida politics. Previous to his publishing efforts, Peter was a political consultant to dozens of congressional and state campaigns, as well as several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella. Follow Peter on Twitter @PeterSchorschFL.


  • Ian

    July 19, 2023 at 2:56 pm

    Is this supposed to be a news article or an editorial?

    • TJC

      July 19, 2023 at 3:08 pm

      Facts are presented, and perhaps they are not what you want to hear. Can you prove any of these facts wrong? if so, let’s hear it. But just because the facts don’t fit your politics doesn’t make the article an opinion piece. It’s just the facts, man.

      • Ian

        July 19, 2023 at 3:21 pm

        I don’t “want to hear” anything, other than an answer to my question, man.

    • AnneJohn

      July 19, 2023 at 3:48 pm

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  • TJC

    July 19, 2023 at 3:03 pm

    Florida was once admired for its government-in-the-sunshine laws, which banned secret back door dealings by government officials. Now, after twenty years of Governors Bush, Scott and DeSantis, the sunshine is all but gone. Apparently these “leaders” feel they know what is right for the rest of us, and we needn’t be bothered with the details — either that, or they all had/have something to hide, maybe lots of things. But we’ll never know unless good reporting, like we see above, shines a light on their dark deeds.

  • NotanExtremist

    July 19, 2023 at 6:46 pm

    Florida is spiraling down the toilet.

  • CVS Aetna

    July 20, 2023 at 10:00 am

    In my experience, CVS Aetna is apparently brought on to raise prices, reduce benefits, provide kickbacks to the HR types that hired them, and to deny coverage. Period.

    Their business model seems to be having somebody be CEO, load that person up with stock options, and then send them on to CEO at some other place, choosing CVS Aetna for benefits “administration” (denial) at their new job.

    Then they r@pe the workers at the new place until such time that it’s personally ideal for that ex-CVS(Aetna) CEO to exercise their stock options.

    I think it’s brilliant for the ex-CVS(Aetna) CEO and other CVS/Aetna stockholders. It’s not great for anyone else except the labor union at the new place the CEO works at.

Comments are closed.


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