After three terms in Congress and a primary loss last spring, Pennsylvania Congressman Jason Altmire is heading to Florida Blue as senior VP for government affairs, leaving one of the most fractious institutions in the country for one of the most tumultuous industries.
Well known as one of the few Democrats that voted against the Affordable Care Act, Altmire was basically thrown into healthcare, working for a Florida congressman as a legislative assistant in the early 1990s and finding himself, at the age of 25, on President Clinton's health reform task force, only to watch those reform efforts fail.
"There was this group think that was going on," he said. "While there were a lot of really smart people who knew a lot about healthcare policy, there were a lot of politically naive people also."
In 1998, Altmire became government and community affairs director at the University of Pittsburgh Medical Center (UMPC), an integrated healthcare system that's built a hospital empire in western Pennsylvania as well as its own health plan, with about 1.7 million members. ("That market is unique, with a dominant insurer and a dominant provider, and they're both trying to dabble in the other's business -- UPMC much more successfully than Highmark, to date," Altmire said, commenting on UPMC's market challenges to Highmark, Pennsylvania's largest insurer.)
Altmire ran for Congress in 2006, representing the northern Pittsburgh suburbs and countryside as a quasi-conservative "Blue Dog" Democrat -- supporting President Obama's stimulus program, for instance, while opposing cap-and-trade climate change legislation, immigration reform and civilian trials for Guantanamo Bay detainees.
Altmire's ACA vote was courted heavily by the Obama Administration. Altmire said he voted against it because it was unpopular in his district and also because he opposed provisions like the Medical Loss Ratio, the medical device and premium taxes and age rating restrictions.
"I thought it might actually result in increasing the costs of care, and I think that's going to be proven out over time," he said. "And we didn't do nearly enough on quality. Some of the pilot and demonstration projects are good; the value-based purchasing was actually based upon my legislation. But we should have gone a lot further. We didn't address the costs through reforms in the provider side, making sure that they're accountable."
The ACA was enormously controversial in Altmire's district, and he voted against it even as UPMC urged him otherwise. "Some of the fears were unjustified and based upon misinformation. But some of them were legitimate," he said. "I have more Medicare Advantage recipients than any district in the country. So when you cut Medicare Advantage, you're hurting my district."
[See also: HIXs, HIEs and industrialization of healthcare]
Altmire declined to talk about the issues he'll be working on at Florida Blue, "because people will tie my views from 2010 in with where I'm going to be working in 2013," he said, referring to the caricature of Washington's revolving doors. He does think the ACA's age rating restrictions will be disastrous.
In most states, the current average age rating ratio between young and old health plan members is about 5:1. The ACA restricts that to 3:1, and will likely bring increased premiums for young insurance buyers.
"When that sticker shock occurs, it has the potential to force change, because people are going to say, 'This isn't what I thought I was signing up for,'" Altmire said. "Small businesses employing younger workers are going to get that first bill and see that their costs have gone up by 50 percent or more."
"That's going to start the national discussion. It's going to come up," he said. "Then you're going to run in to the AARP. This is their issue, and they're a very powerful lobby. I don't know if you're going to be able to actually overturn it."
Whatever his public policy goals, Altmire is joining Florida Blue as the company evolves beyond the bounds of a traditional insurance company. One of the largest insurers in the state, with about 4 million members, Florida Blue is rebranding itself as a "health solutions company."
The not-for-profit, tax-paying mutual company recently announced the creation of an accountable care partnership with the Tampa-based Moffitt Cancer Center, in addition to accountable care arrangements with Naples-based NCH Healthcare and Palm Beach-based Holy Cross Hospital. Florida Blue also recently announced the acquisition of the multi-specialty medical practice Diagnostic Clinic, based in Largo, and a bundled payment agreement with the Mayo Clinic for knee replacements.