THE CAPITAL, TALLAHASSEE, February 3, 2012 -

Jim Saunders, The News Service of Florida

A House committee Thursday approved a proposal that would make major changes in the state-employee health insurance system, shifting responsibilities to workers and making the system more closely resemble private-sector health plans.

The proposal (PCB HHSC 12-02) would involve the state annually setting aside a certain amount of insurance money for each employee and giving options about how the money could be spent. That would be different from the current system, which involves the state selecting health benefits for employees.

In insurance-speak, the proposal would mean shifting from a "defined benefit" plan to a "defined contribution" plan.

House Health & Human Services Chairman Rob Schenck, a Spring Hill Republican whose committee approved the bill Thursday, said the proposal would improve the health-insurance system. He said it is not about the costs of insurance, which have increased significantly in recent years for the state.

"It's more about responsibility,'' Schenck said. "Who should have control of those health care dollars?''

But some Democrats criticized the proposal, saying it would shift additional financial risks to state workers, who have not received pay raises in recent years.

"This is another form of gambling that would be imposed on our state employees,'' said Rep. Elaine Schwartz, D-Hollywood.

The changes, approved with an 11-5 vote, would take effect in 2014. The bill calls for the Department of Management Services to hire a benefits consultant, which would submit a plan by Jan. 1, 2013, for carrying out the changes.

The House, Senate and Department of Management Services have looked during the past couple of years at revamping the insurance program. The department, for example, moved forward with a money-saving change last year that reduced the number of HMOs available to employees --- with only one HMO available in most counties.

Schenck said he has not discussed the House bill with Senate leaders. But in the past, Senate President Mike Haridopolos, R-Merritt Island, and other Republican leaders have expressed interest in making the state insurance program similar to plans offered by private employers.

Michael Garner, president of the Florida Association of Health Plans, told the House committee that he sees the private market moving in the direction of employees making more choices about health coverage.

"This is not a gamble,'' said Rep. Ronald "Doc" Renuart, a Ponte Vedra Beach Republican and physician who said he offers the same type of plan to his medical-office employees. "But this does put some of the responsibility back on the individual.''

The state pays for the vast majority of employee health costs. As an example, the total cost this year for a rank-and-file worker with family coverage is $14,920. The state pays $12,760 of that total, while the worker pays $2,160.

Premiums paid by the state also have grown during the past decade. During the 2006-07 fiscal year, for instance, the state's share of a rank-and-file worker's family coverage was $9,451, according to a House staff analysis.

Under the House proposal, the state in 2014 would contribute about the same amount for each employee that it spends now and then offer a range of options for how the money is spent.

An employee could use all of the state contribution to pay for insurance and then pick up any additional costs exceeding that contribution. Another option would be to use part of the contribution to buy a high-deductible insurance policy and put the rest in a "health savings account" --- a type of account that has tax benefits and can be used to pay out-of-pocket health expenses.

Still another option would be to use part of the state contribution for health insurance and use the rest of it to increase employee pay.

The bill calls for future state contributions to be "actuarially equivalent" to the state's current share of benefit costs. But it also makes clear that annual contribution amounts are subject to legislative budget decisions.

Rep. Mark Pafford, a West Palm Beach Democrat who voted against the bill, said the concept will lead to cutting costs. He said the state already has a lean workforce, compared to other states, and described the proposed changes as "very short sighted.''

But supporters said state employees should be able to make choices based on their health needs.

"Our health care should be related to us personally,'' said Rep. Dennis Baxley, R-Ocala.