Florida citrus industry shows signs of recovery
Overcoming effects of Ian, greening disease Cost comparisons have been hard to come by
TALLAHASSEE — As it hopes for a warm winter, Florida’s struggling citrus industry could be showing signs of recovery from the devastation of Hurricane Ian and progress in the decadeslong fight against citrus greening disease.
The U.S. Department of Agriculture
The day before she underwent surgery to remove an ovary, Laurie Cook drove to a Nashville hospital for a written estimate of how much the operation would cost.
She’d already paid the $783 surgeon’s fee. But she needed to know what the hospital would bill for the operating room, nurses, medications, lab tests and more. She left with a written estimate: $5,535.
Her insurance plan required $12,000 out of pocket before her coverage kicked in. She and her husband determined they could fit the surgery into their household budget using a payment plan.
The following day, the operation was completed without complications. She was home within a few hours. Weeks later, she received the hospital’s bill: $61,314.
Cook knew health care pricing is notoriously mysterious, but she was astonished to get a bill more than 11 times the estimate. She asked the hospital to audit the bill and explain, but they haven’t given her a breakdown.
“It’s an astronomical charge,” Cook said. “And it’s just not fair.”
A federal law that went into effect in 2021 is supposed to prevent surprise charges like those Cook experienced. The price transparency law requires that hospitals post cash prices and rates negotiated with health insurers for a broad list of procedures. One hundred million Americans are in medical debt.
But price comparisons have been hard to come by – until now. This week, the Patient Rights Advocate released its Hospital Price Files Finder: a free, searchable database that compiles pricing data from nearly 6,000 U.S. hospitals.
PRA officials said the tool fulfills a necessity, letting people compare prices and save on medical procedures and services. Cynthia Fisher, founder and chair of PRA, said the data is incomplete because as of July, just 36% of the nation’s 2,000 largest hospitals have fully complied with the federal price transparency law. She hopes the PRA database convinces the Department of Health and Human Services it’s time to “expedite enforcement” of the law.
“Every day that prices are withheld from consumers, Americans are harmed by overcharges, unexpected bills and unwarranted debt collection,” Fisher wrote Monday to Health and Human Services Secretary Xavier Becerra.
Had such a database been available to Cook, she would have used it to compare prices, she said – like shopping for a car with the Kelley Blue Book.
Instead, she’s fought the charges as the hospital hired a collections agency to get nearly $8,800 from her. She also received a separate, surprise $2,700 bill from an anesthesiologist.
Bill collectors “blow up my phone daily,” Cook said, when she’s teaching school and at home. She’s always paid her bills on time and earned a lifetime of good credit before the surgery.
“People want to be responsible,” she said. “They should have the ability to do so.”
Several health insurance companies have introduced price-lookup tools for their customers. These tools often include information about out-of-pocket requirements, deductibles, copays and coinsurance, tailored to an individual’s plan and network.
But these tools typically list average costs, not the actual billed amount, according to a paper in Health Affairs. Consumers and employers that purchase health care have little use for estimates, the authors argue.
Ge Bai, a Johns Hopkins University professor of accounting and health policy and management, said price transparency has tremendous potential for patients and employers seeking to keep spiraling health costs under control. But she also says that people need better incentives to seek lower-cost services.
In a recent study, Bai found that in nearly half of cases, hospitals charged patients who paid cash less than those on Friday revised a forecast for the 20232024 citrus growing season by upping projections for grapefruit and specialty fruits, which are mostly tangerines and tangelos. The projection for oranges remained unchanged from the season’s initial forecast in October.
The combined projections are nearly 30 percent ahead of last season’s production, which was hammered by Hurricane Ian and a winter freeze. But the overall forecast total for 2023-2024 is just over half the production amount who used insurance. In other words, consumers with high-deductible plans would have a lower bill if they paid in cash rather than using their insurance.
But consumers and employers would know this only if they shopped around and asked for prices. And people might not be willing to do that unless they know they have a financial incentive to do so, Bai said.
“We engage in comparison shopping only when the financial benefit directly flows to our own wallets,” Bai said.
Some state insurance plans are beginning to use price information when making coverage decisions. The California Public Employees Retirement System has directed retirees and their families to lower-cost surgeons for joint replacements and outpatient operations. Montana’s state employee health plan administrators demanded better rates when they discovered hospitals charged them up to five times as much as they charged Medicare.
Consultants predict employers and other health care purchasers will use the hospital pricing tool from PRA or something like it to scrutinize medical charges and insurance claims.
Stephen Carrabba, president of Claim Informatics, which analyzes insurance claims on behalf of unions, companies, states and local governments, said the PRA tool could be a boon. It “will help us more easily track and fight waste, fraud and abuse that makes coverage and care unaffordable for employers and their members,” he said.
Suzette Sontag learned to shop for medical prices when her adult son slipped off the tailgate of a truck and injured his knee a few years ago.
He needed an MRI to find out the extent of his knee injury. Because her son was uninsured, Sontag, who lives in Wisconsin, suggested he call several hospitals and clinics to find out how much they would charge.
Her son phoned eight hospitals and clinics and received prices from four of them. The prices ranged from $499 to $7,000, Sontag said. He went to the
from the 2021-2022 season.
Also, the projected total remains closer to production in the 1930s than in the 1990s, before citrus greening began to ravage groves and development pressures exploded for land.
Shannon Shepp, executive director of the Florida Department of Citrus, called Friday’s update “another indicator that a more integrated and innovative approach to combating citrus greening as an industry is having an impact.”
“While there are still challenges ahead, these forecasts are a foundation for optimism that we now feel across the communities that make up Florida’s iconic citrus industry,” Shepp said.
Saying that treatment methods being used against citrus greening are proving effective, Florida Citrus Mutual CEO Matt Joyner expressed optimism that production will continue to improve “if citrus trees can come out of the winter months unscathed by freezing temperatures and continue to grow in the new year.”
The new forecast said the industry remains on pace to fill 20.5 million 90pound boxes of oranges. That compares to 15.8 million boxes during the 2022-2023 season and 41.2 million boxes during the 2021-2022 season. Most of Florida’s oranges are processed into juice.
Another 2.4 million boxes are expected to be filled this season with grapefruit and 550,000 boxes with specialty fruits.
Growers filled 1.81 million boxes of grapefruit during the 2022-2023 season and 3.33 million boxes during the 2021-2022 season. The initial October forecast for the 2023-2024 season put grapefruit production at 1.9 million boxes.
The industry filled 480,000 boxes of specialty fruits in 2022-2023 and 750,000 boxes in 2021-2022. The initial October forecast for 2023-2024 estimated a total of 500,000 boxes.
The growing season begins as summer turns to autumn and runs into June and July.
Alico, Inc., a major citrus grower, said in a quarterly financial filing this week that it anticipates an improved crop after Hurricane Ian cut the company’s production last season by just over 50 percent from the 2021-2022 season.
“We are confident that Alico’s crop recovery this season will be significant because of our exceptional caretaking practices and the maturity of over 2 million trees planted by the company since 2017,” John Kiernan, president and chief executive officer of the Fort Myers-based company, said in a prepared statement. “In addition, over 35 percent of our trees have now been treated with an oxytetracycline injection since January 2023 to combat citrus greening, with the goal to improve fruit quality and decrease the fruit drop rate.”
Ian made landfall in Southwest Florida and crossed through major citrus-growing areas. After Ian, Alico received about $28.2 million in insurance money, which helped in maintaining 49,000 citrus acres across seven counties, according to Kiernan’s statement.
The company also said it expects market prices to be consistent or slightly above the past season, amid continued consumer demand for orange juice, low levels of inventory at juice processors and a tighter global supply of oranges.
Alico and other parts of the industry also are waiting for federal assistance stemming from Hurricane Ian.
Meanwhile, Gov. Ron DeSantis on Tuesday released a proposed $114.4 billion budget for the state’s 20242025 fiscal year that would provide $20 million for citrus research and the Citrus Health Response Program, which is administered by the Florida Department of Agriculture and Consumer Services. Another $10 million is proposed for advertising by the Florida Department of Citrus.
Joyner also said DeSantis’ support of $100 million for conservation easements under the Rural and Family Lands Protection Program would help the industry. A priority of Agriculture Commissioner Wilton Simpson, the easements allow farmers and ranchers to continue operations with the promise that their land won’t be developed.
Lawmakers included $65 million for various aspects of the citrus industry in the state’s current budget, which took effect July 1. The total, which included $49.5 million for citrus protection and research on trees resistant to citrus greening, was a $28 million increase from the previous year.