This article started out as a story of hope for uninsureds, andhope for everyone looking to control health-care costs. A stateadvisory board in December came up with two ideas that, on thesurface, could put one of the biggest dents in the uninsuredpopulation in years. One recommendation would let all young adultsin Florida stay on their parents' health insurance policies untilage 25. Today, kids typically are jettisoned from coverage oncethey complete college or leave home at age 18. A second proposalwould require all college students to have coverage as aprerequisite for taking classes. In Florida, only Florida StateUniversity has adopted this rule.

While an advisory committee recommendation has a long, long wayto go before becoming a Florida law, there has been a glimmer ofoptimism recently because officials from the Office of InsuranceRegulation and the insurance industry are supporting bothideas.

“This would not be an incremental step, it would be a major stepin lowering the number of uninsureds,” said Steve Smith, a lobbyistfor Blue Cross and Blue Shield of Florida, in regards to the ideaof keeping young adults covered until age 25 regardless of whetheror not they are still dependents. He estimates the change would addas many as 200,000 to the insurance rolls.

Insurers also said building a market for college students to becovered would be a good step — mostly because it would add a layerof generally healthy people to the insurance pool.

Looking for a New Direction

The Florid Health Insurance Advisory Board, which is chaired byFlorida Insurance Commissioner Kevin McCarty and containsrepresentatives from insurers and insurance agencies, made a totalof 16 recommendations. They carefully avoided making anysuggestions that would incite a political backlash, such asrequiring employers to pay into a state fund or provide insurancecoverage. Instead, they called for expanding Health Kids,increasing the use of electronic medical records, and updating the2004 University of Florida study on uninsureds. They also calledfor continuing a little-used state program called Health Flex,which allows insurers to sell coverage without state-mandatedbenefits.

But by far the two ideas that generated the most excitement wererequiring college students to have insurance and extendinginsurance coverage to children who no longer are dependents oftheir parents until they reach the age of 25.

Why is this so important? The most common age to be uninsured inFlorida is between the ages of 18 and 24. In this group, about 29percent of Florida females and 37 percent of Florida males areuninsured — higher than any other age category. In all, one in fourFloridian residents under the age of 65 lacked health insurancecoverage in 2006, according to an estimate by the U.S. CensusBureau. That means nearly four million Floridians had no healthinsurance.

Despite these ballooning figures, the issue of not havinginsurance has yet to resonate among legislative leaders in recentyears — possibly because of all the attention to auto and propertyinsurance.

Another Year, Same Song?

However, here's where the hope for major health reforms beginsto fade. Lawmakers took a wait-and-see attitude towards theadvisory committee's recommendations. Cue the sad music.

“I am enthusiastic about looking at any suggestion anyone has toreduce the cost of health care,” said Sen. Bill Posey, a RockledgeRepublican and chairman of the Senate Banking and InsuranceCommittee.

Similarly, a spokeswoman for Gov. Charlie Crist would not saywhether he would endorse any of the recommendations from theadvisory board. The state's Agency for Health-Care Administrationhas put together its own group to study the issue of uninsureds andis looking to make recommendations.

Harry Spring, a lobbyist for Humana and a member of the advisoryboard, said that adding more people to the same policy will driveup overall costs. “What you are talking about are people over theage of 25 who cannot find employment that offers health insurance,”said Spring. “We have to be straight about it, that it willincrease costs.”

State University System Chancellor Mark Rosenberg said the groupthat oversees Florida public universities has discussed the healthinsurance mandate, but members worry about dramatically increasingthe cost of college. “It could become another unfunded mandate,”said Rosenberg.

With these criticisms, it is easy to see how these good ideas toreduce the number of uninsureds could get lost in the backwater ofTallahassee committee meetings this spring. The comments furthershow why reducing the number of uninsureds has remained one of themost intractable problems not only in Florida, but also nationwide.Consumers don't want to give up any disposable income, employersdon't want to give up their bottom line, and insurers do not wantto sacrifice any of their profits. Even colleges are afraid ofdoing anything that will make themselves less attractive.

Karen Hovis, an insurance agent with Hovis Insurance andFinancial in Stuart, said the state needs to not only change thelaws, but also change the culture about health insurance. “Peopleneed to know it's unacceptable not to have health insurance,” shesaid. “A lot of young people have decent jobs with benefits, butthey would rather spend the money elsewhere than on insurance.”

Many recent high school and college graduates in Florida leaveschool for jobs that don't provide health benefits, so allowingthem to stay under mom and dad's policy would be a major help.Because young adults are healthy, she doesn't think it will have abig effect on costs.

Under the advisory board proposal, children would have to staycontinually on their parents' policy. They would not be allowed tojump in and out of coverage when they needed it. “This proposalwould help increase the pool of healthy people covered byinsurance, which would lower premiums for everyone,” saidHovis.

In effect, the proposal would help in the same way thatmandating all individuals to buy insurance would — a proposal beingpushed by several Democratic presidential candidates and inMassachusetts.

If the state legislature adopts the board's recommendation oncollege students, Florida would join Massachusetts, New York, andIdaho in imposing such a requirement. The cost of coverage variesgreatly throughout the state, according to the board, with a policycosting nearly $2,400 in Miami. The board said it would set up“hardship waivers” for those students who could not afford thecoverage. The measure would impact about 25,000 studentsstatewide.

Managing a Mandate

Hovis likes the idea of a college health insurance mandate, butshe thinks it will be a problematic to administer. “It's a goodgoal to have, but enforcing it will be difficult, ” she said.

FSU officials found that out this year when they tried toimplement their new law. They acknowledged that they didn't catcheveryone because they allowed students to register for classeswithout showing proof of insurance — something that won't happennext year. “It's been an accounting nightmare for us,” said LesleySacher, director of the Thagard Health Center at FSU, who helpedapply the mandate. “We will be doing things differently next year.”She said that next year's students who don't have health insurancewill be treated the same way as those who fail to get the requiredvaccinations — they won't be allowed to register for classes.

FSU does not care where the student gets health insurance,though the university offers a policy through a subsidiary of Aetnathat costs about $1,440 a year. This year, it sold about 3,500 suchpolicies, which is triple the amount sold in previous years. To putthat number in perspective, the university has about 41,000students, including nearly 9,000 freshmen who were affected thisyear by the new insurance mandate.

The University of Florida is considering mandating healthinsurance for next year and Sacher said that she would welcomeother Florida schools joining in. “Anyone who wants to share thewind on this branch would be welcome,” she said. “As mandatoryhealth insurance becomes the norm and not the exception, majorinsurers will become more interested in selling policies to thismarket.”

Dan Rosenthal, CEO of UnitedHealthcare of South Florida, saidthat everyone has a responsibility to make health care affordable.“Anything that expands access for people to have coverage is a goodthing.”

Blue Cross' Steve Smith doesn't think allowing young adults tostay on their parents' policy longer will increase premiums. Onereason is that many policyholders pay the same premium regardlessof how many children they have. Smith notes that Blue Cross andBlue Shield of Florida already sell individual policies that havehigh deductibles and low premiums that would make sense for collegestudents to buy.

There will always be naysayers to any approach that helps theuninsured. Smith has heard some critics say requiring collegestudents to have insurance coverage while also increasing theirtuition will be too difficult on some. But he's optimistic forchange. “We need to make sure we add people to the insured ranksand if we can do that, that would be good for everyone.”