Governor Charlie Crist finally got his Kodak moment a few hoursbefore the Florida legislature wrapped up its 2008 session. TheHouse and Senate passed the governor's plan to provide low-cost,no-frills health-care coverage to the 3.8 million uninsuredFloridians. The bill also included the House initiative thatcreates a state-run corporation to work as a clearing house forselling low-cost, stripped-down health benefits to workers of smallbusinesses

On the surface, Crist had achieved something that eluded hispredecessor, Jeb Bush, as well as California Governor ArnoldSchwarzenegger: He got his health-care reform plan through thelegislature. “This is historic legislation,” a beaming Crist told aroomful of reporters minutes after the final vote in the House.

Sen. Durell Peaden (R-Crestview), who carried the bill throughthe Senate, remarked, “In the 14 years that I've been in thelegislature, we've taken baby steps to improve the quality ofinsurance for every citizen in Florida. Today, we took a giantstep.”

Now comes the hard part: Actually convincing the uninsured tobuy the health plans.

Some Better than Nothing?

Crist said that while the health-care plans won't offer“Cadillac-type” coverage, he has argued that some health-carecoverage is better than nothing. But critics, including someinsurance agents, predict that uninsureds won't jump at thebare-bones type of coverage because it may not help them when theyreally need it. “I don't think agents are going to be able to sellit,” said Steve Israel, spokesman for the Florida Association ofHealth Underwriters and a health insurance agent in Delray Beach.“I don't see this as a solution. It's hardly a Band-Aid.”

Israel said that he worries some buyers will purchase cancercoverage and have a heart attack. “Then they will ask the agents,'Why did you let me buy this?'”

Bob Lotane, a spokesman for the Florida Association of Insuranceand Financial Advisors, said the health-care reform plan is a goodstart. But he adds that he was disappointed there was norequirement to ensure consumers are informed in writing that theywere not getting full coverage. “The jury is still out on this,” hesaid.

Consumer advocates warn that people may be getting less coveragethan they need from the plan and the policies may not be an easysell. “This is a step in the right direction, but there are someglaring loopholes,” said Bill Newton, executive director of theFlorida Consumer Action Network.

AHCA Seeks Bids

This summer, the Agency for Health-Care Administration will putout a request to the state's insurers for bids asking them tosubmit products that cost no more than $150 a month. Crist's CoverFlorida plans will have to have some preventive benefits such ascheckups, mammograms, and pharmaceuticals but plans won't have toinclude any of the state's 51 mandated benefits. At least two plansare expected to be available in each county, including acatastrophic plan that would include some hospitalization coverage.There likely will be at least one state-wide plan and severalregional plans.

Florida's health-care insurers supported Crist's plan, sayingthat they would be able to develop inexpensive policies. Blue Crossand Blue Shield of Florida, Humana, Aetna, and UnitedHealthcare areamong the companies that stood with Crist a week before thelegislative session ended, urging the House and Senate to pass aplan.

Insurers have argued for years that the state's long list ofmandated coverages is a big reason for their high rates. Now theyget to show off what they can do without them. The first plans areexpected to be rolled in early in 2009.

One in every four Floridians under the age of 65 lacks healthinsurance, one of the highest rates in the nation. Because peoplewithout insurance delay seeking care when they are sick and avoidscreenings and checkups, they are 25 percent more likely to dieprematurely than people with insurance, an advocacy groupestimated.

Crist's Cover Florida plan also requires insurers to accept allpatients, regardless of health status, with the bare-bones plans.That's a key point because insurers today turn away up to 30percent of individual policyholder applicants because they don'twant their health risks. Insurers under Crist's plan still wouldhave pre-existing condition requirements, which would mean thatthey don't have to cover an individual's pre-existing conditionsuch as diabetes or cancer for two years. Residents will have to beuninsured for at least six months to buy a policy.

Not All Victories

The plan includes a major component that Crist did not like butwas favored by House leaders. Florida Health Choices, Inc., a newstate corporation run by 15 political appointees, would become aclearinghouse for insurers and other companies to sell “healthproducts,” including insurance and prepaid health-care plans, toworkers employed by businesses with 50 or fewer employees.

Though Crist for months said that he did not want to “spend adime” of taxpayers' money on the corporation, the final billallocates $1.5 million annually. Crist has promised not to veto thefunding. He compromised in part because he needed the House toagree to streamline the approval process for new hospitals, and heneeded votes for a bill making it easier to recruit dentists totreat Medicaid patients. He got both.

Crist's Cover Florida plan allows insurers approved by the stateto offer basic coverage to uninsured residents ages 19 to 64.Anyone working for an employer with 50 or fewer workers could gethelp through Florida Health Choices.

“Folks want more choices,” said House Health-Care CouncilChairman Rep. Aaron Bean (R-Fernandina Beach), who was behind themarketplace plan. He negotiated with the governor while sitting ona couch in his office. “This is big,” he said at the congratulatorynews conference with the governor.

Insurers Offer Support

Insurance companies, who say mandates raise premiums, welcomedchanges that open up the market. “We think it has great potential,”said lobbyist Gerald Wester, who represents Aetna and Cigna.

But under Florida Health Choices, virtually anyone could sellhealth-care products that don't have to be insurance and don't haveto win approval from the state Office of Insurance Regulation.Hospitals, health plans, health networks, and medical providerscould sell prepaid health benefits. The corporation would acceptcontributions for employer and employee and evaluate companieslooking to sell benefits to small employers. The OIR would get oneseat on the corporation board and judge the merits of each plan.But the corporation — not the OIR — would have the final say onwhat is sold.

While Republicans stressed their free-market approach to helpemployers, critics said the idea could allow unregulated firms tocollect premiums with no guarantee that they would providecoverage. Persuading people to buy limited-coverage policies isdifficult, said Dwight Chenette, CEO of the Health-Care District ofPalm Beach County. The district has offered a health coverage planfor as low as $50 a month, but has attracted just 1,000 buyers intwo years. “These plans do not sell themselves,” Chenette said.“It's not automatic.”

Several insurers, including Blue Cross and Blue Shield ofFlorida, already sell low-cost policies with high deductibles andlimited benefits. Blue Cross last year started selling “Go Blue,”which doesn't even cover hospitalization or emergency room visits.But the plans have received little widespread interest.

There's also concern that employers will drop more-comprehensivepolicies that they now offer employees in favor of the cheaper butless comprehensive plans. Nonetheless, the governor and legislativeleaders hailed the legislation as a model for the nation, thoughCrist stopped short of predicting how many of Florida's uninsuredresidents would enroll. “We hope as many as possible,” the governorsaid.

One part of the health-care reform bill that has received scantattention is that it will allow adult children to remain on theirparents' health-care policy until they turn 30. Today, they canonly remain on the policy until age 25, and they have to live athome or be in college. Insurance experts say this provision couldhelp tens of thousands. The highest percent of uninsureds are inthe 18-to-34 age group — an age group that is also the least costlyto insure.

Crist's plan became a reality because he was able to win thesupport of all major lobbying groups, including Florida'shospitals, doctors, and insurers. Even the business lobbies — theNational Federation of Independent Businesses and the AssociatedIndustries of Florida — supported it.

Allen Douglas, legislative affairs director for the Floridachapter of the National Federation of Independent Businesses,worried that the Florida Health Choices Corp. could run intoproblems of another popular state corporation, Citizens PropertyInsurance Corp. “The state's done a pitiful job running propertyinsurance and I don't think health insurance would be a whole lotbetter,” Douglas said. Nonetheless, NFIB applauded the statepassing one of the biggest expansions of health-care coverage inmore than a decade.

It's unclear how heavily health insurers or agents will marketthe Cover Florida plans because there will be little if any profit.The state included no money in its budget to sell the new types ofpolicies.

“We are prepared to use every bully pulpit to sell these plans,”said Mark Thomas, chief of staff at the Agency for Health-CareAdministration. He said the main target of Cover Florida is healthyyoung adults who often go without coverage — “the invincibles” —because they think they will never get sick and live forever.

Crist showed his political skills in getting the legislature topass health-care reform. He will have to show that he has theskills of a magician to convince this demographic of the need tobuy insurance. If he can do that, then Florida can really say ithas accomplished health-care reform.