At the start of 2009, there were high hopes but low expectationsfor Florida's new program to help its nearly four million residentswithout health insurance.

In those terms, the Cover Florida Health Access Program did notdisappoint.

In the first 11 months of the state's new effort to help theuninsured, just over 5,000 Floridians have enrolled. That is lessthan one percent of the state's uninsured.

The concept behind Cover Florida was to offer low-cost healthinsurance options to the uninsured. The plans are guarantee issue,meaning no one can be turned away due to a pre-existing healthcondition like diabetes or cancer. All Florida residents areeligible regardless of wealth as long as they did not have healthcoverage in the past six months; premiums increase with age.

The goal was to develop health insurance products that cost anaverage of $150 a month. To do that, some plans provide nohospitalization, no mental health benefits, or no brand-nameprescription drug coverage. To further lower costs, the programitself was exempted from the state's more than 50 mandated healthbenefits, such as chiropractic care and bone marrowtransplants.

To keep the state's dollar investment in the Cover Florida tozero, the state chose to devote no money to marketing oradvertising. Instead, it relies on news media and insurance agents.In effect, it got what it paid for.

Better Than Nothing?

Agents have little financial incentive to sell the plans.UnitedHealthcare, one of only two insurers selling the CoverFlorida plans in all 67 counties, pays agents just a $3.15 a monthcommission per enrollee — not even $38 a year. In contrast, withmore standard health insurance, agents typically get paid about 20percent commission in the first year, which usually can meancommissions approaching $1,000.

“A lot of agents won't sell it because it's not worth theirtime,” said Donna Hamilton, an agent with Jack Rice Insurance inLargo. “But we are in the business to help people, and for some,Cover Florida is a last resort.”

That is the case with Judy Easton of St. Petersburg. She boughta Cover Florida policy from UnitedHealthcare in April after herCOBRA policy ran out from a group policy. Despite Gov. CharlieCrist's intention, Easton's Cover Florida policy is not cheap.However, she chose to buy it for $473 a month because with highblood pressure, high cholesterol, and a degenerative spinecondition, she could not find another insurer willing to write apolicy for her.

“I guess it's better than nothing,” said Easton, who turns 65 inMay and will then leave Cover Florida for Medicare. Under herpolicy, primary care doctor visits cost $20 and specialists visitscost $40. She has hospitalization coverage, but it is limited to 10days per year.

After eight months on the policy, Easton wonders if she shouldhave saved her money and gone without coverage. “I have secondthoughts as to whether I made the right decision,” said Easton.“But I am a responsible person, and the responsible decision was tohave insurance.”

No Changes Planned

Tom Arnold, Secretary of the Florida Agency for Health CareAdministration, makes no apologies for the limited enrollment inthe program. “Over 5,000 people are enrolled who previously did nothave any health insurance,” he said.

Arnold said Cover Florida needs more time to mature beforeregulators or the state Legislature tinker with it. He said thestate does not have the money to market the program, and he doesnot see that changing in 2010.

According to Arnold, the biggest problem in trying to get theuninsured to enroll is that many do not look for coverage when theyare healthy. “When people are young and healthy, they don't see anurgent need for health care insurance,” he said.

Pressed to respond to criticism that Cover Florida has barelymade a dent in the state's uninsured problem, Arnold said theprogram was “never meant to be the 'be all and end all' to theuninsured.”

Some of the insurers offering the plan have barely sold anypolicies. UnitedHealthcare, the nation's largest health insurer,has only sold 732 Cover Florida policies. Total Health Choice hassold 48 policies.

Asked why UnitedHealthcare has sold so few policies, spokesmanRoger Rollman blamed the poor economy. He said that because moreFloridians were out of work, they did not have enough money to buyeven a low-cost health insurance plan. Of course, the slumpingeconomy has led to more people losing health coverage in Floridaand nationwide, which seemingly would add to the pool of peopleeligible for Cover Florida.

“In circumstances other than a recession this deep and broad,that would be the case,” Rollman said. “But the severity of thisrecession could very well be the underlying cause.”

UnitedHealthcare and Blue Cross and Blue Shield of Florida(BCBSF) offer plans in all of the state's 67 counties. Fourcounties — Miami-Dade, Broward, Volusia, and Flagler — haveadditional options from other providers. Florida Health Care Plansis available in Flagler and Volusia counties; Medica Health Plan ofFlorida and Total Health Choice are offered in Broward andMiami-Dade counties. JMH Health Plan also serves Miami-Dade. (Plandescriptions and other information are available atwww.coverfloridahealthcare.com.)

BCBSF has 60 percent of the Cover Florida enrollees. The companyrefused interview requests to talk about the program's results.

Crist Still On Board

Cover Florida is the only real effort Crist has made to respondto the uninsured crisis in Florida, which has the fourth highestrate of uninsured in the country. Crist has told reporters that theprogram should be a national model for how states can help theuninsured. “It may be exactly the health insurance you have beenlooking for,” Crist says of Cover Florida on the program's webpage.

The governor never predicted how many uninsured would enroll inCover Florida, so no one can say if the state did or did not reachits goals.

But Steve Israel, a spokesman for the Florida Association ofHealth Underwriters and an insurance agent with South FloridaAffiliated Health Insurance in Delray Beach, said the problem isthat people want a full set of benefits so that if they get sickthey know they will be covered. He said he has sold only threeCover Florida policies and he knows few people on the FAHU boardwho have sold many. “We haven't heard much interest. People wantfull coverage,” he said. “It is just not enough of a plan where youwant to recommend it to a client. The positive is that people havea chance to get insurance, and for most everyday things, it willhelp,” Israel continued. “But to me, it is very inadequate. A lotis not covered.”

Hamilton said she has sold 25 Cover Florida policies this year.She would sell more if the benefits were not so limited. “I get somany calls from people who just can't find anything else,” shesaid.

Under the program, health plans sell a preventive type plan thatdoes not include hospitalization coverage and a catastrophic planthat does. Enrollment data shows more than 4,100 of the 5,000 CoverFlorida chose the catastrophic coverage. The data also show womenoutnumber men buying policies by an almost two-to-one margin.

While most of the state's uninsured are between 18 and 40, thisage group is actually least representative of those buying CoverFlorida policies. Nearly half of the enrollees are between ages 50and 64.

These past few months have added one more item to the mix.Depending on the final health-care reform package out ofWashington, limited benefit policies such as Cover Florida might beoutlawed because they would not meet minimum coverage standards. Asthe debate continues, the ranks of Florida's uninsured continue togrow.