Governor Charlie Crist finally got his Kodak moment a few hours before the Florida legislature wrapped up its 2008 session. The House and Senate passed the governor's plan to provide low-cost, no-frills health-care coverage to the 3.8 million uninsured Floridians. The bill also included the House initiative that creates a state-run corporation to work as a clearing house for selling low-cost, stripped-down health benefits to workers of small businesses

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

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

Now comes the hard part: Actually convincing the uninsured to buy 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-care coverage is better than nothing. But critics, including some insurance agents, predict that uninsureds won't jump at the bare-bones type of coverage because it may not help them when they really need it. “I don't think agents are going to be able to sell it,” said Steve Israel, spokesman for the Florida Association of Health 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 cancer coverage 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 Insurance and Financial Advisors, said the health-care reform plan is a good start. But he adds that he was disappointed there was no requirement to ensure consumers are informed in writing that they were not getting full coverage. “The jury is still out on this,” he said.

Consumer advocates warn that people may be getting less coverage than they need from the plan and the policies may not be an easy sell. “This is a step in the right direction, but there are some glaring loopholes,” said Bill Newton, executive director of the Florida Consumer Action Network.

AHCA Seeks Bids

This summer, the Agency for Health-Care Administration will put out a request to the state's insurers for bids asking them to submit products that cost no more than $150 a month. Crist's Cover Florida plans will have to have some preventive benefits such as checkups, mammograms, and pharmaceuticals but plans won't have to include any of the state's 51 mandated benefits. At least two plans are expected to be available in each county, including a catastrophic plan that would include some hospitalization coverage. There likely will be at least one state-wide plan and several regional plans.

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

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

One in every four Floridians under the age of 65 lacks health insurance, one of the highest rates in the nation. Because people without insurance delay seeking care when they are sick and avoid screenings and checkups, they are 25 percent more likely to die prematurely than people with insurance, an advocacy group estimated.

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

Not All Victories

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

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

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

“Folks want more choices,” said House Health-Care Council Chairman Rep. Aaron Bean (R-Fernandina Beach), who was behind the marketplace plan. He negotiated with the governor while sitting on a couch in his office. “This is big,” he said at the congratulatory news conference with the governor.

Insurers Offer Support

Insurance companies, who say mandates raise premiums, welcomed changes 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 sell health-care products that don't have to be insurance and don't have to win approval from the state Office of Insurance Regulation. Hospitals, health plans, health networks, and medical providers could sell prepaid health benefits. The corporation would accept contributions for employer and employee and evaluate companies looking to sell benefits to small employers. The OIR would get one seat on the corporation board and judge the merits of each plan. But the corporation — not the OIR — would have the final say on what is sold.

While Republicans stressed their free-market approach to help employers, critics said the idea could allow unregulated firms to collect premiums with no guarantee that they would provide coverage. Persuading people to buy limited-coverage policies is difficult, said Dwight Chenette, CEO of the Health-Care District of Palm Beach County. The district has offered a health coverage plan for as low as $50 a month, but has attracted just 1,000 buyers in two years. “These plans do not sell themselves,” Chenette said. “It's not automatic.”

Several insurers, including Blue Cross and Blue Shield of Florida, already sell low-cost policies with high deductibles and limited 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-comprehensive policies that they now offer employees in favor of the cheaper but less comprehensive plans. Nonetheless, the governor and legislative leaders hailed the legislation as a model for the nation, though Crist stopped short of predicting how many of Florida's uninsured residents would enroll. “We hope as many as possible,” the governor said.

One part of the health-care reform bill that has received scant attention is that it will allow adult children to remain on their parents' health-care policy until they turn 30. Today, they can only remain on the policy until age 25, and they have to live at home or be in college. Insurance experts say this provision could help tens of thousands. The highest percent of uninsureds are in the 18-to-34 age group — an age group that is also the least costly to insure.

Crist's plan became a reality because he was able to win the support of all major lobbying groups, including Florida's hospitals, doctors, and insurers. Even the business lobbies — the National Federation of Independent Businesses and the Associated Industries of Florida — supported it.

Allen Douglas, legislative affairs director for the Florida chapter of the National Federation of Independent Businesses, worried that the Florida Health Choices Corp. could run into problems of another popular state corporation, Citizens Property Insurance Corp. “The state's done a pitiful job running property insurance and I don't think health insurance would be a whole lot better,” Douglas said. Nonetheless, NFIB applauded the state passing one of the biggest expansions of health-care coverage in more than a decade.

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

“We are prepared to use every bully pulpit to sell these plans,” said Mark Thomas, chief of staff at the Agency for Health-Care Administration. He said the main target of Cover Florida is healthy young 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 to pass health-care reform. He will have to show that he has the skills of a magician to convince this demographic of the need to buy insurance. If he can do that, then Florida can really say it has accomplished health-care reform.

Special Reports /

Finally, Florida Takes a Step Forward

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