At the start of 2009, there were high hopes but low expectations for Florida's new program to help its nearly four million residents without health insurance.

In those terms, the Cover Florida Health Access Program did not disappoint.

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

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

The goal was to develop health insurance products that cost an average of $150 a month. To do that, some plans provide no hospitalization, no mental health benefits, or no brand-name prescription drug coverage. To further lower costs, the program itself was exempted from the state's more than 50 mandated health benefits, such as chiropractic care and bone marrow transplants.

To keep the state's dollar investment in the Cover Florida to zero, the state chose to devote no money to marketing or advertising. 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 Cover Florida plans in all 67 counties, pays agents just a $3.15 a month commission per enrollee — not even $38 a year. In contrast, with more standard health insurance, agents typically get paid about 20 percent commission in the first year, which usually can mean commissions approaching $1,000.

“A lot of agents won't sell it because it's not worth their time,” said Donna Hamilton, an agent with Jack Rice Insurance in Largo. “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 bought a Cover Florida policy from UnitedHealthcare in April after her COBRA policy ran out from a group policy. Despite Gov. Charlie Crist's intention, Easton's Cover Florida policy is not cheap. However, she chose to buy it for $473 a month because with high blood pressure, high cholesterol, and a degenerative spine condition, she could not find another insurer willing to write a policy for her.

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

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

No Changes Planned

Tom Arnold, Secretary of the Florida Agency for Health Care Administration, makes no apologies for the limited enrollment in the program. “Over 5,000 people are enrolled who previously did not have any health insurance,” he said.

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

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

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

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

Asked why UnitedHealthcare has sold so few policies, spokesman Roger Rollman blamed the poor economy. He said that because more Floridians were out of work, they did not have enough money to buy even a low-cost health insurance plan. Of course, the slumping economy has led to more people losing health coverage in Florida and nationwide, which seemingly would add to the pool of people eligible for Cover Florida.

“In circumstances other than a recession this deep and broad, that would be the case,” Rollman said. “But the severity of this recession 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. Four counties — Miami-Dade, Broward, Volusia, and Flagler — have additional options from other providers. Florida Health Care Plans is available in Flagler and Volusia counties; Medica Health Plan of Florida and Total Health Choice are offered in Broward and Miami-Dade counties. JMH Health Plan also serves Miami-Dade. (Plan descriptions and other information are available at www.coverfloridahealthcare.com.)

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

Crist Still On Board

Cover Florida is the only real effort Crist has made to respond to the uninsured crisis in Florida, which has the fourth highest rate of uninsured in the country. Crist has told reporters that the program should be a national model for how states can help the uninsured. “It may be exactly the health insurance you have been looking for,” Crist says of Cover Florida on the program's web page.

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

But Steve Israel, a spokesman for the Florida Association of Health Underwriters and an insurance agent with South Florida Affiliated Health Insurance in Delray Beach, said the problem is that people want a full set of benefits so that if they get sick they know they will be covered. He said he has sold only three Cover Florida policies and he knows few people on the FAHU board who have sold many. “We haven't heard much interest. People want full coverage,” he said. “It is just not enough of a plan where you want to recommend it to a client. The positive is that people have a chance to get insurance, and for most everyday things, it will help,” Israel continued. “But to me, it is very inadequate. A lot is 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 so many calls from people who just can't find anything else,” she said.

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

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

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

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