Crist’s health-coverage fix likely isn’t, experts predict

Orlando Sentinel--December 22, 2008

Anika Myers Palm

Sentinel staff writer

Disappointment may be in store for those hoping that Gov. Charlie Crist’s Cover Florida health plans will solve the problem of unaffordable health care for the state’s 3.8 million uninsured adults.

Healthy uninsured people have little new incentive, experts say, to pursue coverage through the governor’s program, which debuts Jan. 5 and offers a number of low-cost health-insurance plans.

That’s because the policies are similar to existing health plans promoted by the state — and might not even be as cost-effective or comprehensive as coverage already available on the open market.

“If they’re insurable, they can probably get an underwritten product with basically the same coverage that’s available here,” said Bob Arnold, agency manager at Murray Insurance in Altamonte Springs, which sells Blue Cross Blue Shield policies.

Blue Cross Blue Shield has offered low-cost coverage to individuals for about a year through its Go Blue options, some of which offer combinations of deductibles and copayments for doctor visits that are less expensive than the plans the company is now offering through the governor’s Cover Florida program.

Coverage for a 35-year-old man seeking preventive care, for example, might start as low as $26 a month with Blue Cross’ Go Blue plan, while the company’s Cover Florida plan would begin at $41.64.

About 24 percent of Florida’s adults can’t or won’t buy health insurance — the third-highest percentage among U.S. states, according to the Census Bureau.

Blue Cross Blue Shield is one of only two companies that will offer Cover Florida insurance plans in all 67 counties. The other one, UnitedHealthcare, says its Cover Florida plan is a new product for the company.

“This is not a plan that you had on the shelf and you could bring it out,” spokesman Roger Rollman said.

However, a UnitedHealthcare subsidiary called Golden Rule does offer lower-priced medical policies for individuals in Florida.

Florida Health Care Plans, a Holly Hill-based nonprofit offering a Cover Florida plan in Volusia and Flagler counties only, has until now specialized in Medicare and employer-sponsored plans, spokeswoman Bissy Holden said. A handful of other insurers — Medica Health Plan of Florida, Total Health Choice and JMH Health Plan — are also offering Cover Florida plans, but only in South Florida.

‘Nobody is turned away’

The main advantage that Cover Florida plans offer the state’s uninsured is that even those who have been refused coverage by other insurers for health reasons can’t be turned away.

Nationally, about 30 percent of people with pre-existing medical conditions are turned down when they seek an individual insurance policy, health-advocacy groups say.

“What’s really new here is that nobody is turned away for a pre-existing condition,” said Bill Newton, executive director of the Tampa-based Florida Consumer Action Network.

This isn’t the first time the state has tried to whittle down the percentage of uninsured Floridians.

Gov. Lawton Chiles championed a state-sponsored expansion of health coverage in the early 1990s but “the insurance companies came in and underpriced them,” Newton said.

“I would expect to see the same thing happen again” with Cover Florida, he said, as healthy consumers realize that medical plans already available commercially may be cheaper than what’s being offered through Crist’s program.

‘Very underutilized’

In 2002, the Florida Legislature authorized a similar series of medical plans through a program known as Health Flex. Insurance companies continue to offer these low-cost alternatives to conventional health insurance — though the program does not require the insurers to include coverage for outpatient services, surgery or emergency care.

“These have been very underutilized as well, because of marketing challenges and the fact that people know that what they really need is meaningful coverage,” said Greg Mellowe, policy director for the Florida Community Health Action Information Network, a consumer-health-care-advocacy group.

The Cover Florida plans offer more benefits than the Health Flex plans do. Still, prescription-drug coverage is one area where some of the Cover Florida plans may fall short of other low-cost policies on the market.

“The benefit levels are so low — for example, some plans provide customers with a prescription-drug-discount card instead of actual drug coverage — that, even once the condition is covered, the benefits will be exhausted much more quickly than people may be expecting, if they’re covered at all,” Mellowe said.

The experts agree that people considering enrolling in a Cover Florida plan should consider all of their options.

“In the phone calls we get [about Cover Florida], we want to find out, ‘Is the individual insurable?’ ” Arnold said. “That way, they have a wider choice.”

More information on the 25 Cover Florida plans offered statewide or in a portion of the state is available at CoverFloridaHealthCare.com.

How low-cost health plans compare

Cover Florida, which debuts Jan. 5, is a statewide program initiated by Gov. Charlie Crist early this year through which 25 low-cost health-insurance plans will be offered to the state’s 3.8 million uninsured adults. No applicants to the program can be turned down for health reasons, but healthy applicants may find conventional plans already on the market both cheaper and more comprehensive.

The average monthly premium for a Cover Florida policy ranges from $50.75 to $170.55, depending on the plan and the person’s gender and age. Below is a look at two plans being offered statewide: a prevention-oriented health plan from Blue Cross Blue Shield and a catastrophic-illness/injury plan from UnitedHealthcare.

— Blue Cross Blue Shield of Florida — PREVENTIVE CARE — UnitedHealthcare — CATASTROPHIC CARE Benefits — $0 deductible — $0 deductible Doctor visits — $50 copay or difference between insurer’s payment and the allowed amount, whichever is less — $20 copay Preventive care — Patient pays difference between insurer’s payment and allowed amount for cervical cancer, prostate and colorectal screening. Free mammogram each year. — No copay for 1 annual adult exam; 1 annual gynecological exam; prostate, colorectal and cervical cancer screenings; and mammograms. Hospital in-patient services — Not covered. — Up to 10 days in hospital each year, $500 annual deductible, services up to $2,000 a day (in network). Hospital outpatient services — Not covered. — Up to $600/year in preventive services; $400/year in nonpreventive services. Emergency care — Not covered. — Hospital ER services up to $1,500/year; ambulance services up to $500/year (with $100 copay); 80% of charges covered for accident, heart attack, stroke, trauma. Prescription drugs — Insurer contributes $15; patient pays the rest. $10 copay for generic drugs up to $500/year. Other included services — No copay for mammograms or osteoporosis screening. Average monthly rate* — $50.75 — $170.55

*May vary based on age and gender. SOURCE: Cover Florida