Health care plan a catchall

The governor wants private firms to provide low-cost options to Florida's uninsured.

By Steve Bousquet and Kris Hundley, Times Staf Writers
Published February 20, 2008

TALLAHASSEE - Gov. Charlie Crist will ask the Legislature to help millions of Floridians who have no health insurance by inviting private companies to offer a range of coverage options at reduced cost.

But the initiative, laid out for the first time in an e-mailed news release Tuesday, lacked key details, making it far from clear if Crist's effort would significantly address a problem that has vexed health experts nationwide.

Nearly 1 of 4 Floridians under age 65 has no insurance. Their lack of coverage overburdens hospital emergency rooms, driving up health care premiums for others while lowering health care quality because the uninsured receive no preventative care.

"Health care is so expensive," Crist said. "I want us to try to do everything we can to provide more coverage and less expensively for our fellow Floridians."

Crist calls his plan "market-based," and it depends on voluntary participation of licensed health care providers and HMOs - a sharp contrast to efforts in other states, such as Massachusetts' universal health care plan. Nor does Crist's plan call for state funding, a contrast to the recent California proposal that failed over concern of long-term cost.

Crist's proposal would require insurers that participate in the program to guarantee coverage to people age 19 to 64 and include catastrophic coverage and treatment for pre-existing medical conditions.

A draft legislative proposal requires firms to provide a wide range of coverage options, including annual doctor visits, inpatient hospital stays, mammograms, prostate screenings, immunizations, emergency room visits and prescription drugs. It states premiums would be "$150 a month or less."

Supplemental plans would offer vision, dental and cancer coverage.

The state would start negotiating with insurers next summer to develop plans tailored to consumers' preferences and ability to pay, with far fewer mandated coverages than exist in current law.

The size of deductibles is not specified in the bill, and Crist's plan does not offer subsidies to low-income people.

Crist's policy director, David Foy, who has been putting elements of the program together, said the initial reaction from insurers has been "very favorable."

The initial political reaction also was optimistic, but most said they need to know a lot more about the details.

"I'm glad we're seeing attention to what I think is a legitimate crisis in our state," said Rep. Dan Gelber, D-Miami Beach, the House minority leader.

But insurance executives and policy experts said the details will be crucial to determining the value of Crist's proposal

Harvard professor and health policy expert Robert Blendon said it's a good thing if Crist wants to help individuals, even those with health problems, buy insurance coverage at a competitive rate.

But he said there must be a limit on how much of a surcharge insurers could tack onto premiums for people with pre-existing medical problems. "If there are no limits, people with health problems probably can't afford the policies," said Blendon, who has tracked the implementation of mandatory health insurance reforms in Massachusetts.

He also questioned what kinds of deductibles and copays an individual would pay under Crist's low-cost premiums.

"What do they get for their $150 a month?" he asked, "and is the state going to subsidize premiums for people who can't afford it? The governor doesn't appear to be going near this idea."

Steven Smith, director of legislative relations for Blue Cross Blue Shield of Florida, praised Crist's desire to cover the uninsured. But he cited a tradeoff between Crist's desire to keep premiums affordable while guaranteeing coverage to all, including those with health problems.

Smith was also wary of Crist's call for a "robust" package of preventive, primary and urgent care benefits including hospitalization. "We wonder how generous and expansive the governor's definition of 'robust' will be," he said. "This is clearly an issue where the details will matter."

Smith said Blue Cross, the state's largest health insurer, supports another Crist initiative, to allow policyholders to keep dependents on their policies until age 30. "This is a way we could cover a lot of people without raising the cost," he said.

A second, more controversial health care proposal by Crist would change the law to eliminate a requirement known as certificate of need for acute care hospitals, which must show an unmet need before doing business.

Crist said certificate of need regulations stifle competition and delay availability of new beds because of lawsuits. But a lobbyist for some of the state's largest hospitals said Crist's plan would shift an even greater burden for uninsured health care to hospitals that now provide much of it.

"When you build boutique hospitals for profit, you undermine the safety net in this state," said Tony Carvalho, a lobbyist for the Safety Net Hospital Alliance of Florida, a group of 10 hospitals that provide more than half of all charity care in the state.

Times staff writer Jennifer Liberto contributed to this report. Steve Bousquet can be reached at bousquet@sptimes.con or 850 224-7263.