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Cover FL a model? Most say no

By Christine Jordan Sexton

8/7/2009 © Health News Florida

Kathleen Lieberman has been trying for years to find affordable health insurance.
 
Small-group? Too expensive. Adding her to her husband’s plan? Unaffordable. Discount medical card? Too scary, since there’s no hospital coverage. 

So when Cover Florida came along, the 63-year-old Apollo Beach real estate agent latched on to it. For $190 a month, she has a “catastrophic” plan that would cover a serious health problem – surgery, chemo, a hospital stay – but only up to $25,000. 

“I understand it’s bare bones,” Lieberman said, but real insurance would cost $800 to $900 a month. “Having something is better than having nothing.” 

That’s the attitude Gov. Charlie Crist started out with when he introduced the Cover Florida concept: A bare-bones plan with no government subsidies that would be available to all comers for an affordable price. 

That modest vision has grown. This week, the governor’s office released an opinion column to newspapers across the state touting Cover Florida as a solution to the nation's health-care crisis, an alternative to the “all or nothing debate” occurring in Washington.

“We have found that by working with the private sector, we can increase health care choices without increasing taxes or the size of government,” he said. Republican Party chief Jim Greer echoes that view in an e-mail he sent out this week seeking donations.

But that proposal doesn’t get much support from those who sell the plan, those who have bought it or the statistics.

Since Cover Florida became available to the public in January, 3,757 previously uninsured residents have enrolled in one of the plans. While the governor considers that a “good start,” it didn’t make a dent in the state’s uninsured -- now estimated at 3.9 million.

Indeed,a study released by Families USA last month, based on census data, estimates that 15,000 Floridians a month are losing their health insurance. If the study is right, Cover Florida isn’t even close to keeping up.

Blue Cross & Blue Shield of Florida, which has sold more Cover Florida plans than any other company, says those enrolling tend to be in the 50-64 age group or “worse than average risk,” people who can’t find affordable insurance anywhere else.
 
The company’s statement of support for national health reform calls for a program that goes far beyond Cover Florida. It should include a “meaningful public subsidy” for those who cannot afford it, Blue Cross says, and an enforceable requirement that all individuals and businesses participate. 

Tallahassee actuary Joyce Bohl says the benefits in the two types of Cover Florida plans – preventive care and “catastrophic” – are just too lean to serve as a national model of reform.

“These enrollees are underinsured, as an acute or chronic illness could bankrupt the average middle or working class family,” she said. 

For example: A 42-year-old woman who bought a "preventive" plan would have access to a mammogram, but if it found a cancerous lump, she’d be in trouble. She’d have coverage for doctor’s visits and some drug costs, but not chemotherapy, radiation, or hospitalization. 

"The vast majority of the cost of care would not be covered," Bohl said. 

The top-selling catastrophic plan – the one Lieberman enrolled in -- would cover those services. But the cap of $25,000 would soon run out, Bohl said.
Cover Florida might work for those with chronic conditions such as asthma or diabetes yet are healthy otherwise, Bohl said. But woe be unto them if they suffer a heart attack, stroke or broken hip. 

Cover Florida is “the solution until you get sick,” Bohl said, only half joking. 

Sarasota insurance agent George Jenkins says he steers clear of selling the plans because he worries clients will complain or even sue when they discover their low-priced plan doesn’t cover much. During the legislative debate on Cover Florida, insurance agents lobbied unsuccessfully for immunity from lawsuits.

“Many agents won’t touch it,” Jenkins said. 

Venice insurance agent Noel Brown set up a Web site to attract customers to the program: coverflorida.com (the state’s site is www.CoverFloridaHealthCare.com). He said he has gotten about 1,500 inquiries; about 100 made a purchase.

Brown says that while the benefits need to be richer to appeal to a broader range of people, especially those who have had employer-sponsored coverage, “it’s the right idea and a step in the right direction.”

Crist pushed Cover Florida in 2008 amid sobering statistics: nearly 25 percent of Floridians under 65 were estimated to lack health insurance.

The program requires participating companies to provide a core set of benefits, including preventive services such as cancer screening. It also requires that companies offer a more expensive plan that includes inpatient and outpatient hospital care.

Blue Cross’s Chip Kenyon, senior director of expansion markets, says that while the plans are selling better than the original estimate of 2,000, the new sales projection is still just 5,000. 

United Healthcare, which offers the only other statewide plan, has sold fewer policies because it’s more expensive. Its catastrophic plan averages about $344 a month compared to Blue Cross’ $148, but its lifetime cap of $500,000 is ten times higher than Blue Cross’ $50,000.

Kenyon said early data indicate many enrollees have higher-than-average health risks and a majority are between ages 50 and 64 – those who have difficulty buying insurance in the individual insurance market, where companies turn high-risk people away. Most – 2,344 -- are women. 

The plans aren’t selling well with the so-called “invincibles,” the under-30 set who don’t rank health insurance high on their scale of demands. Just 133 preventive plans have been sold to people between 19 and 29 years old, even though the cost for the Blue Cross plan for a woman in her 20s is only $23.70 to $40.51 a month. 

In all, only 544 people under the age of 30 had purchased Cover Florida as of the end of June. David Foy, the governor’s policy director, says his staff will work to increase those numbers. 

“(Young adults) would be a big help to our marketplace if they are insured,” said Foy. 

Teri Hanna of Tallahassee, who is three years from Medicare age, is a typical Cover Florida member. She initially dismissed it because of the pared-back coverage, but grew weary of the $900-a-month premiums she’d been paying for three years.

She enrolled in the Blue Cross preventive plan, without high hopes. She worries she’ll lose her home if she has a costly injury or illness. 

“I don’t feel relieved,” she said. “I guess I just don’t think about it.”

-- Christine Jordan Sexton is co-founder of Tallahasseereporters.com.