Crist's plan for health insurance for all can work, experts say
14 03 08 - 11:56
His proposal is doable, experts say, if people rein in expectations.
Harry Wessel | Sentinel Staff Writer
March 14, 2008
Among the many ideas floated by Gov. Charlie Crist last month for improving health care in Florida, one stood out for its simplicity and its allure: Offer the estimated 3.8 million Floridians who lack health insurance an affordable plan for "$150 a month or less."
Crist's "Cover Florida" proposal would not come with a state mandate that individuals had to buy it or employers had to offer it. And it would give insurance companies lots of leeway in deciding how to structure such a health plan -- as long they included "a robust package of preventive, primary and urgent-care benefits, including hospitalization."
Such a plan is doable, health-care and insurance experts say, though people would need to rein in their expectations -- particularly when it comes to coverage for hospital stays and other high-ticket medical costs.
A $150-per-month health-insurance policy "can't get you comprehensive coverage. It's impossible," said Rich Morrison, Florida Hospital's vice president for government and regulatory affairs.
Although a basic health plan could make visits to the doctor's office affordable and thus increase the number of Floridians receiving primary and preventive care, Morrison said, such a plan would either have sky-high deductibles for hospital stays or have no hospitalization coverage at all.
Morrison worries that a low-cost plan without meaningful hospitalization coverage could make matters worse for Florida's hospitals. In January alone, for example, Florida Hospital spent $14 million on uncompensated or "charity" care, largely to cover the bills of uninsured or underinsured patients, he said.
Randy Kammer, a vice president with Blue Cross and Blue Shield of Florida, also wonders whether even $150 would be a low-enough price to attract all those healthy, young Floridians who are currently uninsured.
Healthy people needed, too
Bluntly put, insurers need healthy people in their pool of insured customers to balance the high costs of the unhealthy ones.
"I don't know how we get a good risk pool until we get young 'immortals,' and other healthy people who do not currently participate in the insurance system, to participate," she said.
Kammer thinks the solution is to require Floridians to buy health insurance, with subsidies available for those with low incomes. But Crist has made it clear that such mandates are off the table.
His proposal must go through the legislative process, but in a detailed draft sent to the Florida House and Senate late last month, Crist indicated that his Cover Florida plan would include coverage for both hospitalization and catastrophic illness or injury. And it would be available only to adult Floridians younger than 65 who "have not been covered by any health insurance program at any time during the past six months."
Insurers consulted
According to policy specialists in Crist's office, the insurance industry was heavily consulted about the Cover Florida proposal, and some carriers have indicated they could provide a patient in-network hospital coverage for as many as 30 days.
Crist is leaving it up to insurance companies to draft proposals for Cover Florida plans -- with the stipulation that benefits must be reasonable "in relation to the premium charged."
But a couple of current insurance products may give an idea of what to expect from a $150 policy.
Blue Cross' GoBlue plan, with monthly premiums much less than $100, provides low-cost primary care, low copayments on generic prescription drugs, and coverage for certain lab and screening tests. But there's no coverage for hospital stays, emergency-room visits, maternity care or other higher-cost services such as mental-health care or physical therapy.
Aetna offers a plan for less than $200 a month -- Open Access 2500 -- that includes coverage for hospital stays. It pays just 20 percent of the bill after a $2,500 deductible, though it ensures that the most you'll pay in a year for hospitalizations is $5,000.
Guaranteed coverage costly
Both plans provide easier access to primary- and preventive-care services, which is one of Crist's main goals. But unlike Crist's proposed plan, neither is a "guarantee-issue" policy -- insurance-speak for plans that must accept all comers." 'Guarantee issue' is a critical element," said Jim Bracher, a spokesman for the Florida Association of Health Plans, an industry trade group. Not being able to weed out people with chronic health problems, or charge them more than others, would raise the cost of the plan, Bracher said, though that higher cost could be brought down by limiting the scope of its coverage.
"There can be a reasonable level of coverage" for $150 a month, Bracher said, "but it won't be comprehensive, especially with the 'guarantee issue' requirement."
Becky Cherney, chief executive of the Florida Health Care Coalition, thinks Bracher is overly optimistic. She notes that 80 percent of all health-care money is spent on 20 percent of all people -- mostly those with chronic conditions.
"You can't do 'guarantee issue' at that [$150] rate for the chronic-care group. It will eat up all your dollars," she said.
Cherney, whose coalition represents many of Central Florida's largest employers, shares Morrison of Florida Hospital's worry that a low-cost, basic plan could have unintended consequences.
"If I know there's guarantee-issue insurance for $150, I won't sign up until the day I need gallbladder surgery, or when I find out I have cancer," she said. "People won't pay $150 until they're sick."
Plan 'is worth considering'
But Paul Duncan, chairman of the University of Florida's Department of Health Services Research, Management and Policy, is more upbeat about the governor's proposal.
"Anything that moves some number of people from the uninsured category into the insured category," Duncan said, "is a good thing that is worth considering."
Harry Wessel can be reached at hwessel@orlandosentinel.com or 407-420-5506.
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