Guest AuthorCharlie Crist was on to something with his 2008 plan to cover Florida’s uninsured, but he was also its undoing.
Called “Cover Florida,” it was designed to offer lower-cost options to the uninsured without mandates or tax dollars. Instead, the program was designed to use competitive negotiations between the state and insurers.
The state’s pitch to insurers was that if they could find a way to offer quality benefits at a rate of $150 per month or less, they’d have exclusive access (and some free marketing!) to a giant pool of Florida’s 3.8 million uninsured.
“The negotiating power of the state far surpasses that of any small business or group,” Crist wrote in an August 2008 opinion column.
He was right in that… If only that’s how things had gone.
Cover Florida’s legislation delineated a set of benefits that must be covered by proposed plans, including preventive services, office surgery, behavioral health services, diabetic supplies, prescription drugs, and more. The program made optional some costly benefits mandated by Florida law that not every consumer needs, and put in place a number of important consumer protections.
Cover Florida was written to be “guaranteed issue,” meaning that people with preexisting conditions would be accepted, and selected plans were to be considered “creditable coverage.” That means that if policyholders join other plans in the individual market, they don’t need to go through a new preexisting-condition-exclusion period.
Rather than limiting the scope of benefits, insurers were encouraged to contain costs by limiting the quantity of services.
For example, while many plans offer coverage for 365 hospital days a year, Cover Florida plans were directed to provide for at least the average stay. Negotiations were supposed to ensure that plans exceeded these minimums.
But sadly, it seems, the negotiations were mostly for show.
Crist claims that Cover Florida failed to attract consumers because the state spent no money to market it. But it wasn’t a lack of awareness that accounted for the program’s paltry enrollment numbers.
In the first year of Cover Florida, its website received 563,705 hits. But at its peak in 2010, the program had just over 6,000 enrollees.
Selecting a health plan is hard work. Benefit packages can be confusing to read, even without fine print. But consumers are smart when their own dollars are on the line, and it wasn’t hard to do the math on Cover Florida plans.
Of the six plans that were “competitively” selected, only one company offered products worth buying.
But, Crist wanted to tell Floridians that they had a “choice” among several Cover Florida plans.
This meant backing off on terms in negotiations that he could have pressed harder for. Doing so would have meant plans backing out or the state rejecting proposed packages. It would have meant Floridians getting fewer choices of plans. But it also would have meant quality, worthwhile winning bids, even if just one or two made it out of the gates.
Plans knew they didn’t have to give it their best. In 2009 and 2010, Crist was concerned with the headlines reflecting his promise of “more choice and less government.”
But by not negotiating the plans to be what he had promised, Crist lost the chance to use this boast in his gubernatorial bid: “I created a national model for covering the uninsured that has worked in Florida while federal programs full of mandates and costs falter.”
All it would have taken is a firm stand.
