For the first time, the governor and the Legislature may be on the verge of taking a significant step to reduce the number of uninsured in Florida.
The changes are most likely to come among children and young adults -- groups in which a few dollars in preventive care could mean lifelong savings.
Gov. Charlie Crist and the insurance industry appear to have agreed that adult children should be allowed to stay on parents' policies until the age of 25 or 30, even if they're no longer in school.
What's more, the governor proposes the expansion of Florida Kidcare to include all uninsured children in the state. Some consumer advocates, however, question how much that plan will reduce the number of uninsured.
About 3.9 million nonelderly Floridians -- about one out of every four in the state -- are without insurance.
That includes 548,000 children -- 12.6 percent of those under 19, according to a University of Florida study.
Among adults, the most likely to be uninsured are the young ones -- 35.1 percent of 19-24 year olds and 28 percent of 25-34 year olds, according to the Florida Health Insurance Study.
Many experts say an inexpensive, efficient healthcare system can be created by spending dollars on the young, because early preventive care tends to be cheap and can avoid or lessen serious diseases later in life.
DEPENDENTS
Most health plans now support employees' children until they reach 19 or, if they stay in college, until they reach 22 or 23. When these young adults enter the work force, many must start with part-time jobs that offer no benefits because employers are trying to keep down healthcare costs.
For these young adults, Crist is proposing that insurers be required to carry them on their parents' plans until they reach 30. This proposal applies only to regulated insurance plans. It doesn't affect large corporations that are self-insured and use an insurance company only as a third-party administrator.
An insurance trade group is willing to accept Crist's concept -- at least up to age 25, ''if they're willing to pay slightly more,'' says Sam Miller of the Florida Insurance Council. ''This is a group that doesn't buy insurance,'' but because they're young and generally healthy, ''it's very affordable'' to insure them.
The powerful Florida Hospital Association backs this concept, as well as the expansion of Kidcare because it knows those without insurance tend to postpone primary care until they're so sick they go to the emergency room, where by law hospitals can't refuse them. ''We have become de facto primary care,'' says Rich Rasmussen of the FHA.
Florida's Kidcare has generally been for lower- and lower-middle income children who have no insurance and are not poor enough to qualify for Medicaid. Parents pay for coverage on a sliding scale, depending on income. Most families pay $15 or $20 a month, according to a state website.
The Jeb Bush administration cut back on Kidcare and restricted enrollment periods to narrow periods each year. That led to enrollment dropping 124,000 between 2004 and 2005.
Last year, during Crist's first legislative session as governor, a push to reform Kidcare died in political wrangling.
This year, Crist is back with a new plan: Proposing to eliminate all income caps for enrollment. If parents were willing to pay the full cost of the insurance, 126,000 more kids could be covered by the plan.
Lisa Margulis of the consumer healthcare advocacy group Florida CHAIN says that plan might expand coverage some, but the premiums will be $128 to $159 per month, discouraging many parents from signing up.
`BROADER STRATEGY'
''That could be one piece of a broader strategy,'' says Margulis. ``There are really other ways that the state could do more.''
One way: By changing income limits, the state could pay more of the premiums. The state also could expand Kidcare coverage by including the children of legal immigrants who are not now covered (until they've been in the country for five years) and the children of state employees, who sometimes cannot afford the dependent premiums that the state demands.
CHAIN also is supporting a separate effort, to use tobacco tax dollars to add up to 100,000 Kidcare slots in which parents would pay only low premiums.
Other health insurance proposals before the Legislature are much more problematic, largely because they're opposed by the insurance industry.
One major push, which came from the Senate Committee on Banking and Commerce, recommends health plans be required to offer coverage for mental and nervous disorders ``that is on par with coverage for physical and surgical healthcare.''
Insurers say this provision could increase premiums by 5 or 10 percent. Any time premiums go up, some employers drop coverage, increasing the numbers of the uninsured.
In another move, autism lobbyists, including former Dolphins quarterback Dan Marino, want Florida to follow the lead of 26 states and order health insurers to cover services for the treatment of autism.
The Florida Insurance Council says it's concerned because autism is such a complex disease with lengthy treatment and educational options, which could cause a large increase in premiums. At present, insurers and employers have flexibility on what autistic services to include, if any, in a policy.
The council's Sam Miller says many autism services already are being offered by public school systems. The South Florida Hospital and Healthcare Association is on record as opposing any insurance mandates that will raise the costs of premiums.
State lawmakers already have more than 50 mandates that insurers are required to cover, including chiropractors, acupuncturists, anesthesia during dental surgery, marriage therapists and massage therapists.
Insurers say they could offer much more affordable policies if they weren't forced to include these mandates.
HELP UNINSURED
Using that information, Crist announced last week plans to help the uninsured with new, low-cost health insurance that would eliminate all of the 50-plus mandates now required.
Crist said the cost would be $150 a month for an individual policy.
Insurers questioned his math. Randy Kammer of Blue Cross Blue Shield of Florida said she feared only the sick who couldn't get other coverage would buy into the plan, creating a high-risk pool that the cheap premiums couldn't cover.
