When Gov. Ron DeSantis ran for governor, he said he planned to modernize the state's "insurance laws so patients have access to nontraditional products, like expanded, direct physician care agreements or tailored plans, like short-term coverage or limited-benefit plans."

In 2019, Florida legislators passed two key pieces of legislation that affected health insurance offerings in the state. First, SB 322 allowed for short-term health insurance plans — defined as plans lasting less than a year — that have certain exclusions on pre-existing conditions and other limitations. This is the policy that DeSantis' office pointed to when asked about this promise.

HB 843 codified direct health care agreements, otherwise known as a contract between a patient and a health care provider that is not considered insurance or subject to Florida's insurance code. The patient and provider can agree to a monthly fee and what services it covers. Both gave consumers the option to choose nontraditional health insurance plans — and the caveats that come with them. 

These Florida laws aligned with a Trump administration rule that allowed short-term insurance policies to not follow guidelines on pre-existing conditions and coverage for prescription drugs and maternity care set out by the Affordable Care Act.

Also in 2019, DeSantis' office touted new Medicare Advantage and Prescription Drug health plans available to more than 30,000 Medicare-eligible retirees, according to a press release. These insurance plans offer Medicare and prescription drug coverage in one plan, along with benefits within vision, hearing, dental and wellness. The state's Department of Management Services procured the plans from Humana, UnitedHealthcare and Capital Health Plan and made them available for the 2020 enrollment year. 

"Florida is finding innovative health care options to improve the quality of health care services for state retirees while also saving taxpayers money," DeSantis said in the statement. "These new health plans will provide more flexibility while creating the potential to save more than $80 million for taxpayers."

Ordinary Medicare comes in four parts, two provided by the government — Part A, which covers skilled nursing and inpatient hospital care and Part B, which covers doctor services and outpatient hospital care. Private insurers cover Part C, aka Medicare Advantage, and Part D, prescription drug coverage.

Medicare Advantage plans are all-in-one managed care plans providing Part A and B benefits and often Part D.

As the program director of Florida Covering Kids & Families, Jodi Ray helps patients access and use affordable health care coverage through publicly funded programs or the federal marketplace. 

Ray said she's seen little evidence in practice that DeSantis has expanded what he said he would expand — namely, limited-benefit plans, direct physician care agreements or short-term coverage. 

"One time in the past four years, somebody walked in with a short-term plan. When I showed them what was in it compared to a marketplace plan, it was actually kind of scary that they were sold this as a good idea for affordable health care," Ray said. 

Florida's decision not to expand its Medicaid program has drawn criticism from Democrats. (Charlie Crist, a Democrat who is running to replace DeSantis as Florida's governor, has said that if he's elected, he'll veto any proposed state budget that does not include an expansion of Medicaid.) 

Florida is one of only 12 states — all of which have Republican-led legislatures — to not expand Medicare under the Affordable Care Act. If Florida were to expand Medicaid, more than 800,000 low-income Floridians would have access to the coverage, according to the Florida Policy Institute. When the state first had the option to expand the program, then-Gov. Rick Scott balked, saying that a requirement to have Florida eventually pay a portion of the cost would burden taxpayers.

This philosophy did not appear to change under DeSantis. 

Because legislation enacted in 2019 expanded access to both short-term health care plans and direct physician care agreements, as DeSantis specified, we rate this Promise Kept.