25 percent of Highlands still has no health insurance

June 05--SEBRING -- Two years after the Affordable Health Care Act required most Americans to either buy insurance or pay a penalty, a quarter of Highlands County residents are still uninsured.

Nearly half of all Florida counties show high uninsured numbers, the U.S. Census Bureau reported May 12.

Highlands County's rate of uninsured for people under 65 is 25.1 percent, and it's lower than its rural neighbors: Hardee, 27.2 percent; Glades, 28.2 percent; DeSoto, 30.8 percent; and Okeechobee, 27.1 percent. Only more urbanized counties reported better rates: Charlotte, 20.7 percent; Polk, 19.6 percent; Osceola, 21.8 percent.

The Affordable Care Act became law on March 23, 2010, but implementation has happened over the years as different aspects become effective. Full implementation was complete in 2015.

"Consumers in Florida will continue to have affordable coverage options in 2017 and will benefit from two new issuers entering the Marketplace," Jonathan Gold, press secretary for the U.S. Department of Health and Human Services, said.

Not so, said Heather Stephenson, executive director of Samaritan's Touch Care Center in Sebring.

"Since the implementation of the Affordable Care Act, STCC continues to see a surge in demand for medical, dental and vision services," Stephenson said. STCC is a faith-based, charitable health care center that provides free primary and specialized medical, dental and vision care to Highlands County adults who are uninsured, including Medicaid and Medicare recipients and are at or below 200 percent of federal poverty guidelines.

"Due to Medicaid not being expanded in Florida, these adults fall into what is known as the coverage gap," Stephenson said. Their incomes are limited, but they do not qualify because non-disabled adults without dependent children are ineligible for Medicaid.

In 2014, an Affordable Care Act provision went into effect giving states the option to expand Medicaid eligibility to most working-age adults living at or below 138 percent of poverty. In states that expanded Medicaid eligibility, uninsured rates for working-age adults decreased in 96 percent of counties. Gov. Rick Scott and the Florida Legislature opted out.

"Because the ACA envisioned low-income people receiving coverage through Medicaid, people below poverty are not eligible for Marketplace subsidies," Stephenson said. They earn too much to qualify for Medicaid, but not enough to qualify for premium tax credits.

"No matter how well the ACA works, there are still a substantial number of uninsured people with no affordable option for health coverage in Highlands County," Stephenson said. "The need for strong healthcare safety nets like STCC, is not going away anytime soon."

Last year, Gold said, the average monthly premium for people with Marketplace coverage getting tax credits increased just $2, from $82 to $84 per month, despite headlines suggesting big rate increases.

That wasn't Stephenson's experience. "I can provide you with a real-life example: a single, unemployed, homeless, 27-year-old male came in to STCC seeking assistance with a health issue."

The health issue prevented him from being employed, and the man didn't have access to a computer, Stephenson said. He used an STCC computer at STCC to apply for health insurance through Florida's marketplace.

"I have attached a printout that he permitted me to share that shows what his premiums/deductibles/co-pays would be should he sign up," Stephenson said. The Catastrophic Plan wasn't an option, because it doesn't cover routine medical care. Therefore, his cheapest option -- the Bronze plan -- would be $210 per month with a $5,829 annual deductible. That plan would cover 60 percent of his total average health costs.

"People in Florida understand how the Marketplace works, and they know that they can shop around and find coverage that fits their needs and budget," Gold said. The sheet the homeless man received said six plans were available from two insurance companies, whether he bought Bronze, Silver, Gold or Platinum.

Cigna and Harken Health are entering the state's Marketplace, while United is exiting, Gold said. People in Florida will be able to choose from 11 issuers next year, one more than this year. Gold said 91 percent of Marketplace consumers in Florida receive tax credits, and therefore can buy a plan for less than $75 per month.

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