Florida Leading The Nation In ACA Enrollments

Florida is leading the nation in Affordable Care Act health insurance enrollments on healthcare.gov during this sixth enrollment period and will likely again be the platform's biggest customer when the sign-up period ends Dec. 15.

But, so far, statewide enrollments are below last year's mid-November count. Dramatic Trump administration cuts to public outreach and enrollment assistance programs since 2017 aren't helping.

In the first half of November, 463,066 Floridians had signed up for new plans or renewed the ones they had, according to the most recent federal data that runs through Nov. 16. This time last year, 489,843 had signed up for plans. There was one extra day in that time period in last year's count.

It's too soon to know if Florida enrollment will continue to climb this year, said Jodi Ray, director of the University of South Florida-based Florida Covering Kids & Families, which oversees enrollment throughout the state. But she said her program has been inundated with calls for assistance.

"Everyone seems pretty busy. I myself am doing more applications than I think I've done in all of the (enrollment) years," Ray said. "I think people still really understand that they need health coverage, and they're taking it pretty seriously."

But many parts of the state – particularly outside of metropolitan areas – will again have to do without the help of in-person sign-up counselors known as "navigators," who help enrollees select the best, most affordable, plans.

The Trump administration, which is backing a federal lawsuit to overturn the entire law, has cut funding nationally for the program. Florida's has reduced 86 percent since 2016.

"Although we try to serve the whole state by providing options for 'virtual' and phone appointments, that's got limitations," Ray said. "Nothing beats being able to sit down with somebody together, answer questions and print out a summary of benefits and make comparisons. It gets pretty involved."

The Trump administration has encouraged Americans to use private brokers to help with insurance selections, in lieu of navigators. The private brokers often receive commissions by insurers. A list of them, by location, are searchable on healthcare.gov.

Nearly 1.8 million Floridians signed up for Affordable Care Act plans last year, the most in the nation.

Florida's enrollments have increased almost every year since Affordable Care Act plans became available on the government exchange. The exception was in 2017, when cuts to the navigator program began.

Regardless of the enrollment challenges, the Affordable Care Act remains stable in Florida.

This year, two additional insurers, Bright Health Insurance Co. of Florida and Cigna Health and Life Insurance Co., agreed to sell exchange plans in certain counties.

Average premiums are expected to remain flat. And, as of last year, more than 90 percent of Floridians qualified for subsidies to cover all or some of premium costs.

Program cuts and the repeal of the tax penalty for not getting coverage likely led to the first year-to-year increase in the nation's uninsured rate last year to 8.5%.

Florida's uninsured rate also ticked slightly upward – from 12.9% in 2017 to 13% in 2018, according to the U.S. Census Bureau. It was 12.5% in 2016.

The Trump administration notes that many people who do not qualify for tax credits to cover premium costs cannot afford the monthly rates, even if they are largely not increasing.

The administration announced last month that 2.5 million Americans left the individual market between 2016 and 2018, demonstrating "the ongoing challenges the individual market faces."

Anne Swerlick, a senior policy analyst with the Florida Policy Institute, said the continuing political controversy over the law and multiple repeal attempts may also be taking a toll on Affordable Care Act enrollment.

"I think that families are confused, many are confused, about whether the ACA still exists, whether marketplace plans still exist," Swerlick said. "There have been a lot of efforts to repeal the ACA, to get the courts to overturn the ACA as unconstitutional."

About 105,000 residents of Lee, Collier and Charlotte counties signed up for Affordable Care Act plans last year, data show.

County-specific enrollment figures for this year are not yet available.

This year, Lee County residents have one insurer available on the exchange: Florida Blue and its HMO, Health Options Inc. Collier has two: Florida Blue and Cigna.

Lee Health, Southwest Florida's largest hospital system and a designated "safety net" health care provider for the region's uninsured, credits the health law with reducing the number of patients it treats who cannot pay.

"The implementation of premium subsidies through the Affordable Care Act has increased our mix of commercially insured payers by two percentage points and slowed the growth rate of charity care and self-pay," Ben Spence, Lee Health's chief financial officer, said in an email. "Prior to the ACA, our commercial payer mix had been decreasing each year."

Connect with this reporter on Twitter: @FrankGluck

What you need to know

The enrollment period for individual market plans runs from Nov. 1 through Dec. 15.

For more information, go to heathcare.gov or call 800-318-2596. In Southwest Florida, contact the Health Planning Council of Southwest Florida at 866-547-2793 or visit hpcswf.com.