Florida is on track to enroll more than a million people for health insurance through the Affordable Care Act this year, putting the state on track to again outpace the rest of the nation.
The state continues to lead the country with just over 999,000 people enrolled already, a number that advocates say will continue to climb through Saturday's deadline for signing up. Last year, more than 1.7 million people in Florida were insured through Obamacare, the most in the nation.
Elsewhere in the country, the number of people enrolling in health insurance plans under the law has slowed, the result of several factors.
This is the first year consumers won't face a monetary penalty if they don't have health insurance, thanks to a change by the Trump administration. In addition, new "short-term" health plans offered by private insurance companies are available off the federal marketplace, which can be a more affordable option for some middle class consumers.
And for the third year in a row, the government has drastically reduced the marketing budget for Obamacare plans, leaving advocates with fewer resources and less access to people who may need help signing up.
As of Dec. 8, 4.1 million people had enrolled on the federal exchange for health insurance plans. That's dipped 11 percent from the 4.6 million who signed up by the sixth week of enrollment last year.
Despite the challenges, local advocates have been "busier than ever" this enrollment period, said Melanie Hall, executive director of the Family Health Care Foundation, which helps people sign up on the federal exchange. A large number of people who "auto-enroll" by selecting the same plan as the previous year aren't counted in the weekly enrollment reports until the very end of the sign-up period, advocates say. Florida will likely get a big boost at that time.
"We're definitely not feeling a downshift," Hall said. "Even though we have less resources, we are on track to meet our enrollment level from last year. Florida isn't experiencing the same lack other states are seeing."
Navigator groups in the state have been forced to do more with less this year.
Florida Covering Kids & Families, a navigator program based at the University of South Florida, received $4.9 million in federal funds last year for open enrollment marketing and consumer assistance. It was one of several in the state to receive funding. This year, it was the only group in Florida to get any funding, and received just $1.2 million, said Jodi Ray, the group's director.
She said the number of calls for help is more than last year, when the group was receiving a thousand calls a day during peak times.
"But we are certainly reaching less people," Ray said. "We are only in half the counties we were in last year, and we have few assisters."
Some local charities have tried to help fill in the gaps. Allegany Franciscan Ministries donated $50,000 and the Foundation for a Healthy St. Petersburg donated $45,000 to navigator groups in Tampa Bay, Hall said.
"We would not have been able to meet the needs of the community during this open enrollment period without their support," she said.
The short-term plans that are attracting some consumers are generally cheaper and less comprehensive than Obamacare. And they became available in October, the same time open enrollment began for 2019 on the exchange.
The goal, according to Health and Human Services officials, is to offer options outside the exchange for consumers who may have been "priced out of coverage" last year. That's when the federal government ended its cost-sharing relationship with insurers, removing a mechanism that had helped to keep deductibles, copayments and coinsurance low.
Some consumers who did not qualify for tax credits saw double-digit increases last year as insurers were forced to pick up the cost of those extra subsidies.
"We've offered short-term plans for many years, but there's only been a small interest in that market," said David Pizzo, the West Florida market president for Florida Blue. "We try to encourage people to buy regular plans on the marketplace. We estimate that there's 1 million people in Florida who are uninsured, but who would probably qualify for a subsidy. They really owe it to themselves to see. People think they can't afford it, and are surprised when they find out they can."
A Kaiser Family Foundation analysis shows that 4.2 million uninsured people in the U.S. could get a so-called "bronze" plan from the federal exchange this week and have no premium to pay after tax credits. Some plans still have fairly high deductibles, but there are affordable plans still available.
Florida Blue, the state's largest insurer, also offers additional plans similar to Obamacare off the exchange. These non-Obamacare plans are similar in price and coverage to those on the exchange. The company started offering them in response to last year's premium increases on so-called "silver" plans, which are priced in the middle range and are among the most popular Obamacare options.
Despite the challenges, Tampa Bay residents are finding affordable plans on the exchange.
Michael Dominick, 30, from Riverview, said he enrolled on the healthcare.gov website in 45 minutes.
"I was born with congenital heart disease, so health insurance is a requirement for me," he said.
The plan he found for himself, his wife and their 2-year-old son will cost him a little over $1,000 a month.
"The individual plans seem fairly OK. They're not anywhere near what you get from an employer-based coverage, but they're OK," Dominick said.
He also looked around for health insurance for his small business, an IT company called the Mad Botter, where he employs five people. He used Obamacare's "SHOP Marketplace" to compare plans.
"It's been a week and a half, and I still can't find a quote for a company plan on the website," he said. "We're a small company. It should be fairly easy. My next step is to call a navigator or a broker."
For Alex House in Tampa, the enrollment period was easy. He signed up for a different plan this year after sticking with the same one the previous two years.
"I took advantage of some of the tax credits and got better coverage for a little cheaper," said House, who works as an administrative assistant at a local accounting firm. He's never paid more than $45 a month for health insurance on the exchange, he said.
But having coverage has paid off.
"I caught the flu in February and eventually got pneumonia," House said. "That was the first time I ever had to use my health insurance. Then I got pneumonia again in early October. I never had any trouble covering the costs with my insurance."
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.
How to sign up for health insurance:
Open enrollment under the Affordable Care Act ends at midnight Saturday.
• Find help at CoveringFlorida.org or CoveringTampaBay.org.
• Call the Family Health Care Foundation at (813) 995-1066 or Covering Florida at (877) 813-9115.
• Sign up on your own at healthcare.gov.