1. Health

Why is Florida bucking the trend? Obamacare signups are up, not down.

The number of Floridians signing up for health insurance through the Affordable Care Act increased this year despite nationwide declines and repeated efforts in Congress and the courts to undercut the program, according to a final enrollment count this week.

With nearly 1.8 million people enrolled for 2019, Florida also topped the 39 states who use the federal exchange. That's up slightly over the 1.7 million Floridians who signed up on the exchange last year.

The enrollment period ended Saturday.

"Florida stands out for a few reasons," said Melanie Hall, executive director of the Family Health Care Foundation, a "navigator" group that helps consumers in the state sort through their options.

"We're a state with a lot of people who don't have access to an employer-based insurance policy, because people are self-employed or work contract type jobs," she said. "We also see a lot of people in Florida who are retired, but not yet 65 so they can't get Medicare — and families who are looking to cover their adult children but struggle to find affordable plans through private insurers."

Those factors overcame a number of forces that contributed to a decline in other states.

PREVIOUS COVERAGE: Florida on track, again, to lead the nation in Obamacare sign-ups

For example, this was the first year consumers didn't face a monetary penalty if they don't have health insurance, a change by the Trump administration that removed a key incentive to participate in the program, also known as Obamacare.

In addition, new "short-term" health plans offered by private insurance companies were available off the federal marketplace, which proved to be a more affordable option for some middle class consumers. And for the third year in a row, the government drastically reduced the marketing budget for Obamacare plans, leaving advocates with fewer resources and less access to people who may need help signing up.

These changes played out mostly on the federal exchanges, where signups for 2019 totaled about 8.4 million people — down about 4 percent from last year. Those exchanges are separate from a smaller number of state exchange programs in places like California, New York and Colorado, which enroll people through January.

Despite the challenges, Florida navigators said they were pleased to see how many people were able to get health insurance.

"It just demonstrates how much people in Florida need and want coverage," said Jodi Ray, director of Florida Covering Kids & Families, a navigator program based at the University of South Florida.

Just as the six-week enrollment period came to a close last week, a federal judge in Texas ruled the Affordable Care Act was unconstitutional. The ruling will not affect 2019 coverage and proponents plan to appeal, but it does call the program's future into question.

If the courts eventually strike the law down, it will affect nearly every American in some way, a recent analysis by the Kaiser Family Foundation shows.

"We tried not to get sidetracked, and end the enrollment period on a high note," Ray said. "We're a ways out from knowing what will happen. It could be years before we'll know what this ultimately means."

The Affordable Care Act has come under threat in the past, most notably last year when Republicans in Congress tried and failed to repeal it.

Since the law's passage in 2010, it also has brought about changes in the health care industry beyond government-subsidized insurance. It helped usher in a shift in thinking about the overall cost of health care, which is driving many of the changes consumers are seeing these days — namely a push to keep people healthy and out of the hospital.

It would be hard to tread backward, Hall said.

"It has been upheld in the Supreme Court twice already," Hall said of the law. "It has survived multiple challenges at every level. It's legally sound, and the demand continues to grow. At least in Florida."

Contact Justine Griffin at or (727) 893-8467. Follow @SunBizGriffin.