Obamacare still thrives in Florida, despite new hurdles

Budget cuts mean residents in many areas won’t have as much help signing up. But the state is expected to lead the nation in enrollment, again.
Sandra Wells, right, a health care navigator at the University of South Florida, assists Tampa resident Lourdes Castellano with her health care coverage options during Obamacare open enrollment in 2018. This year, navigators like Wells are in short supply, leaving many areas of Florida with little access to help.
Sandra Wells, right, a health care navigator at the University of South Florida, assists Tampa resident Lourdes Castellano with her health care coverage options during Obamacare open enrollment in 2018. This year, navigators like Wells are in short supply, leaving many areas of Florida with little access to help.
Published Oct. 28, 2019|Updated Oct. 29, 2019

As open enrollment nears for the Affordable Care Act, large swaths of Florida are doing without the health care “navigators” who help Americans understand and sign up for insurance plans.

The Trump administration slashed the budget for their services over the last two years, one of the reasons enrollment in the federal health care program is down nationally.

Yet Florida remains an exception, an Obamacare juggernaut.

Despite the national enrollment dip, the state saw record numbers last year. Nearly 1.8 million people enrolled for 2019, the most of any of the 39 states that use the federal exchange. That was up over the 1.7 million Floridians who signed up the previous year.

Experts don’t see those numbers slowing down, with premiums expected to stay flat and more insurers offering plan options.

Still, more Floridians will be on their own as they shop for plans.

“While we managed to get people enrolled across the whole state last year after some severe cuts, we still saw significant gaps,” said Jodi Ray, executive director of Florida Covering Kids & Families, a navigator program based at the University of South Florida.

“We had to pull in-person assistance out of half the counties," she said. "We’re serving those counties with virtual and phone appointments — that’s something. But it’s not enough for these largely rural counties.”

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

In previous years, the USF group was one of several in the state to receive federal funding for open enrollment marketing and consumer assistance. Last year, it became the state’s sole support service, and its budget was cut by 80 percent.

This year, a single navigator is assigned to cover the entire Panhandle — every county west of Duval, Ray said. The Treasure Coast and the counties stretching from Palm Beach to Orange won’t have any in-person team. It will be the same along a stretch of Florida’s west coast, from Citrus County to Taylor County.

“We do everything we can to reach as many people, including connecting virtually and on the phone. And we still help so many people," Ray said.

However, she added: "I’ve been doing this for 20 years, and it bothers me because I know that in-person assistance is so essential to try to educate someone about their coverage. There’s a whole health literacy component to what navigators do.”

While the virtual and phone appointments have been helpful, the face-to-face meetings are vital for people in Florida’s rural areas, said Melanie Hall, executive director of the Family Health Care Foundation, a navigator group that helps consumers in the Tampa Bay area sort through their options.

“You’re talking about a population that may be less comfortable to engage with technology,” Hall said. “People will be left out of the process.”

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Last year, the United States saw the first increase in the number of people living without health insurance since the Affordable Care Act was passed in 2010, according to the Census Bureau. About 27.5 million Americans, or 8.5 percent of the nation’s population, were uninsured in 2018. That’s up from 7.9 percent in 2017. Before passage of the Affordable Care Act, 15 percent of Americans went without health insurance.

“We’ve actually seen the opposite of the national trend in Florida," Hall said.

Predictions that insurers and consumers would walk away from Obamacare never panned out in the state, even as congressional Republicans tried to repeal the program and conservative judges ruled against it, she said.

“The (law) is doing what it is designed to do,” Hall said. "We’re seeing that come to fruition as the market and prices stabilized. Seven years down the road, it’s interesting to see the intent. We didn’t know how it would play out, but it’s encouraging to us to see it fulfill the intent of the law.”

Two insurance providers that are relatively new to Florida — Oscar and Bright Health — are offering plans in the Tampa Bay area for the first time this year. Bright Health also offers Medicare insurance plans in the market.

“There’s been quite a bit of stabilization for this program, regardless of the negative things that have happened over the years,” said Lou Ann Watson, director of financial assistance with BayCare, a hospital operator in Tampa Bay. BayCare employs eight health care navigators who help local residents sign up for insurance plans on the federal marketplace.

“It does seem that there is a significant population of people who need this and seek health care through the marketplace," Watson said.

RELATED: Obamacare open enrollment begins amid confusion over new short-term plans

Even though advocates and navigators say that the plans and prices offered by the Affordable Care Act seem to have stabilized, consumers continue to face some barriers.

Florida still has 2.7 million uninsured residents and affordability remains a top concern for them, said Anne Swerlick with the Florida Policy Institute in Tallahassee. Swerlick referenced a recent study by Altarum, a research group supported by the Robert Wood Johnson Foundation, which showed that 56 percent of uninsured Floridians struggled with the high cost of health plans.

“There’s increasing uncertainty over whether the Affordable Care Act coverage will stay in place, after so many efforts to sabotage it legislatively and through the courts,” she said. "There’s still a whole lot of folks who are still struggling with affordability.”

That includes consumers who earn too much to qualify for a subsidized plan under Obamacare. For them, the Trump administration has been promoting so-called “short-term” health plans offered outside the federal marketplace by insurance companies. The plans expire within a year and the premiums are more affordable. But the benefits are more limited — as in no coverage for preexisting conditions — than what’s available under Obamacare.

There also has been confusion over a proposed rule that would make it easier for immigration officials to deny green card or visa applications filed by legal immigrants who were using benefits like government-run health insurance programs. Judges from three federal courts have blocked the rule.

“The rule only applies to Medicaid, and even then, only certain adults enrolled in Medicaid,” Hall said. “When you drill down, it’s fairly narrow on who it applies to, but there seems to be quite a chilling effect to the public, which makes people very nervous.”

Ray said they’ve already seen immigrants choose not to sign up for health insurance because they were afraid.

“They’re being advised not to enroll in health coverage, but the rule is not in place,” she said. “It comes down to making sure people are informed.”

Open enrollment: What you need to know

  • The period is from Nov. 1 to Dec. 15.
  • Even if you’ve already enrolled in a marketplace plan, it’s important to update personal information to ensure the best tax credit and premium prices.
  • Book appointments for in-person, virtual or phone assistance with Covering Florida by calling 877-813-9115 or visit
  • The Family Healthcare Foundation will host face-to-face appointments at the St. Petersburg Library and the Hunt Center in Tampa every Saturday during open enrollment. For more information call 877-813-9115 or (813) 995-1066. Appointments can be scheduled online at
  • The BayCare health system has eight navigators available Monday through Friday in Hillsborough, Pinellas and Pasco counties. Call 855-404-3334.


Obamacare in Florida

Below are the top 10 states in the federal health care marketplace this year, ranked by enrollment.

Florida: 1,783,304

California: 1,513,883

Texas: 1,087,240

North Carolina: 501,271

Georgia: 458,437

Pennsylvania: 365,888

Virginia: 328,020

Illinois: 312,280

Massachusetts: 301,879

Michigan: 274,058

* * *

Except for a slight dip in 2018, Obamacare enrollment numbers have gone up in Florida:

2014: 983,775

2015: 1,596,296

2016: 1,742,819

2017: 1,760,025

2018: 1,715,227

2019: 1,783,304

SOURCE: Kaiser Health News