With more than 1.9 million consumers signed up for 2020, Florida once again leads the nation in health insurance enrollment under the Affordable Care Act.
Among the 38 states that participate in the federal program, also known as Obamacare, Texas had the second-highest enrollment this year with 1.1 million and North Carolina was third with 505,275.
“We’ve always outpaced enrollment in other states, and I think it really shows that the marketplace coverage is extremely popular in Florida,” said Anne Swerlick with the Florida Policy Institute in Tallahassee.
But the Sunshine State has consistently outperformed all states, even those that run their own health insurance marketplaces and other insurance programs.
“Florida is a state that chose not to expand Medicaid and is second in the nation for its uninsured rate,” said Rachel Fehr, a research assistant with the Kaiser Family Foundation, a nonprofit health care policy organization.
“So compared to states like New York and California, people in Florida rely more on the Affordable Care Act for coverage because there is less choice," she said. "If Florida expanded Medicaid, there would likely be more people who receive health care now through the ACA who would qualify for that program.”
California, which runs its own state program, signed up 1.3 million people for 2019 out of 3.7 million potentially eligible state residents, according to Kaiser. New York signed up 240,025 people the same year, out of about 1 million eligible residents. Both of these states also offer other insurance programs to residents and have expanded Medicaid coverage.
Obamacare plans in Florida reached 47 percent of the eligible residents in the state last year, Kaiser estimated, which was fourth behind three states that run their own marketplaces: Massachusetts, Maine and Vermont.
Fehr said a better comparison to Florida would be Texas, which has the highest uninsured rate out of all states, and like Florida, has not expanded Medicaid.
But Florida’s diverse population also plays a role in the success of the Affordable Care Act, Fehr said. The state had more insurance providers participating on the exchange than most other states, including a few companies that were new to the market this year. That competition also helped drive down premium costs for consumers, she said.
“Many uninsured residents were eligible for a bronze plan that had no premium this year,” Fehr said, referring to the lowest-cost plan available on the exchange. “That’s pretty attractive, even with a high deductible, if you’re someone who previously had no insurance at all.”
Since Affordable Care Act enrollment began in 2014, Florida’s uninsured rate has dropped dramatically, said Swerlick. But about 2.7 million people remain uncovered.
“Florida is still higher than the national average at 12.9 percent, and the drop has stalled a bit in recent years,” Swerlick said. “We’re still lacking in options for people. If we didn’t have the ACA, there would be no other option.”
Despite the program’s popularity in the state, this year’s open enrollment period was not without its pitfalls.
In a surprise announcement Dec. 16, the Centers for Medicaid & Medicare Services, citing technical issues, extended the period by three days after it officially closed on the 15th.
But the extension did not generate much more interest, said Jodi Ray, executive director of Florida Covering Kids & Families, a health care navigator program based at the University of South Florida.
“We had just a couple of people come in, but it was a struggle to get the word out about the extension in such a short period of time,” she said.
Amy Burns is a self-employed contractor in the corporate events industry in St. Petersburg, and struggled to re-enroll for the insurance plan she’s had through the Affordable Care Act for a number of years.
“I’m no novice at this,” she said about signing up on healthcare.gov.
But a technical glitch delayed her ability to enroll and she spent weeks trying to complete the process online, calling the national help hotline twice.
“I was told, ‘Don’t worry, you’ll still be able to enroll in time no problem,’” she said.
The holidays arrived and there was no change on the website. She got an email about the enrollment period being extended and tried again to sign up. But while she was able to select a plan, she now faced penalties for signing up late.
The penalty meant her tax subsidies won’t kick in until February, making her monthly premium jump from $260 to nearly $2,000. Burns said she couldn’t afford to pay that.
“Now I’m stuck in this limbo,” she said. “I had to file an appeal, which could take up to 30 days, and now my husband and I don’t know if we are insured this month.”
Her husband canceled a scheduled procedure because the out-of-pocket cost was going to exceed $7,000.
“Somehow I fell through the cracks,” she said. “It’s always been easy peasy in the past, and two or three years ago this wouldn’t have been a problem. But this year, we’re both battling chronic illnesses and can’t afford to be without insurance.”
Despite the technical issues, the federal exchange seems to have stabilized, experts said. Consumers are finding more affordable plans and more insurers are joining the marketplace. But the future of the program is still uncertain, as a court case in Texas could decide the future of the Affordable Care Act as early as this summer.
“To me, Florida is an anomaly at this point. It has to be,” Ray said. “There’s been a decline in sign-ups nationally, and we know that the uninsured rate is going up nationally. It’s having a negative impact across the board. But not here in Florida.”