At times, it seemed like the Affordable Care Act was on life support during Donald Trump’s four years in the White House.
The federal health insurance program was saved from being repealed by the defection of three Republican senators in a dramatic 2017 vote. That same year, the U.S. Centers for Medicare and Medicaid Services shortened the signup window for consumers to six weeks, slashed the program’s marketing budget by $90 million and cut $25 million from the funding for so-called navigators, who help people pick and enroll in insurance plans.
The environment will be very different Monday when enrollment opens for the federal marketplace insurance plans for the first time since President Joe Biden was elected.
The enrollment window has been extended through Jan. 15, and the U.S. Department of Health and Human Services has restored $80 million to outreach efforts, including plans to quadruple the number of those navigators.
More Americans than ever will be eligible for marketplace insurance plans through subsidies established in the American Rescue Plan. That has the Biden administration predicting that four out of five consumers will be able to find health care coverage for $10 or less per month.
The subsidies introduced in the American Rescue Plan are scheduled to run out at the end of 2022, although there are discussions about extending them as part of the spending bill being debated in Congress.
Nationwide, premiums in the program will remain at the same price or drop slightly compared to 2021. More insurers are entering the marketplace, providing more choice for consumers, said Cynthia Cox, a vice president who does economic and policy research on the Affordable Care Act for the health nonprofit Kaiser Family Foundation.
“It’s clear insurers have been quite profitable in this market, so insurers can’t justify increasing premiums anymore,” said Cox.
Florida led the nation with a record high 2.1 million residents enrolled in federal health care marketplace plans in 2021. The increase in funding will make it easier to reach and enroll people from the state’s rural areas and minority communities, said Anne Swerlick, senior policy analyst and attorney at the Florida Policy Institute, a non-partisan nonprofit based in Tallahassee.
“I anticipate that enrollment will be at least comparable to last year and likely more because of increased navigator resources to reach some of the hard-to-reach communities that have been left out in the past,” she said.
Swerlick is optimistic that the boost will help reduce the number of uninsured people — especially children — in Florida.
A June study by the Georgetown University Health Policy Institute found that the number of Latino children with no insurance rose from 7.1 percent to 9.3 percent during the first three years of the Trump administration, reversing years of progress in reducing that rate. In Florida, 9.5 percent of Latino children are uninsured.
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The study points to policies such as the “public charge” rule, which penalized adults for using public programs prior to gaining citizenship, as producing a “chilling effect” on families, even though 95 percent of Latino children are citizens.
“There’s a lot of work to be done for families who have immigrant household members,” Swerlick said.
In Florida, the job of reaching people who could benefit from the subsidized heath insurance plans falls to Florida Covering Kids & Families, a navigator program based at the University of South Florida.
Last year, the program received just $1.6 million, which was enough to pay for about 60 navigators, most of whom were part-time, said Executive Director Jodi Ray.
This year, funding has been increased to $12 million, enough to have 200 navigators employed year-round, Ray said. That should allow them to find families who might not realize they qualify for low-cost or free premiums. Issues such as a lack of transportation, not speaking English or having little access to computers can hinder families from being able to find health insurance, Ray said.
Consumers in the Tampa Bay area will have more than 100 plans to choose from, Ray said. The navigators work with families to explain the options and help them choose between plans that have lower premiums, but require more out-of-pocket expenses, and those with higher premiums that cover more of the costs of treatment.
Navigators can identify when families might qualify for other public programs, such as Medicaid.
“It can get overwhelming for people who don’t have to look at this every day; it can be daunting,” Ray said. “The help we provide is always free to consumers and objective.”
As many as 400,000 Floridians who qualify for insurance coverage through the Affordable Care Act do not participate in the program, said Katherine Skube, center director at Tampa, Westshore for health insurer Florida Blue. Many of them would be eligible for free coverage, she said. Instead of getting regular check ups and preventative care, many seek medical attention in emergency rooms only after their symptoms have become severe.
“We’ve got to get the word out to them,” she said. “If you don’t have insurance and think you won’t qualify or think it’s too expensive, come check it out.”
As a diabetic who is dependent on insulin injections, Rory Noonan signed up for a federal marketplace plan in 2021 and plans to stay in the program next year.
A 26-year-old graduate student at USF’s College of Public Health, he’s too old to be on his parents’ health insurance policy. This year, his insurance cost him $198 per month. He’s been pleasantly surprised at how little he has had to pay for his prescriptions for insulin and glucose-monitoring devices.
“Insulin can be prohibitively expensive. It was imperative for me to find my own insurance,” he said. “The current plan I have now has been pretty good for me.”
What’s new for the 2022 Affordable Care Act enrollment?
- The enrollment window, which opens Monday, has been extended through Jan. 15, although the deadline is Dec. 15 for those who want their insurance to be effective by Jan. 1.
- Those who sign up for plans will pay no more than 8.5 percent of their income on coverage, down from nearly 10 percent. Some lower-income enrollees may receive subsidies that mean they pay nothing in premiums.
- Those earning more than 400 percent of the federal poverty level — about $51,000 for an individual and $104,800 for a family of four — are eligible for help for the first time.
For more information or to get help finding an insurance plan, go to Coveringflorida.org or call 1-877-813-9115.