Florida leads the nation again in Affordable Care Act enrollment

It was another record-breaking year for Affordable Care Act enrollment in the U.S., with Florida taking the lead once again.More than 4.2 million Floridians signed up for the federal health care marketplace for 2024 coverage, a 31% increase from last year — and more than 54% from the year before that.“We expected it to be high,” said David Pizzo, market president of the West Florida region for Florida Blue, one of the state’s leading providers of marketplace plans. “We can’t wait to see the final numbers to see where the growth came from and what parts of the state that it came from.”Enrollment in the federal health care marketplace has been on the rise nationwide since the COVID-19 pandemic. New subsidies, introduced through the American Rescue Plan, offered expanded coverage options for families above the federal poverty level. The subsidies were later extended through the Inflation Reduction Act and are now set to expire in 2025.Florida has the highest enrollment of any state. In 2023, Hillsborough County had the seventh-highest enrollment in the nation, behind five other Florida counties and two in Texas. Data showing 2024 enrollment by county has not yet been released.Much of the state’s persistent increase is due to its swell in population in recent years, experts say. But even accounting for its growth, Florida has one of the highest enrollment rates, with tallies higher than larger states with more residents.The enrollment increase also “definitely aligns with the fact that we have not expanded Medicaid,” said Katie Roders Turner, executive director of the Family Healthcare Foundation, adding that the pandemic made clear people’s jobs and employment statuses change, sometimes quickly.“For so many people, the federal marketplace may be the only option for them for affordable coverage,” she said.In 2023, more than 911,000 Floridians were taken off the state’s Medicaid rolls, after the end of pandemic-era protections. Experts say some of those individuals came to the federal health care marketplace.This year’s increase was nearly double the change from 2022 to 2023, but it was little surprise given the state’s rising cost of living, said Pizzo and Estella Gray, Florida Blue’s senior regional communications lead. Gray also noted there are more workers in Florida’s economy that own small businesses or work multiple part-time jobs that don’t come with insurance.“We’ve seen inflation, and we’ve seen how the economy has impacted members of our team,” she said. “We have taken the calls of people who needed assistance for food; we’ve done backpack giveaways and things where we’ve had to support families.”“We’re not fully shocked that the enrollment numbers are going up,” she added, “because we know health care is not affordable in this country.”Meanwhile, education about marketplace offerings has also improved over the years, Pizzo said. More people are realizing they are eligible for subsidies.Jeannie Moran, 56, lived without health insurance for years. She ran several enterprises — she was a real estate broker and a mortgage broker, and managed a legal documents service — but she still didn’t think she could afford insurance. She didn’t know until recently she was eligible for marketplace subsidies.“Every time I spoke with someone, I got more confused,” Moran said.But this year, she signed up for a marketplace plan with Florida Blue, after talking with one of the provider’s representatives.“I felt such a sense of relief,” Moran said. “Before, when I had insurance a while back, I always checked up on myself. But then it got to a time when insurance was just so doggone expensive. It was just one of those things you had to do without. ... But now, I’m happy, I’m insured.”To qualify for subsidies on the federal marketplace as an adult, a policyholder must have a projected income of 100% of the federal poverty line. For example, this means an individual must make at least $14,580, while a family of four must make $30,000. If they expect to make less than that, they might not qualify for subsidies or meet the state’s strict Medicaid standards. Adults without children are not eligible for Medicaid in Florida, regardless of income, unless they are pregnant, disabled or over 65.

Florida leads the nation again in Affordable Care Act enrollment

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