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Florida has more people using Obamacare than any other state. Will that continue in 2019?

Navigator Elizabeth Ruiz, right, worked with University of South Florida sophomore Nadim Joudeh during the 2017 Obamare enrollment cycle. For 2019, navigators are concerned about another drastic cut in marketing funds for the health insurance program, as well as some new wrinkles that might cause confusion among consumers. Open enrollment for 2019 begins Nov. 1. [CHRIS URSO | Times]
Published Sep. 7, 2018

With just about two months to go before the start of open enrollment for the Affordable Care Act, local advocates say they are worried they won't have nearly enough resources to get the word out to consumers about some confusing changes this year.

More than 1.7 million people in Florida were insured through Obamacare last year as the state led the nation in enrollment. And with only minimal premium increases expected for 2019, the state stands a good chance of keeping that distinction.

But those responsible for telling people about their options on the federal health care exchange say they are facing some concerning headwinds.

For the second straight year, they say, the government has drastically reduced funding for marketing Obamacare plans. And new rules for short-term insurance plans offered outside the federal exchange are likely to cause confusion over coverage.

The latter problem stems from a recent change by the Trump administration, allowing insurance companies to start selling short-term health care plans that are generally cheaper and less comprehensive than Obamacare. Those plans will be available in October, the same time open enrollment begins for 2019 on the exchange.

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"Consumers are being offered these short-term plans as an alternative, but the fact that it's being pushed at the same time adds another layer of confusion," said Anne Swerlick with the Florida Policy Institute. "These short-term plans do not have to comply with the same rules as the plans on the exchange. For example, there are no protections for consumers with pre-existing conditions, and many of them skimp on coverage like maternity care, mental health services and substance abuse treatment."

The goal, according to Health and Human Services officials, is to offer options outside the exchange for consumers who may have been "priced out of coverage" last year. That's when the federal government ended its cost-sharing relationship with insurers, which helped keep the price of deductibles, copayments and coinsurance low. Some consumers who did not qualify for tax credits saw double-digit increases last year as insurers were forced to pick up the cost of those extra subsidies.

Also, the "short-term" plans have been extended to last up to 12 months, the same length as the annual plans offered on the exchange.

"There's a whole parallel market of these other plans that now exist," Swerlick said. "And with less funding for navigators who educate consumers on the plans available, it's easy to get lured into these other plans that are cheaper, but don't provide the protections if consumers already have medical conditions that need treatment."

Seven insurers will sell plans on the federal health care marketplace in Florida for 2019, and two companies will sell only plans off the exchange. Premiums are expected to increase by about 5 percent this year, which is about the average across the country.

Florida Blue, the state's largest insurer, will offer additional plans off the exchange for the second time this year, said spokeswoman Christie DeNave. She said the non-Obamacare plans will be similar in price and coverage to those on the exchange. The company started offering them in response to last year's premium increases on so-called Silver plans, which are priced in the middle range and are among the most popular Obamacare options.

"We will continue to offer that this year off the marketplace," DeNave said.

Also this year, she said, there are no fears of the double-digit "sticker shock" that consumers saw on the exchange during the last cycle.

Meanwhile, health care navigators are preparing to do more with less in anticipation of the open enrollment period. This is the second year in a row that budgets have been slashed for the nonprofit and public-private groups funded by the government that help the uninsured sign up on the exchange.

For perspective, Florida Covering Kids & Families, a navigator program based at the University of South Florida, received $4.9 million in federal funds last year for open enrollment marketing and consumer assistance. The group was one of several in the state to receive funding.

This year, the entire state of Florida will get $1.2 million for marketing and consumer support, said Jodi Ray, director of the USF group.

"It's been a very difficult process to figure out how do we continue to make an impact," Ray said. Last year, her organization was fielding 1,000 calls a day from Floridians needing assistance with signing up on the exchange.

"It's hard to know how many people we'll reach this year, because we've never been in this situation," she said. "I am concerned about the people who truly need our help. It's going to be challenging for everyone."

Ray and others will know next week just how much funding they'll get.

"We are really anxious to hear where the resources will be dispersed in Florida," said Melanie Hall, executive director of the Family Health Care Foundation in Tampa Bay, which also helps people sign up on the federal exchange.

"The good news is that people seemed to be pretty happy with the coverage they got last year. And it seems like the 2019 marketplace has stabilized, so we should expect less increases than we've seen the last few years."

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

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