HNF Stories
1:25 am
Thu February 13, 2014

Enrollment Surges in FL

Despite state officials' opposition to the Affordable Care Act and the relative scarcity of helpers available,  Floridians are finding their way to Healthcare.gov and signing up for plans even beyond the growth in most states.

Avalere Health, a consulting company, rates Florida as one of just 15 states closing in on projected enrollment for 2014.
Avalere Health, a consulting company, rates Florida as one of just 15 states closing in on projected enrollment for 2014.
Credit Avalere Health

By the end of January, nearly 300,000 Floridians had enrolled in a new health plan through Obamacare -- a surge that left most other states in the dust.

Jodi Ray at University of South Florida, who leads the grant-driven effort to sign up the uninsured in most counties of Florida, said she's not in the least surprised.

"I have been saying all along that people want coverage," said Ray, director of Florida Covering Kids & Families. "Finding the folks that want to apply has not been a challenge for our Navigators. We are limited only by the resources, but not at all by the demand."

Health & Human Services gave USF $4.2 million in August to train and deploy licensed navigators, who understand the federal law and the tax credits available to most enrollees. As Health News Florida reported in August, HHS Secretary Sebelius visited USF to announce the grant, explaining that Ray's program had done an outstanding job of getting uninsured children enrolled in federally-supported programs in the past.

"We really looked for already established groups who were ready to hit the ground running," Sebelius said.

USF contracts with non-profits throughout the state to carry out the mission. In the counties that it doesn't cover -- Miami-Dade, Broward and Monroe -- other non-profits received grants to do the work.

In addition, Florida's community health centers -- which treat many of the uninsured on a sliding scale -- received federal grants of over $8 million in July and $4.4 million in December to train certified application counselors. Those counselors receive training and certification from the federal government, but don't require state licenses as navigators do.

According to the federal report released Wednesday, about 297,000 Floridians had selected a plan through the Health Insurance Marketplace. The national total, counting state-operated exchanges as well, was around 3.3 million, the report said.

Florida, like most states, elected to let the federal government operate the exchange instead of building its own. The federal site didn't work for most of the first two months of operation, so enrollment in earnest began in early December. Since then, there has been a rush.

The Feb. 1 enrollment for Florida, means the state was already three-fourths of the way to the total enrollment that it was projected to achieve in 2014, according to Avalere Health. The consulting company is forecasting that 403,520 Floridians will enroll this year.

As of Feb. 1, Florida was among only 15 states that had reached the point of enrolling at least 60 percent of the annual projection.

Only six weeks remain in open enrollment for 2014, which is supposed to end March 31. Applicants are supposed to sign up by Feb. 15 to have coverage in effect on March 1, but actually they need to sign up by Friday, Feb. 14. The Healthcare.gov website will be down most of the weekend for maintenance.

More than 80 percent of those who have enrolled nationwide qualify for tax credits that reduce the price of monthly premiums, according to the federal report; it's 88 percent for Florida, South Florida Business Journal reports. 

Those who qualify for tax credits have household incomes of between 100 percent and 400 percent of the poverty level.

Under the Affordable Care Act, those who do not already have health coverage -- such as through work or a government program -- are legally required to buy it or pay a penalty. (Certain groups are exempt from the requirement, including those who have incomes under the poverty level and are in states like Florida that have not expanded Medicaid to cover them.)

The federal report shows that in Florida, 56 percent of those who had enrolled as of Feb. 1 were women. That's similar to the national gender split, with women in the lead at 55 percent.

Even if Florida meets Avalere's projected enrollment for the year, that will represent only one-tenth of the estimated number of uninsured in the state.  Nearly 1 million of those without coverage were left out of the Health Insurance Marketplace by a legal quirk: The Supreme Court ruled in 2012 that the federal government couldn't force states to expand Medicaid to cover those below the poverty level. Florida has so far refused.

Another several hundred thousand living in Florida cannot enroll because they are not in the country legally. The rest of Florida's uninsured will presumably be covered next year or the year after, when the mandates for large and medium-sized businesses to cover their workers or pay a penalty go into effect.

The ACA had originally required employers with at least 50 workers to cover them in 2014. But the Obama administration extended the deadline after employer groups said they hadn't had time to adjust.