(UPDATED) Thousands of previously uninsured Floridians woke up Wednesday morning with peace of mind for the first time in years: They had a health insurance card, or at least the promise that one is in the mail.
They're the lucky ones who were able to get through the enrollment process in the federal Health Insurance Marketplace website, Healthcare.gov, by Christmas Eve. Coverage through the exchange is one of the key parts of the Patient Protection and Affordable Care Act that took effect Jan. 1.
Federal officials said more than 1 million people nationwide had signed up by Dec. 24. No state breakdown was immediately available. Open enrollment for 2014 continues through March 31.
More than half of Florida's nearly 4 million uninsured are projected to qualify for coverage through the Marketplace. Another million would qualify if the Florida Legislature would permit it.
One who took advantage of the new ACA coverage is Bo Frazer, a 62-year-old professional fiddle player from Melbourne who has a heart condition. As Florida Today reported on Monday, Frazer could not qualify for coverage on his own or even through his wife's employer-sponsored plan, for which she paid $500 a month.
Through Healthcare.gov, Frazer said, he was able to enroll himself and his wife in a midlevel health plan for just $70 a month, after qualifying for a subsidy. He said he's glad to have no more sleepless nights wondering what would happen if he had a another heart attack or stroke.
Before he got covered, Frazer said, "I always worried about losing my house."
Kevin Bonhomme, 39, a long-term-care nurse in Port Charlotte, told Health News Florida that he had been uninsured for a year and a half before getting enrolled in a Florida Blue plan with the help of a navigator. He qualified for a subsidy and will have a "silver" plan for $38. "I've got great monthly payments," he said.
That kind of quiet relief is what a Santa Rosa Beach couple, artist David Hart and his wife Karen, a marketing consultant, are yearning for. As the Washington Post reported on Sunday, the Harts signed up for a Florida Blue plan through the federal Marketplace and paid the insurer Blue by phone on Dec. 19. But they got worried when the check to Florida Blue hadn't been cashed by Dec. 27, and began making calls. The problem still hadn't been resolved as of Wednesday.
"We're now stuck in the middle," Karen Hart says. "It's been an absolute nightmare."
(UPDATE) On Friday, Karen Hart told Health News Florida that they still hadn't heard from anyone with Florida Blue. But there is a glimmer of good news: "Our account shows a pending debit from Florida Blue for the amount of the policy we selected! We'll see if it clears our account tonight."
For a decade, the Harts were stuck in an insurance policy with ever-increasing premiums that reached $1,223 a month. They couldn't jump to any other plan because they had pre-existing conditions, Karen Hart said.
As of Jan. 1, the practice of exclusions for pre-existing conditions is no longer legal under the ACA. The law also gave the Harts a choice of plans -- 82 of them, in fact.
Assuming the mix-up is resolved, Karen Hart said, the couple is likely to save money on the new plan. Their income is too high to qualify for a subsidy, so they opted for a high-deductible bronze plan that will save them about $340 a month if they stay relatively healthy.
Changes That Took Effect Jan. 1
The Patient Protection and Affordable Care Act of 2009 was signed into law in 2010. But its main provisions didn't kick in until Wednesday:
- Health insurers can no longer turn away the sick or those at risk of relapse. They also can't write a policy that excludes the risky body part.
- A choice of insurance policies is being offered to Floridians through the federal Health Insurance Marketplace (Healthcare.gov or 1-800-318-2596). Those who signed up between Oct. 1 and Dec. 24 were covered effective Jan. 1; policies bought after Dec. 24 and by Jan. 15 will take effect Feb. 1.
- Subsidies for health coverage went into effect Jan. 1 for workers who have modest incomes, between 100 and 400 percent of the federal poverty level (check the income range by family size at this site.) The subsidies for premiums -- and for some enrollees, even the out-of-pocket expenses -- are available for those who enroll through the government site or toll-free line.
- Insurance coverage has to cover 10 "essential benefits" listed in the ACA, including some -- such as mental health and maternity care -- that weren't always included in the past in non-group policies. Old policies that don't meet the ACA standards can be carried over another year, but as of Jan. 1 insurers can no longer sell new policies with minimal coverage.
These ACA provisions don't have much immediate effect on the majority of Floridians -- those who already have health coverage through their employer or a government program, such as Medicare or the VA.
They have the potential to rescue many of the uninsured, like the Frazers and Bonhomme, as well as those caught in unaffordable plans like the Harts. But it's likely that some of the uninsured will be less than thrilled at the requirement that they buy health coverage for 2014 whether they want it or not. They must buy it by the end of open enrollment, March 31.
Those who go without coverage for more than three consecutive months in 2014 are subject to a penalty of $95 or 1 percent of income, whichever is greater. The penalty will grow each year.
(There are exemptions from the penalty for several groups, including Native Americans, prisoners, Americans living abroad and certain religious sects. Also, low-income people can qualify for a "hardship exemption.")
Of course, those who are exempt can buy coverage if they want to. Those who don't will be at financial risk for any health-care expenses they incur.
What About the Others?
Nearly 1 million uninsured legal residents in Florida have incomes too low to qualify for the subsidies available through the federal marketplace, as odd as that sounds. Their incomes are under 100 percent of the federal poverty level, but they don't fall into one of the coverage groups for Florida Medicaid, which has very strict limits for adults (See Health News Florida's Putting a Face on the Forgotten.)
The Affordable Care Act provided federal funding to give Medicaid coverage to uninsured adults under the poverty level. But the Supreme Court said that had to be optional, and not all states agreed to take the money. Florida was one that did not.
The ACA provides for three years of 100 percent federal funding to states that expand Medicaid coverage to the poor, and at least 90 percent thereafter. If a state is slow to expand Medicaid, it could miss out on a year or more of the 100-percent funding.
Florida Gov. Rick Scott and the Florida Senate wanted to take the funds, an estimated $51 billion over 10 years. But the initiative was blocked by Florida House Speaker Will Weatherford, who said he was standing on principle (see FL Medicaid: Why Doesn't House Take the Money?)
His critics said the vote just means that on Jan. 1, Florida taxpayers' money began flowing to other states instead of coming back and bolstering the economy here.
If the Florida House had a change of heart, it could enact a measure to accept the money during the 2014 session, scheduled March 4 through May 2. Florida would not get back the share of funds that it missed for 2014, but could step into the money flow for the other nine years.
Business groups, hospital associations, and consumer advocates have been pressing the House Speaker to accept the money. But Weatherford has said he sees no reason to do so, and political experts say that in an election year, Republicans from conservative districts may be afraid to take any action that would inflame their anti-"Obamacare" base.
Even the next House Speaker, state Rep. Steve Crisafulli, says he won't approve of taking the money.