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1.7M in FL Could Get Lower Premiums

More than 1.7 million Floridians will qualify for health insurance premium subsidies under the Affordable Care Act, according to a national consulting company report released Tuesday by the consumer group Families USA. 

But if surveys are any indication, those who will benefit probably don't know it.

The premium assistance, which begins Jan. 1, will come in the form of tax credits for low- and middle-income workers and their families. The money will flow directly to the patients' health plans, which simplifies matters and means patients don't have to come up with cash and wait for reimbursement.

The premium subsidies don't require state officials' approval -- unlike another part of the health law, the expansion of Medicaid, which is now stuck in the Florida Legislature.

"The tax credit subsidies are a game-changer," said Ron Pollack, executive director of Families USA. "They will make health coverage affordable for huge numbers of uninsured families who would have been priced out of the (market)."

The vast majority of people lack information about what the health law contains, especially the tax credits for individuals and small businesses, said Rep. Kathy Castor, D-Tampa, citing a survey released last week.

"When I talk to people in the grocery store or at church, they simply are unaware that part of the (law) is to help families afford health insurance," Castor said.

Because the Affordable Care Act requires health plans to include a fairly generous set of benefits, some -- especially those who now buy skimpy or high-deductible coverage through the individual and small-group market -- could suffer "sticker shock" when they shop for a plan beginning Oct. 1. The subsidies are intended to offset that.

Families USA sponsored the state-by-state breakdown by The Lewin Group. Because it has so many uninsured -- estimated at 4 million -- Florida's health-care system could be transformed by the influx of newly insured if the state takes advantage of all options in the Affordable Care Act.

The premium subsidies cover individuals and families who are in households with incomes of between 138 and 400  percent of the federal poverty level. The ACA did not include those who are below 138 percent of the poverty level, because the law assumed those families would be covered through the expansion of Medicaid, the joint state and federal insurance program for those with very low incomes.

However, the Supreme Court ruled last summer that states had to agree to the Medicaid expansion for it to go into effect, and so far, that has not yet happened in Florida. The governor, Senate and federal health officials all seem on the verge of agreeing to an alternative version of the expansion that would be based on private plans, but the House has not agreed.

If the standoff continues, here will be the odd result: The uninsured most likely to gain coverage under the Affordable Care Act would be those who have small but not ridiculously low incomes. Those who remain uninsured would be those under 138 percent of the poverty level -- people who may work hard but bring home very little money.

How much income is 138 percent of the poverty level? About $16,000 a year for an individual -- someone who makes about $8 an hour for a 40-hour-a-week job. For a family, that 138-percent limit depends on the number of people in the household, but it's about $32,500 for a family of four.

The smallest subsidies would go to those who are at 400 percent of the poverty scale, or about $46,000 for an individual and $94,200 for a family of four.

The report, Help Is at Hand: New Health Insurance Tax Credits in Florida, was written by The Lewin Group on behalf of Families USA, a consumer group. Here are key findings:

  • The vast majority of those eligible will be working adults or members of a family in which at least one adult works.
  • About one-third of those eligible in Florida will be between ages 18 and 34, and almost that many will be between 35 and 54, the report says. About 20 percent will be children, and 15 percent will be 55 or older, it forecasts.
  • Just over half of Floridians eligible for premium tax credits will be white, and another 30 percent Hispanic; about 13 percent will be black.
  • The state's urban counties have the most eligibles. Miami-Dade has the most, around a quarter-million, followed by Broward, Orange, Palm Beach and Hillsborough, all of which have more than 100,000 estimated as eligible. Pinellas and Duval are close behind.

The Affordable Care Act provides the tax credits to be used by families that are buying coverage through the health-plan marketplace, or exchange. In Florida, that marketplace will be set up and run by the federal government, at least in 2014; committees that studied the matter in the House and Senate voted to leave the costly and complex project to the federal government.
Some who are eligible are workers who cannot afford their employers' plans because the cost is more than 9.5 percent of their wages. Others will qualify if their employer plan pays less than 60 percent of the  cost of their benefits.


Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.