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'Working Around the Clock'

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Health and Human Services Secretary Kathleen Sebelius, who swooped into Tampa for a 90-minute visit on Tuesday, said "today is better than yesterday" for the still-balky Health Insurance Marketplace. Each day the online enrollment site,, will work better than the day before, she said.

But problems persisted, according to many reports. The Washington Post reported that there was a flaw in the design of the project, in that it was set up to handle no more than 50,000 to 60,000 visitors at a time -- far fewer than the wave that tried to use it in the first week.

Another flaw in design, as reported by the Associated Press, was that it required everyone who wanted to browse the plans to first set up an account. That contributed to the overload. Most websites allow anonymous browsing.

In her Tampa visit, Sebelius said HHS is working around the clock to work the bugs out and provide enough capacity to handle the millions of uninsured Americans in Florida and nearly three dozen other states that left it up to the federal government to create the online enrollment system. The Marketplace opened on Oct. 1, only to freeze out most who have tried to use it.

There is no need to fret, Sebelius said, since the system will be running seamlessly "in the near future" and the open-enrollment period for lasts through the end of March. Those who enroll in a plan by Dec. 15 can be covered as of Jan. 1.

The Marketplace offers a huge number of plans in Florida -- 102, on average -- with more in urban areas and fewer in rural areas. Most of the people who sign up for coverage through the federal website in Florida are expected to qualify for subsidized premiums or special help with out of pocket costs, Sebelius said. 

The subsidies are available on a sliding scale to individuals and families who have incomes between 100 and 400 percent of the federal poverty level. That's between about $11,500 and $46,000 for a single person, and  between about $23,500 and $94,200 for a family of four. (see chart)

Sebelius, who has come to Florida for short visits half a dozen times since June, sees this state and Texas as the two must-haves in the rollout of the main parts of the Affordable Care Act. Texas and Florida are numbers 1 and 2 in the rate of uninsured citizens,  but both states have refused to accept federal funds intended to cover those who are under the poverty level.

The HHS Secretary participated in a briefing for University of South Florida officials and the media along with Jodi Ray, director of the Covering Kids & Families project at USF.  That project received a $4.2 million grant to provide "navigators" -- enrollment advisors -- in most Florida counties.

One of the navigators and two students who hope to enroll in a plan also spoke at the event, which was held at USF's Center for Advanced Medical Learning and Simulation (CAMLS) in downtown Tampa. 

Sebelius reiterated her hope that the Florida Legislature will agree to expand coverage to those uninsured who are under the poverty level but still don't qualify for Medicaid under Florida's stringent guidelines.

Federal funds are available to cover almost all of the cost for the first decade, she stressed: about $51 billion for Florida. And the economic impact that would result -- mainly for jobs --has been estimated at $90 billion.

This part of the Affordable Care Act is called "Medicaid expansion," but several states have been given permission to use the money to buy coverage for the low-income group from private insurers. That's the gist of the bill that the Florida Senate passed this year, but the House refused to accept the funds.

Sebelius said the money is sitting there waiting for the Florida Legislature to take it.

"It is fully paid for within the health care act," Sebelius said. "This doesn't add a dime to the deficit; it's already paid for."

She said she hoped the Legislature will continue talking about it.

"The offer is on the table," Sebelius said.

A number of studies have estimated the number of uninsured Floridians who will be left out of the enrollment because they are under the poverty level at 1 million. But Sebelius said she thinks the number who will be "left out in the cold" without Medicaid expansion in Florida at closer to 2 million.

Sebelius said about 3.5 million in Florida will be eligible to sign up for a health plan through the Marketplace, including 467,000 in Tampa Bay. 

"For the first time ever, they have an online shopping experience that gives them side-by-side comparisons," Sebelius said.

"Nothing like this has ever been available before for people who shop in the individual market or are uninsured," she said.

Most Americans will not need to use the Marketplace because they already have good coverage through another source, such as their employer, Medicare or the military.

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.