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2.8M in Florida Still Uninsured

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.

Florida still has nearly 2.8 million residents who lack health insurance, according to a new report, and 80 percent of them are uninsured for reasons that have nothing to do with Medicaid politics.

Many qualify for subsidized plans under the Affordable Care Act but haven’t signed up, says the reportreleased today by the Kaiser Family Foundation. Others have enough income to buy it on their own or through their employer, but don’t.

The report by the foundation, which tracks health policy, indicates there are hordes of uninsured Floridians eligible for financial help in getting coverage under the ACA. Open enrollment for the 2016 Marketplace nears on Nov. 1.

However, “the breakdown of who the remaining uninsured are suggests that many may be difficult to reach and will still remain uninsured,” the authors wrote.

Florida Covering Kids and Families, based at the University of South Florida in Tampa, has led the statewide enrollment effort to enroll an uninsured population that peaked at 3.9 million in 2013.

Director Jodi Ray said enrollment navigators will use non-traditional routes to reach people this year, including phone banks and digital tools. Referring to the Kaiser Foundation report, she said, “Clearly we still have a lot of work to do.”

In the report, titled “New Estimates of Eligibility for ACA Coverage among the Uninsured,” the uninsured in Florida fall into groups that:

·         Qualify for subsidized Marketplace plans but haven’t enrolled, 825,000 (30%).

·         Fall into the Medicaid coverage gap left when Florida turned down expansion funds, 567,000 (20%).

·         Could enroll in an employer-sponsored plan but have not, 417,000 (15%). These are workers with incomes high enough to afford their company plan, under ACA guidelines.

·         Don’t qualify for an ACA-subsidized plan or Medicaid because they are not U.S. citizens or legal immigrants, 384,000 (14%).

·         Could get free coverage under existing state Medicaid income guidelines but have not enrolled, 306,000 (11%).

·         Remain uninsured even though they have substantial incomes, too high to qualify for tax credits on the Marketplace, 290,000 (10%). 

When the Affordable Care Act became law in 2010, it created an income-tax penalty for Americans who could afford a health plan, but choose to not obtain one. The number of people not getting insurance could also decline as the income-tax penalty increases each year.

Judging by media coverage and the squabbles over Obamacare in Tallahassee, many may think the largest group of uninsured Floridians as of 2015 were those in the Medicaid “coverage gap.” 

These residents earn too little to qualify for the existing Medicaid program under state guidelines but not enough to enroll in a subsidized plan under the Affordable Care Act. In Florida, the current threshold is 100 percent of the Federal Poverty Level, or just about $16,000 for a family of two.

For the past three years, the Florida House has consistently blocked bills that would allow for an expansion of Medicaid, and refused to accept federal funds that would cover most of the cost.

But for all the angst, the Kaiser Foundation report says the number of uninsured Floridians who fall into the Medicaid gap is about 567,000, or about 20 percent.

By contrast, there are more than 1 million uninsured in Florida who could get financial help to pay for coverage if they asked for it, the report shows. That includes 306,000 who qualify for existing Medicaid but haven’t signed up and 825,000 who qualify for subsidies to buy a private plan through the federal Marketplace.

“(M)isperceptions about cost, lack of awareness of financial assistance, and confusion about eligibility rules were barriers to some eligible uninsured gaining coverage,” the report says. “Others report that they found coverage to be too expensive, even with the availability of financial assistance.”

The research team’s finding that there are more than 300,000 more Medicaid eligible will not be good news for Florida lawmakers. They are already grumbling about the enrollment having doubled over the past decade.

The Medicaid population is projected to reach 4 million in the coming year, according to a reportby the state’s Economic and Demographic Research (EDR) unit.

The statewide managed care program that Medicaid launched in 2013 and 2014 has trimmed the per-enrollee cost, the economic report says. But drug prices and other medical costs keep going up, forcing state Medicaid this year to raise premiums 7 percent to keep them actuarially sound.

Also, with the aging of the population comes increasing disability, according to the state report. While the elderly and disabled comprise about 30 percent of Florida’s Medicaid caseload, it shows they account for 63 percent of program spending.

Nationally, the Kaiser researchers reported that 32.3 million people in the U.S. lacked health coverage as of April. Nearly half – 15.7 million --would qualify for financial help to get coverage through the Marketplace or Medicaid. About one-fourth are either newly eligible for Medicaid, or always were. About one in five could get premium tax credits for the Marketplace.

One in 10 – 3.1 million – fall into the coverage gap because of their state’s politics.  About 15 percent of the uninsured are illegal immigrants who don’t qualify for the federal Marketplace coverage.

Carol Gentry is a special correspondent for WUSFin Tampa. Health News Florida receives support from the Corporation for Public Broadcasting.

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.