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Many to Get a Break on Health Premiums

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Depending on how you define "Tampa Bay," around 300,000 or more uninsured residents in the area will receive subsidies to buy health coverage as of Jan. 1 under the Affordable Care Act, a national consultants' report says.

But the chances are, those who are eligible don't  know it, according to recent surveys that show most Americans know little about the health law.

Statewide, about 1.7 million Floridians will qualify for the tax credits, according to the report by The Lewin Group. Its sponsor, consumer group Families USA, released it Tuesday.

Congresswoman Kathy Castor, D-Tampa, appealed to reporters on the press call to publicize the fact that tax credits are available for individuals and families of lower- and middle incomes, as well as to small employers who provide coverage for workers.

"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.

Rep. Castor cited a survey released last week that showed the vast majority of Americans have little idea what is contained in the Affordable Care Act, which became a political football in the past two elections.

The subsidies for individuals and families will be on a sliding scale, based on household income and the size of the family.  The report shows that most urban areas in Florida will have more than 100,000 residents who qualify, and Miami-Dade will have close to a quarter-million.

The report, Help Is at Hand: New Health Insurance Tax Credits in Florida, offers these estimates of the number of people who will qualify for the subsidies in Tampa Bay:

Hillsborough: 105,780
Pinellas: 85,270
Pasco: 46,060
Polk: 52,010
Sarasota: 31,130
Manatee: 28,250
Hernando: 16,940
Citrus/Sumter (the two are listed together in the report): 19,200

Statewide, slightly more than half of those expected to qualify for the subsidies are white; about 30 percent are Hispanic and 13 percent black.   In Hillsborough County, the percentage of whites is slightly lower, 47 percent, and the percentage of minorities correspondingly higher:  34 percent Hispanic and 14 percent black.

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)."

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.

Because Florida has so many uninsured -- estimated at 4 million -- the state's health-care system could be transformed by the influx of newly covered patients 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 they would be covered through the expansion of Medicaid, the joint state and federal insurance program for those with extremely 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 modest but not extremely 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.  (The minimum wage in Florida is currently $7.79 an hour, according to the Florida Department of Economic Opportunity.)

For a family, that 138-percent limit depends on the number of people in the household;  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.

--Health News Florida is a public service of WUSF Public Media. Contact Editor Carol Gentry at 813-974-8629 (desk) or 727-410-3266 (cell), or by e-mail at cgentry@wusf.org.

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.After serving two years as a Peace Corps volunteer in Colombia, Gentry worked for a number of newspapers including The Wall Street Journal, St. Petersburg Times (now Tampa Bay Times), the Tampa Tribune and Orlando Sentinel. She was a Kaiser Foundation Media Fellow in 1994-95 and earned an Master's in Public Administration at Harvard’s Kennedy School of Government in 1996. She directed a journalism fellowship program at the Centers for Disease Control and Prevention for four years.Gentry created Health News Florida, an independent non-profit health journalism publication, in 2006, and served as editor until September, 2014, when she became a special correspondent. She and Health News Florida joined WUSF in 2012.
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