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Florida’s Affordable Care Act Enrollment Surges Despite Obstacles

Dec 20, 2018

The number of Floridians who enrolled in the Affordable Care Act this year increased by more than 55,000 compared to last year.

The surge comes despite funding cuts for advertising and navigators, who help people enroll.

“I think the numbers for Florida show that Floridians want and need health insurance so they can access health care,” said Jodi Ray, director of Florida Covering Kids and Families. Her group has overseen Florida’s largest navigator program since 2014.

When Ray’s budget was cut from $5 million last year to about $1 million this year, she reduced her staff of navigators from 152 to 59.

Still, her team helped Florida reach more than 1.78 million enrollees this year.

“We really did our best to make sure people around the state had access to enrollment assistance regardless of the cuts,” Ray said. “We had to find unique ways to provide assistance to people around the state even where we didn’t have enrollment assistors.”

Ray’s team provided virtual appointments where navigators helped enrollees sign up over a shared computer screen. When technology or proximity was an issue, her team did more phone appointments, she said.

Still, she said, her team of navigators was not able to help everyone who needed it.

“We got to a point towards the end where we didn’t have anymore slots left and we were rearranging things and adding hours to everyone’s days,” Ray said. “It was sad to see the impact that that funding cut had.”

Florida again had more signups than any of the 38 other states who use the HealthCare.gov website because they did not set up their own marketplaces.

The Centers for Medicare and Medicaid Services said nationally nearly 8.5 million people had enrolled as of last Saturday's deadline, with about a dozen states, including California and New York, still left to report. The preliminary number was down about 4 percent, but a much bigger loss had been expected.

Different factors combined to make for an unpredictable sign-up season this year for former President Barack Obama's health care law, commonly referred to as "Obamacare."

On the plus side, premiums stabilized and consumers had more coverage choices.

On the negative side, premiums for the health law's comprehensive coverage remained unaffordable for many people who don't qualify for financial help. Also, Congress repealed a requirement for Americans to get health insurance, and President Donald Trump's administration sharply scaled back advertising and opened the way for competition from lower-cost insurance that covers less.

Then last Friday, a Republican-appointed federal judge in Texas declared the whole law unconstitutional on the eve of the enrollment deadline. Health law supporters are planning to appeal.

Experts said the new numbers show staying power for "Obamacare," even with its continuing political problems and premiums that remain too high for many middle-class consumers.

"Despite everything that has been thrown at this market, politically, with premium increases and also regulation changes, there is still a core group of Americans who want this insurance and buy this insurance every year," said Chris Sloan of the consulting firm Avalere Health. "They are a hardy group of people."

But the number of new customers — the key to growing the market — remained down by about 15 percent when compared to last year.

Wednesday's figures are for the 39 states using the HealthCare.gov website. Not included yet are totals from about a dozen states running their own insurance marketplaces. Also to be added in later are HealthCare.gov customers who signed up close to deadline or who left phone numbers for a callback.

In a twist, Trump administration officials said the enrollment numbers rebut charges of "sabotage" coming from Democrats. Trump has repeatedly called the health law a "disaster" and last year led an unsuccessful drive to repeal it. White House actions last year were blamed for higher premiums.

Nonetheless, CMS Administrator Seema Verma said that the administration has taken strong steps to run a smooth and efficient sign-up process and that Wednesday's numbers are "another sign that the administration's efforts are working." For example, Verma said HealthCare.gov was down for less than an hour this open enrollment season.

After the Republican-led Congress repealed the law's unpopular fines for people who go without health insurance, many experts predicted it would lead to a drop in enrollment. But Verma said that doesn't seem to have happened.

She said the main reason enrollment has continued to gradually erode year over year is because premiums are still unaffordable for people who don't qualify for help.

But Joshua Peck, who headed marketing efforts under the Obama administration, faulted the Trump administration for ratcheting back advertising.

"Consumer demand for health coverage is extremely high," he said. "That doesn't mean the administration is running open enrollment well. In fact, new enrollment — one of the best indicators — has shown a decline."

The health law provides subsidized private insurance for people who don't have coverage through their jobs. It also gives states the option to expand their Medicaid programs to cover more low-income adults. Since it passed in 2010, about 20 million people have gained coverage, keeping the nation's uninsured rate under 10 percent.

Nearly 11.8 million people signed up during last year's open enrollment season, counting consumers in all 50 states. It's possible that number could be matched again, after totals from remaining states are added.

"Obamacare" has survived two Supreme Court challenges and dozens of votes in Congress to repeal it wholly or in part. After Judge Reed O'Connor's ruling last week, another legal challenge is working its way through the courts. The judge agreed with a group of Republican-led states that were seeking to overturn Obamacare.

A group of Democratic senators urged Congress on Wednesday to intervene in the Texas lawsuit in defense of the law. The House is expected to take similar action next year when Democrats retake control of that chamber.