With this summary, we look at a snapshot of health indicators from several sources and examine how the Affordable Care Act is impacting Florida.
While it is too early to determine the long-term impact of the ACA, the factors summarized below help establish where Florida stands and where it may be headed in terms of public health and access to affordable health insurance.
Florida health ratings
When it comes to public health, various ratings place the Sunshine State in the bottom half of the nation. United Health Foundation’s America’s Health Rankings is one of them. In the most recent edition available, 2014, Florida ranks 32nd—up a spot from 33rd in the 2013 evaluation. Florida’s key health challenges include a high percentage of uninsured residents, many poor physical health and mental health days among residents, a low high school graduation rate and a high prevalence of Salmonella.
The state’s health strengths include low levels of air pollution, as well as low rates of pertussis, air pollution, smoking and cancer deaths.
The 2014 Scorecard on State Health System Performance ranks Florida 41st, down one spot from the 2009 ranking. The Scorecard evaluates a range of health indicators and gives an overall score to each of the 50 states and the District of Columbia. Florida’s scorecard details how the state scored on individual measures within five categories: Access, Prevention & Treatment, Avoidable Hospital Use & Cost, Healthy Lives, and Equity.
While it does not include an overall score, the 2014 edition of Trust for America’s Health provides a wealth of public health information; see Key Health Data About Florida.
If you want to examine rankings for a specific area of Florida, check out the county-by-county health rankings from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Florida and the Affordable Care Act
In the 2010 vote on the Affordable Care Act, Florida’s senators split their votes. Democratic Sen. Bill Nelson voted yes, while Republican Sen. George LeMieux voted. LeMieux briefly held the Senate seat after being appointed by then-Gov. Charlie Crist to serve out the remainder of Republican Sen. Mel Martinez, who retired. LeMieux left the Senate in 2011, replaced by Republican Marco Rubio who is now running for president. Rubio is opposed to the Affordable Care Act.
Among Florida’s delegation to the U.S. House of Representatives, 9 members voted in favor of the ACA, while 15 voted against the law. Republicans outnumber Democrats in the current delegation.
The Affordable Care Act was not well received by state-level politicians in Florida. Gov. Rick Scott is vocally opposed to the healthcare reform law, and the state rejected federal loans to evaluate a state-run exchange, was the lead plaintiff in the U.S. Supreme Court case challenging the ACA, and rejected Medicaid expansion.
Is Obamacare helping Florida’s uninsured?
According to a Gallup survey, Florida’s uninsured rate dropped 3.8 points from 22.1 in 2013 to 18.3 percent by the end of 2014, the year the ACA’s individual mandate took effect.
By mid-2015, following the second Obamacare open enrollment period, Florida’s uninsured rate dropped to an estimated 15.2 percent. This rate is still relatively high, especially when compared with the 8.9 percent uninsured rate in states that both expanded Medicaid and opted for state-run exchanges and even when compared with the 13.4 percent uninsured rate in other states that only did one of those things or neither of them.
Florida enrollment in qualified health plans
Despite the ACA’s cold reception among political leaders, Florida residents took advantage of the health insurance marketplace. In 2014, Florida had the highest enrollment of all states using HealthCare.gov. Nearly 984,000 people purchased a qualified health plan (QHP) – 38.7 percent of all eligible consumers – from the exchanged and 91 percent of them qualified for premium subsidies.
In 2015, more than 1 million people enrolled in QHPs through Florida’s marketplace, which accounted for 50 percent of eligible consumers and made Florida third in the nation in terms of percentage of potential marketplace population enrolled. As of June 30, 2015, Florida’s effectuated enrollment was 1.3 million — 91.3 percent of those enrolled were in plans with an advanced premium tax credit, and 69.2 percent were receiving cost-sharing reductions.
Prior to the 2016 open enrollment period, Florida’s insurance commissioner was powerless to regulate proposed health insurance premiums. That has changed, however, and Insurance Commissioner Kevin McCarty was able to challenge proposed 2016 rates. When final rates were released on August 26, 2015, they were lower than proposed for 10 of the 16 carriers selling plans on Florida’s exchange and in the private market. Rates were higher than originally proposed for the other six.
The weighted average approved rate increase for Florida’s individual market was 9.5 percent for 2016. Exchange plan rates varied from a decrease of 9.7 percent (Florida Health Care Plan, Inc.) to an increase of 16.4 percent (UnitedHealthcare of Florida, Inc.). Average benchmark premiums across the state increased by 1.2 percent, which means subsidies will be slightly higher for 2016; however, it is wise to remember that overall premiums will be 9.5 percent higher and consumers should shop around rather than let their 2015 coverage automatically renew for next year.
Medicaid expansion was intended as one of the ACA’s main vehicles for reducing the number of people who lacked medical insurance coverage. However, the U.S. Supreme Court ruling in 2012 opened the door to many states, including Florida, to opt out of Medicaid expansion to single adults ages 19 to 64.
Florida’s decision not to expand Medicaid leaves 567,000 people in the coverage gap, meaning they do not qualify for Medicaid nor are they eligible for tax subsidies to help them afford private health insurance. According to the Kaiser Family Foundation, based on current eligibility for coverage, 948,000 people living in Florida would be eligible for Medicaid if the state expanded.
The Florida Department of Children and Families provides information about Florida’s health insurance assistance programs for low-income individuals and families.
Other ACA reform provisions
The Consumer Operated and Oriented Plan (CO-OP) Program is a provision of the Affordable Care Act. Through federal loans, the program encouraged start-up, nonprofit health insurers to enter the market and increase choice and competition. While no CO-OP plans were created in Florida, 23 private, nonprofit plans were set up across the U.S. By the end of October 2015, there were 12 remaining after several announced closure.
Does Florida have a high-risk pool?
The Consumer Operated and Oriented Plan (CO-OP) Program is a provision of the Affordable Care Act. Through federal loans, the program encouraged start-up, nonprofit health insurers to enter the market and increase choice and competition. While no CO-OP plans were created in Florida, 23 private, nonprofit plans were set up across the U.S. By the end of October 2015, there were 12 remaining after several announced their closure.
Medicare enrollment in the Sunshine State
Florida Medicare enrollment reached 3.9 million in 2015, about 19.5 percent of its population. Florida’s Medicare enrollment numbers are second only to California and the percentage of Florida residents enrolled in Medicare is slightly higher than the 17 percent the total U.S. population enrolled in Medicare.
Historically, 85 percent of Florida Medicare recipients qualify based on age alone, while the remainder are eligible as the result of a disability.
Medicare spends about $11,893 annually per enrollee in Florida and the state ranks second in overall spending with $39.1 billion per year. California is first with $50.6 billion.
Florida residents who want additional benefits beyond those offered by Original Medicare can enroll in a Medicare Advantage plan. About 40 percent of Florida Medicare beneficiaries select a Medicare Advantage plan – about 32 percent of all U.S. Medicare beneficiaries make that selection. Thirty-five percent of Florida Medicare enrollees also select a Medicare Part D plan for stand-alone prescription drug coverage compared with 43 percent nationwide.
Florida reform at the state level
Here’s what’s happening legislatively at the state level with healthcare reform in Florida:
- Gov. Scott announced in April 2015 that his administration was suing CMS over funding for the state’s Low Income Pool (LIP) program. The following month, CMS notified Scott’s administration that Florida could resubmit its proposal and budget for 2016 and obtain $1 billion in LIP funding for the 2016 fiscal year and that the amount would drop to $600 million for the 2017 fiscal year. Scott withdrew his lawsuit June 25 and reached an agreement with CMS. Lawmakers will revisit the LIP funding issue in 2016.
- The Florida House is opposed to Medicaid expansion and was supportive of Scott’s lawsuit. The Senate proposed an alternative to Medicaid expansion known as the Florida Health Insurance Affordability Exchange Program (FHIX). While the Senate approved SB2, the House defeated it.
Other state-level health reform legislation: