Entering 2017 open enrollment, Florida’s uninsured population continues to be among the nation’s highest. However, its 2016 enrollment numbers were also the nation’s highest. Although the Sunshine State has not embraced Obamacare from a legislative standpoint, the healthcare reform law has had some positive impacts there.
Floridians can expect to see increased health insurance premiums and fewer insurers offering 2017 plans. State insurance regulators have approved rate increases averaging 19.1 percent, which is lower than the national average of 25 percent. Furthermore, the Miami Herald reports that five insurance companies will sell ACA plans in Florida; most states using HealthCare.gov have three or fewer. In 2016, Florida lawmakers passed House Bill 221, which bans the practice of balance billing.
The outcome of November’s 2016 general election is sure to impact the future of the ACA and health insurance in Florida. Reuters reported October 30 that Clinton led the state by a narrow margin. The Democratic candidate has vowed to improve upon the Affordable Care Act, while Republican candidate Donald Trump has stated he would repeal and replace it.
Florida health ratings
When it comes to public health, various ratings place the Florida 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, which includes data for 2015, Florida ranks 33rd. A high percentage of uninsured population continues to be a challenge for the state, which ranks 49th for the report’s lack of health insurance measure. Texas comes in last. However, Florida has seen a slight decline in uninsured from the 2014 to 2015 rankings, dropping from 20 percent to 18.3 percent uninsured, respectively.
The 2015 Scorecard on State Health System Performance ranks Florida 37th. 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. The state earned its lowest marks for Access, coming in at 40th. Within this category, its lowest-ranking indicators were uninsured adults (50th), uninsured children (45th) and adults who went without care due to cost (46th).
While it does not include an overall score, the 2016 edition of Trust for America’s Health provides a wealth of public health information; see Key Health Data About Florida. As it does in other rankings, Florida’s percentage of uninsured residents stands out as an area needing much improvement. Based on 2014 data, Trust for America’s Health reports that 16.6 percent of Floridians – adults and children – were uninsured.
Some Florida counties fared far worse than the 16.6 percent average. County-by-county health rankings from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin showed a range of 15 to 33 percent uninsured across the state.
Is Obamacare helping Florida’s uninsured?
According to a Gallup survey, Florida’s uninsured rate dropped 3.8 points from 22.1 in 2013, the year before the ACA’s individual shared responsibility provision took effect, to 15.7 percent by the September 2015.
Nationally, the average uninsured rate went from 17.3 percent to 11.7 percent in the same time period. The average among states that both ran their own exchange and expanded Medicaid was 7.8 percent. Florida did neither.
Nonetheless, Florida’s federally facilitated health insurance exchange has the nation’s largest number of eligible of enrollees and highest enrollment numbers.
2017 Obamacare rates and carriers
As of August 2016, eight carriers will offer 2017 coverage through Florida’s exchange. They include:
- Florida Blue (BCBS of Florida)
- Florida Blue HMO (Health Options)
- Florida Health Care Plan Inc.
- Ambetter (Celtic)
- Health First Health Plans
Cigna left Florida’s exchange in 2016 and is returning with new options for 2017 open enrollment.
Florida insurance regulators approved rate increases averaging 19.1 percent in 2017; changes range from 11.7 percent to 36.8 percent on average. Nationwide, rates will increase an average of 25 percent. Insurers initially requested increases ranging from 0.8 percent to 44.3 percent.
Premium tax credits and cost-sharing subsidies will help those who enroll in coverage through Florida’s exchange to reduce their premium and out-of-pocket healthcare costs. In 2016, more than 93 percent of Florida’s exchange enrollees received subsidies. The average pre-subsidy premium was $386 per month and the average after-subsidy premium was $84 per month. 2017 subsidies will adjust according to Florida’s average benchmark premium. As such, it is wise to shop around and compare rates during open enrollment.
FL 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.
By January 31, 2016, the end of 2016 open enrollment, Florida had again enrolled more people than any other state and had the nation’s highest per-capita enrollment rate. As of March 31, 2016, Florida’s effectuated exchange enrollment stood at 1,531,714.
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 and was replaced by Republican Marco Rubio. 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.
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. As of August 2016, there were 7 remaining after several announced closure.
Medicare enrollment in the Sunshine State
Florida Medicare enrollment exceeded 4 million in 2015, about 20 percent of its population. Florida’s Medicare enrollment numbers are second only to California and the percentage of Florida residents enrolled in Medicare is higher than the 17 percent the total U.S. population enrolled in Medicare.
About 86 percent of Florida Medicare recipients qualify based on age alone, while the remainder are eligible as the result of a disability.
In 2014, Medicare spent about $10,610 per enrollee. The national average was $8,970 per enrollee. As of 2009, the latest available data, Florida ranked second in overall spending with $39.1 billion per year. California was 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:
- Florida lawmakers passed House Bill 221 on March 11, 2016, and Gov. Scott signed it into law in April, thereby banning the practice of balance billing in situations (including non-emergency care) where the patent uses an in-network hospital or urgent care facility and “does not have the ability or opportunity to choose a participating provider at the facility.” For emergency care, insurers are required to cover treatment at in-network rates, regardless of whether or not the providers are in-network and regardless of whether or not the patient could choose another provider.
Other state-level health reform legislation: