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Florida health insurance

Sunshine State ranks 41st on health. Will the ACA help?

With this summary, we look at a snapshot of health indicators from several sources and examine how the Affordable Care Act is being rolled out in 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

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.

Looking at a somewhat different set of indicators, America’s Health Rankings also compares health across the states. In the 2013 evaluation, which is the most recent available, Florida ranks 33rd. Florida ranked 31st in the 2012 evaluation. Florida’s strengths include a low obesity rate and low levels of air pollution. Health-related challenges in the state include a high rate of drug-related deaths, a low high school graduation rate, and a high percentage of uninsured residents.

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. Sen. Bill Nelson (D) voted yes, while the Sen. George LeMieux (R) voted no. 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 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 health care 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 the ACA helping Florida’s uninsured?

According to a Gallup survey, Florida’s uninsured rate dropped 3.2 points from 2013 to mid-year 2014. With a starting point of 22.1 percent, Florida’s estimated uninsured rate remains high at 18.9 percent. That’s 5.5 percentage points above the national uninsured rate of 13.4 percent.

Florida enrollment in QHPs

Despite the ACA’s cold reception among political leaders, Florida residents took advantage of the health insurance marketplace. At 38.7 percent, Florida ranked fourth in the nation for the percentage of eligible consumers who purchased a qualified health plan (QHP). Nearly 984,000 people purchased private coverage, with 91 percent qualifying for premium subsidies.

Florida marketplace enrollment is expected to exceed 1 million for 2015, including 206,000 new enrollees.

A Florida consumers could choose from among 10 insurance carriers during the 2014 open enrollment period.

For 2015, the number of insures has expanded to 14: Aetna, Blue Cross Blue Shield of Florida, Cigna, Coventry Health Care of FL, Florida Health Care Plan, Health First Health Plans, Health First Insurance, Health Options, Humana, Molina Healthcare of Florida, Preferred Medical Plan, Sunshine State Health Plan, Time Insurance Company, and UnitedHealthcare of Florida.

Medicaid in Florida

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.

Florida’s decision not to expand Medicaid leaves 764,000 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.

Learn 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.

Does Florida have a high-risk pool?

Before the ACA reformed the individual health insurance market, medical underwriting was used to determine eligibility for private coverage in nearly every state, including Florida.  People with pre-existing conditions often found themselves unable to purchase coverage at all, or only eligible for plans that excluded their pre-existing conditions or charged them higher premiums in order to offer comprehensive coverage.

Florida created a high risk pool in 1983 to provide an option for people unable to obtain private individual coverage.  But amid rising enrollment and losses, the plan closed to new enrollees in 1990.  By the end of 2010, there were only 235 people enrolled in Florida’s high risk pool.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high risk pools, and the members who were still enrolled in Florida’s risk pool became eligible for coverage in the private market.  The Florida legislature passed a measure in 2013 that called for the termination of risk pool coverage at the end of June, 2014.  The pool will be fully dissolved by August 2015, but no longer has any current policy holders.

Florida reform at the state level

Here’s what’s happening legislatively at the state level with healthcare reform in Florida: