Health Care

Obamacare continues to help Floridians who need it most — but there is cause for concern

Florida’s low-income population is signing up in greater numbers for health insurance using the Affordable Care Act exchange in the last year, led by South Florida counties.

But those who don’t get government subsidies are still fleeing the market, according to a pair of reports released this week by the Centers for Medicare and Medicaid Services or CMS, raising concerns among healthcare experts.

Rising enrollment in the exchange at, which was created by the health law in 2014, represents some stability in the market for those whose incomes are low enough to qualify for government-subsidized premiums on their plans.

But in the two years since President Donald Trump’s administration removed the individual mandate that penalizes those who do not buy health insurance and allowed consumers to purchase non-ACA-compliant plans, there have been other, somewhat predictable, fluctuations in the state’s healthcare market.

Most notably, those who don’t receive subsidized premiums are leaving the market for cheaper plans, or forgoing health insurance altogether.

“It’s like shooting a pinball up in a pinball machine and watching it bounce all over the place,” said Steven Ullmann, a healthcare policy expert with the University of Miami. “There are all these impacts that take place when you change one policy.”

In Florida, the number of people who had enrolled in Obamacare plans and paid their premiums rose from 1.46 million in 2018 to 1.67 million in February 2019, according to the latest data released by CMS. Ninety-five percent of enrolled Floridians receive government subsidies to lower their premiums — one of the highest rates in the country, the data shows.

South Florida counties lead the state in total enrollment, which includes new customers who selected an exchange plan and those who re-enrolled. Miami-Dade and Broward counties had 664,785 customers, or 37 percent of the state’s nearly 1.8 million people who selected plans on the exchange, CMS reported.

Sara R. Collins, a healthcare policy expert with the Commonwealth Fund, a New York-based think tank, said the steady increase in Florida’s enrollment “points to a pretty stable market and a pretty significant need in the state for insurance coverage.”

“The big weakness in the healthcare system prior to the [Affordable Care Act] was that the lower your income was, the less likely you were to get coverage,” Collins said. “This does show how important the subsidies have been in helping people get healthcare coverage.”

But with the repeal of the individual mandate — a key part of the ACA that required most people to have insurance or pay a penalty — younger people and those who perceived they were healthier began to drop out of the market. That was probably at least partly due to higher premiums and that, in turn, increased the number of uninsured people.

That left a higher ratio of people in the market who are older and have more healthcare needs, and who tend to be costlier, which has caused premiums to rise further. The effect is to reduce some of the coverage gains made under the ACA.

“What we are seeing are premiums going up and that pushes more people out of these policies,” said Ullmann, the UM expert. “We are starting to see and we are continuing to see the uninsured rate in the state of Florida and in the country increase.”