When Ben first started looking into his options last year for health insurance under the Affordable Care Act, he didn’t know he already had Stage 4 cancer.
Bur he’d been alarmed when he saw blood after going to the bathroom. And after about two years without insurance — he lost his employer insurance when his tech job was offshored — the 56-year-old from Miami Beach decided he’d better figure out how to get coverage through the ACA, also known as Obamacare.
He looked up the website, HealthCare.gov, but was confused by the forms. Then he heard someone on WLRN, South Florida’s public radio station, mention healthcare “navigators” who help people sign up.
“My ears pricked up and I’m like, ‘That’s it. That’s what I need: a navigator,’ ” Ben said. The Miami Herald is not using Ben’s full name at his request, due to privacy concerns.
The navigator on the radio that day worked for Epilepsy Florida, a nonprofit dedicated to supporting those affected by the disease. The group has run an outreach program for the ACA for years.
Islara Souto, the navigation program director at Epilepsy Florida, said federal budget cuts have left her organization with only about half as many ACA outreach workers as she had last year. She now has seven navigators instead of 12 serving the South Florida region of Palm Beach, Broward, Miami-Dade and Monroe counties during the six-week enrollment period for 2020 that starts Friday and ends Dec. 15.
“We are extremely limited on resources,” Souto said. “We rely on community partners and local and state representatives to conduct outreach on our behalf as we try to maximize our budget on hiring navigators.”
But Ben said the navigators he worked with last year offered invaluable help in selecting a health insurance plan with costs that he could manage, including making sure that he understood that he qualified for federal subsidies that are offered to people with lower incomes.
“[The navigator] helped me find a plan that the deductible and the maximum out-of-pocket were the same amount and they were something I could totally live with,” Ben said, who said his monthly premium ended up being about $100 once the subsidies were applied.
And it turned out to be critically important that he had insurance and sought out care. He had rectal cancer, and the colonoscopy he got was scheduled by the first primary care physician he had seen in years.
He said he worries that attacks on the ACA by Congress and President Donald Trump’s administration are jeopardizing care for people like him.
“To me, it’s inconceivable that they could do that,” he said. “If they were to take this away from me, I wouldn’t be able to pay for my treatment. I’ve seen what this stuff costs.”
One of his bills for a six-day stay in the hospital cost $120,000, he said.
In past years, Souto said her staff participated in health fairs and other events, handing out fliers and providing in-person information, but now navigators often stick to the phones, where they can reach more people who need help.
Florida continues to be a stronghold for the embattled healthcare law, with some of the state’s poorest people flocking to the marketplace even with the cuts to navigator programs that help people access the plans.
The market for plans under the healthcare law appears to have stabilized. Monthly premiums are leveling off in Florida after two consecutive years of increases. Statewide, the average monthly premium for a 27-year-old not receiving federal subsidies on a benchmark “silver plan” cost about $391 last year, and that figure is projected to tick down to $383 for 2020, according to the Centers for Medicare & Medicaid Services.
Nationally, on average, a 27-year-old with a household income of 150% of the federal poverty level who is eligible for federal subsidies would pay a monthly premium of $52 on the silver plan, compared to $374 without the subsidy.
Those who earn more than 400% of the federal poverty line don’t receive subsidies, and they find themselves facing steep costs. The federal poverty level in 2019 is $12,490 a year for an individual and $25,750 for a household of four people.
Moraly Arroyo, who works for the Miami-based nonprofit Florida Health Justice Project, said people who earn just above 400% of the federal poverty line often work in the service industry or in construction — sometimes multiple jobs.
“We don’t really consider the fact that these same people who are providing these services and are working very hard really don’t have access to basic healthcare because it’s a choice between paying the premium or paying for rent or to put food on the table,” Arroyo said.
Nationwide, monthly premiums have dropped by about 4% on average for the 2020 coverage year, CMS said last week.
The number of Floridians who enrolled in Obamacare plans on the Healthcare.gov exchange and paid their premiums rose from 1.46 million in 2018 to 1.67 million in February 2019, according to 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.
But there are still significant coverage gaps. As of 2018, about 2.7 million Floridians, about 13 percent of the state population, are uninsured, according to the latest data from the Census Bureau, representing an increase of about 52,000 people from 2017.
Ben, the former tech worker from Miami Beach, said that although he deals with constant pain due to his cancer he’s glad he has insurance to pay for treatment..
“I don’t wish this on anyone, it’s terrible, and I just can’t imagine what somebody without any health insurance at all would do,” he said. “If I didn’t have access to the Affordable Care Act, to Obamacare, with Stage 4 cancer ... what do people do? Do you just die?”