The rollout of the Affordable Care Act last year avoided disaster only thanks to a late surge of signups that saw more than 980,000 Florida residents obtain health coverage, the most of the 36 states using the federally run exchange.
A glitchy healthcare.gov website prevented consumers around the nation from signing up early and nearly derailed President Barack Obama’s signature piece of legislation.
But this year’s open enrollment — the three-month period when people can sign up for health coverage that begins next Saturday — is likely to run more smoothly, analysts predict.
Chief among the improvements: a much shorter online application, down from 76 pages to 16 for most consumers.
“The folks running the marketplace know they can’t have a repeat of what happened last year,” said Sabrina Corlette, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms.
“Even if the website’s not perfect on Nov. 15, [the government] will be ready to start making fixes in real time,” Corlette said.
Insurers in Florida agree, including the state’s largest, Florida Blue. “We anticipate a smoother enrollment process in year two of the marketplace,” according to an email from Jon Urbanek, senior vice president of health insurance markets at Florida Blue.
Enrollment is particularly important in Florida, which has the nation’s third-highest rate of uninsured people under 65, and in Miami-Dade County, where 33 percent of residents were uninsured in 2012, the most recent year for which data were available.
Ninety-one percent of Floridians who signed up for 2014 coverage under the health law received financial assistance from the federal government. The average monthly premium was $68, counting tax credits.
The initial number of 980,000 enrollees in Florida later fell to about 762,000 by June, state regulators said. Those who lost coverage likely failed to pay monthly premiums or found insurance through new jobs.
State officials, using data submitted by insurers, project 200,000 new customers for 2015. The feds are hoping for greater numbers: The Congressional Budget Office set a target of 13 million people nationwide on the exchange for 2015, nearly double the current total of 7.3 million.
“We’re definitely expecting significant growth in enrollment,” said Caroline Pearson, vice president at Avalere, a healthcare consulting company in Washington.
She said her company believes Florida could see up to 800,000 new enrollees, “depending on how aggressive outreach and enrollment activities are this year.”
“It’s still very up in the air,” Pearson added.
Also unclear is whether Florida will accept $51 billion in federal money to expand Medicaid coverage to an estimated 800,000 uninsured residents, one of ACA’s provisions. Newly reelected Gov. Rick Scott at first opposed the expansion before switching his position in 2013.
Scott, whose enthusiasm for expansion is lukewarm, will have trouble convincing Florida’s Republican-controlled Legislature to accept the Medicaid money. Republicans now hold a supermajority in the state House of Representatives, which has consistently opposed expansion.
People who signed up for coverage last year will be automatically re-enrolled in their current plans if they don’t sign up for a new one. But that doesn’t mean they’ll necessarily pay the same prices they did in 2014.
The average monthly premium in Florida is set to increase by 13.2 percent this year, according to state regulators. People who are already signed up for coverage may see a hike in their premiums if they don’t change plans.
Consumer advocates recommend that current enrollees log onto healthcare.gov when enrollment opens and shop around for the best deal.
Some Florida insurers are anticipating high demand.
Health First, which offers coverage in Brevard and Indian River counties, expects about 5,500 new customers to join the 4,400 who signed up last year, according to Jason Alford, the company’s director of sales.
Health First will also increase the number of ACA compliant plans it offers from 21 to 68.
“Last year was like a blind bid: We didn’t really know what the market would look like and neither did our competitors,” Alford said. “Now we’ve got a year of experience under our belt.”
This year also marks the beginning of the law’s so-called “employer mandate.” Companies with 100 or more full-time employees will be required to provide affordable coverage to 70 percent of their workers or face a financial penalty.
In 2016, the mandate will expand to include companies with 50 or more full-time employees and require them to cover 95 percent of workers.
Another new development: the launch of the federal Small Business Health Options Program, or SHOP exchange, in Florida and 33 other states.
Small businesses with 50 or fewer full-time employees can buy coverage for their workers online starting next Saturday. Businesses with fewer than 25 full-time employees whose average salary is $50,000 or less will be eligible for a tax credit of up to half of their workers’ premium costs.
The White House had planned to open the program on Oct. 1, 2013, but delayed its launch until this year.
An early test run of SHOP that took place last week in five states (Florida was not among them) revealed defects in the exchange’s website, according to the New York Times. Administration officials said they could fix the bugs before enrollment opens, the Times reported.
Six insurers will offer plans on the SHOP exchange in Florida.
Meanwhile, the number of new players joining the individual market in Florida this year, including national giant UnitedHealthcare, suggests that insurers see the state as a place for profit. This year, 14 companies will offer exchange plans in Florida, up from 11 companies in 2014.
But consumers may have fewer choices: State regulators say the number of plans will decrease from 352 in 2014 to 278 in 2015.
Both insurers and advocates are hoping to sign up more Hispanics this year. Thirty-five percent of Hispanics in Florida did not have insurance in 2012, the most of any ethnicity.
“The ACA really provides a significant opportunity to reduce those numbers and provide Latinos new pathways to get coverage,” said Steven Lopez, program manager for the health policy project at the National Council of La Raza, a Hispanic civil rights organization based in Washington.
Last year, Hispanics made up about 20 percent of enrollees in Florida who reported their ethnicity when signing up. That was the fourth-highest rate of Hispanic enrollees in the nation after Texas (33.6 percent), New Mexico (31.1 percent) and Arizona (24.2 percent).
The Spanish language version of healthcare.gov was widely criticized for inadequate translation last time around. This year, Lopez said, the website has been improved, but it may not be the most effective way to reach Spanish speakers.
“We’ve found that Latinos really value face-to-face interaction,” explained Raymond Paultre, Florida field director for Enroll America, a nonprofit that advocates for people to sign up for coverage under the health law.
“You have to be in the local hospitals, in the churches, in the community centers,” Paultre said.
And Hispanics aren’t a monolithic community, added Nicholas Duran, Enroll America’s state director for Florida.
People in middle-class neighborhoods tend to be better informed about the law but jaded by what they heard on the news during enrollment season last year, Duran said. Construction and agricultural workers are more skeptical about giving their personal information to the government and sometimes aren’t aware of the financial aid available, he said.
Advocates need to tailor their message.
“It’s very different when you’re dealing with folks in Homestead than when you’re working in Hialeah,” Duran said.
The health law is not widely popular across the nation: 43 percent of Americans hold an unfavorable view of the law compared to 36 percent who support it, according to a monthly tracking poll conducted by the Kaiser Family Foundation. Twenty percent didn’t have an opinion or didn’t answer. In a nationwide exit poll of voters on Tuesday, 49 percent said the federal health care law “went too far.”
Repeal is unlikely despite Republicans winning control of the U.S. Senate last week. The likely incoming Senate majority leader, Mitch McConnell (R-Kentucky), has said he supports repeal of the law “root and branch” but acknowledged on Fox News last week that his party will not be able to obtain the necessary 60 votes in the Senate — not to mention the president’s signature.
Individual provisions of the ACA — such as guaranteed coverage for people with pre-existing health conditions and children being allowed to stay on their parents’ insurance until the age of 26 — have been more popular than the law as a whole.
Some of the loudest public outcry against the health law came from policy holders who were told they would have to give up their cheaper plans that did not provide the 10 essential health benefits required by the ACA — including coverage for prescription drugs, trips to the emergency room and outpatient care.
The health law did allow consumers to keep so-called “grandfathered plans” that did not meet these new requirements — as long as those plans had been in place before the health law was passed in March 2010 and stayed consistent in price and benefits.
About 140,500 Floridians hold grandfathered plans, according to state data.
An additional 324,800 people in Florida have so-called “transitional plans” that also do not meet the coverage requirements of the ACA.
Consumers were able to stay on these lower-cost plans after President Obama gave states the option to allow insurers to continue offering them — under withering criticism that he had broken his initial promise that “if you like the policy you have, you can keep it.”
Florida elected to allow insurers to continue offering the plans until Oct. 1, 2016, for coverage that will run through September 2017. After that, consumers with such plans will have to sign up for ACA-compliant plans.
Insurers are allowed to cancel grandfathered and transitional plans with 90 days notice.
Despite the political heat generated by the law, many Americans don’t know they can use it to get affordable coverage.
Nine out of 10 uninsured Americans don’t even know that enrollment opens this month, a poll by the Kaiser Family Foundation found.
“There’s a huge knowledge gap that the marketplace needs to overcome,” said Georgetown University’s Corlette.
Miami Herald staff writer Daniel Chang contributed to this report.
This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
Key statistics about 2014 enrollment in Florida
Total sign ups: 983,775
Percent receiving financial aid: 91
Percent choosing a silver level plan: 73
Percent male: 45
Percent female: 55
Percent Latino: 19.2
Percent African American: 19.8
Percent White: 53.5
Average monthly premium: $68
Number of customers as of June 2014: 762,723
Source: Department of Health and Human Services and Florida Office of Insurance Regulation