Miami-Dade County

South Florida signs up nearly all eligible consumers in Obamacare


The long reach of South Florida’s Obamacare enrollment efforts can be quantified in one number: 100. That’s the estimated percentage of eligible people who signed up for health coverage in the country’s top-performing ZIP codes.

One hundred percent.

A report released last week by the Kaiser Family Foundation estimated each ZIP code’s eligible population of consumers who could sign up for coverage and compared it to those who did enroll for 2015. In the nation’s top 10 ZIP codes — all in South Florida — the report found that nearly the entire eligible pool signed up for health insurance.

Across the state, the average was 64 percent.

The report, which also analyzes the percent of the eligible population captured in 2014, surprised even one of its authors. Cynthia Cox said she didn’t expect Florida to show up among the top performers again this year after posting very high numbers during the 2014 enrollment period.

“Florida was already outpacing some places, especially in Miami where they were enrolling well over half in 2014,” said Cox, associate director of health reform and private insurance at the Kaiser Family Foundation. “It seemed less likely that there would still be so much growth.”

But apparently there was space for growth, particularly in South Florida where Obamacare posters and signs have remained scattered around the region from earlier this year when — thanks to a combination of social and economic factors — residents signed up in numbers unmatched anywhere else in the country.

In the areas measured by the survey that include the nation’s top 10 ZIP codes — from Fort Lauderdale to Hialeah to Miami — an average of 94 percent of the estimated eligible population showed up at enrollment events, waited in lines and sat through the application on, many to become insured for the first time.

Of course, the numbers in the report are estimates, calculated by using U.S. Census data to figure out the number of people who were uninsured or had individual coverage before the implementation of the Affordable Care Act, subtracting those who qualify for federal programs like Medicaid and Medicare and then also subtracting those in the Medicaid coverage “gap” — a healthcare purgatory created in states that didn’t expand Medicaid, such as Florida. The numbers do not include those whose coverage was dropped or who stopped paying their monthly premium after enrolling in a plan.

But the numbers do provide an indication of the overwhelming success of South Florida groups’ intense marketing and outreach during open enrollment.

That outreach, said Milton Vazquez, Florida spokesman for nonprofit Enroll America, was what made the difference.

“People who sit down with an in-person assister are twice as likely to enroll than someone who just does the application themselves,” Vazquez said. “Those visits are powerful enough to move the needle.”

There was no shortage of in-person assistance in South Florida, where enrollment counselors were just as likely to set up shop inside insurance agencies as they were to pop up inside malls and barber shops.

That contact is particularly crucial when enrolling an overwhelmingly Hispanic population, said Ammer Cabrera, an enrollment counselor at Sunshine Life and Health Advisors, one of the largest enrollment agencies in the area. Sunshine even opened two mall storefronts inside Westland Mall — located in the top ZIP code 33012 — among other locations. The areas that included the top 10 ZIP codes were generally 75 to 97 percent Hispanic.

“In the Latin community, we want somebody in person to tell us what is what and we don’t trust the voice on the phone,” said Cabrera, who is Cuban American.

In some areas of Hialeah, actual enrollment surpassed the projected number of eligible consumers, indicating that some of the estimates of the uninsured population probably were lower than the reality — a suspicion that Cox, of the Kaiser Family Foundation, said she had about the area while developing the report.

Cox said some consumers may have chosen to sign up on the exchange because they found it more affordable than their employer coverage, which might account for some of the lower-than-reality eligibility estimates.

The numbers also reveal areas in South Florida that didn’t have such widespread enrollment — particularly the Florida Keys, Homestead, Coral Gables and Miami Beach.

Cabrera said more affluent areas may have consumers who are more willing to forgo coverage and pay the penalty for being uninsured — $325 or 2 percent of household income, whichever is greater in 2015 — than predominantly low-income areas where enrollment was high.

Vazquez, of Enroll America, said next year’s efforts will target these lower enrollment areas where 50 to 70 percent of the eligible population was captured instead of focusing on Hialeah, for example, where market saturation did the job this year.

But the lasting symbols of South Florida’s robust enrollment numbers remain. Natalie Castellanos, an attorney with the Florida International University Law clinic that helps conduct enrollment events and education, said she still sees the remnants every day.

“My commute to work in the morning is straight down Coral Way and I can’t even count the number of ‘Obamacare aplique aqui [apply here]’signs,” Castellanos said. “Obamacare is still prevalent on the streets.”

Follow @MHhealth for health news from South Florida and around the nation. This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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