Miami-Dade County

In Florida, another 200K Obamacare enrollees are projected for 2015

Mercy Cabrera, an insurance agent with Sunshine Life and Health Advisors, helps Amparo Gonzalez purchase an insurance policy under the Affordable Care Act at the Westland Mall last year in Hialeah. 206,000 new customers are projected to sign up this year, bringing Florida’s total number of enrollees to more than 1 million. Enrollment begins on Nov. 15.
Mercy Cabrera, an insurance agent with Sunshine Life and Health Advisors, helps Amparo Gonzalez purchase an insurance policy under the Affordable Care Act at the Westland Mall last year in Hialeah. 206,000 new customers are projected to sign up this year, bringing Florida’s total number of enrollees to more than 1 million. Enrollment begins on Nov. 15. Getty Images

About 206,000 additional Floridians are projected to sign up for insurance under the Affordable Care Act when enrollment opens Nov.15, and insurers are hoping the young and healthy will be among their new customers.

The projection, compiled by the Florida Office of Insurance Regulation from information supplied by insurers, would raise total enrollment in Florida to roughly 1,070,000 people.

Mariana Mendoza is likely to be among the newly insured.

Mendoza, 35, hasn’t had health insurance since she left a corporate job in 2011 to start her own graphic design business. Since then, she said, she hasn’t suffered anything worse than an occasional cold.

Now she’s planning to sign up for coverage on the healthcare exchange. “I just want to be able to go to the doctor in case something comes up,” said Mendoza, a lifelong Miami resident.

Healthy, younger people like Mendoza are crucial to the success of the exchange. Because they don’t often run up high doctors’ bills, the young and healthy offset the risks insurers incur by offering coverage to older, sicker people — the people that the health law was designed to help.

“Having younger and healthier folks enrolling in coverage does help to drive down the costs for everyone,” said Athena Smith Ford, advocacy director for Florida CHAIN, a consumer advocacy group, “as well as providing financial and health security for young people.”

Last year, only 26.9 percent of Florida exchange enrollees were between 18 and 34 years old. The Congressional Budget Office had projected a target of 40 percent enrollment for that age group in order for the exchange to function most efficiently.

The Florida enrollment projection takes into account people signing up for both on- and off-exchange plans that are compliant with ACA rules. (Off-exchange plans offer the same “essential health benefits” as those on the exchange but are not eligible for government subsidies.) It was compiled using data submitted by the 19 insurers offering such plans next year, said Harvey Bennett, a spokesman for Florida’s insurance regulator, and only counts people who will pay at least their first month’s premium.

Bennett said the state does not know how many of the 206,000 new customers will sign up for on-exchange plans and how many will choose off-exchange plans. The current ratio between people with on- and off-exchange plans is roughly 8-to-1.

The shortfall of younger people last year might be part of the reason that monthly premiums in Florida will rise by an average of 13.2 percent in 2015, according to projections by the state, though White House officials, using a different methodology, actually predict a 4 percent drop.

A bill signed last year by Gov. Rick Scott, who opposes the health law, prevents the state from regulating health insurance premium rates until 2016.

Mendoza won’t be deterred by higher premiums. “The priority for me is having doctors I trust in my network,” Mendoza said. “I have sensitive skin so I want a good dermatologist … and I’m willing to pay a little bit more for the right benefits and providers.”

She had tried to sign up last year but didn’t know when enrollment closed and missed the deadline. “The online application was so confusing,” Mendoza said.

A little more than 980,000 people joined the exchange in Florida during the previous enrollment period, thanks in part to a late surge of sign ups before the window closed at the end of March.

The number of people on the exchange declined over the next few months as some consumers chose not to pay their premiums or dropped their coverage for other reasons. There are now about 762,000 paying customers enrolled in the exchange in Florida, according to the state.

It’s difficult to speculate about who’s going to sign up this year, said Smith Ford of Florida CHAIN. “There’s no singular group of people who need coverage,” she explained.

People expected to sign up include those who missed the enrollment window last year, young people turning 26 who will lose coverage through their parents, workers who are retiring or lost their jobs, and Medicaid recipients who found new or better employment and whose income now makes them ineligible for the federal program.

Insurers are hopeful that healthy people will also sign up in big numbers. The healthy might be motivated by a rising penalty for not having insurance, which in 2015 will be $325 or 2 percent of annual income, whichever is greater.

“The sickest folks signed up in year one, and those who could afford to sit out did,” Lisa Rubino, a senior vice president at Molina Healthcare, which is based in Doral, wrote in an e-mail. It might be cheaper for consumers to have insurance than pay the penalty, Rubino said.

Other Floridians say they simply could no longer afford insurance on their own. Carl Templer, 62, moved to Miami for work in 2012 but lost his advertising job early last year. He bought his own insurance before Obamacare kicked in but said he couldn’t afford the premiums and let his coverage lapse in May.

“I thought what I had was [affordable], but I was wrong,” Templer said. “And I never even used it once.”

Templer thinks he will find cheaper insurance on the exchange. He plans to ask for help at the Epilepsy Foundation of Florida, which won an $870,000 “navigator” grant from the federal government to help people sign up for coverage.

The exchange might also see more people signing up who have “low-risk” chronic conditions like mild asthma, manageable diabetes and high cholesterol, according to David Hom, chief solutions officer for SCIO Health Analytics, a Connecticut-based company that studies the health insurance marketplace.

Because their conditions are low maintenance and don’t usually require hospitalization, they are a good bet for insurance companies looking to maintain acceptable levels of risk, according to Hom.

“Last year, [these people] sat on the sidelines for a variety of reasons,” he said. “They might have felt the penalties for not carrying insurance were insignificant or that they didn’t need insurance or want to take a risk on an untested product. And a lot of them might not have even known they were eligible for healthcare.”

“Word of mouth will be very important” in getting people to sign up, Hom added.

Almost nine out of 10 uninsured Americans don’t know that enrollment begins on Nov. 15, according to a Kaiser Family Foundation poll released last week.

Advocacy groups say they will focus on raising awareness this year, especially among young people. “In order to reach this age group you have to focus on where you can engage them,” said Nicholas Duran, state director for Enroll America, a non-profit that encourages people to obtain coverage under the ACA.

Duran said Enroll America is partnering with Miami Dade College, Florida International University and the University of Miami to hold informational meetings and enrollment workshops on campuses. “We have seen that financial assistance and cost comparison examples resonate with this age group,” Duran said.

Ninety-one percent of Floridians on the exchange received financial assistance last year. The average premium cost was $68 per month.

At that price, Duran said, coverage is cheaper than most tickets for last Sunday’s Pitbull and Enrique Iglesias concert at the American Airlines Arena.

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.