Florida bucking ACA enrollment trend

Apparently, Floridians have gotten really good at enrolling in Obamacare.

Compared with the nation overall, enrollments in 2019 Affordable Care Act plans are holding steady in the Sunshine State.

Through the first four weeks of the six-week open enrollment period, Florida consumers have selected 622,664 plans through the official Healthcare.gov website, according to newly released figures from the federal Centers for Medicare and Medicaid Services. During the first four weeks last year, consumers selected 626,144 plans.

That’s a decline of just 0.6 percent, or -3,480, which is negligible considering that this year’s first four-week period, Nov. 1-24, was a day shorter than last year’s, Nov. 1-25.

Meanwhile, enrollments in the 38 other states that use the Healthcare.gov website have declined a jarring 16.4 percent compared with last year — roughly 1.8 million so far compared with 2.2 million during the first four weeks last year.

The largest declines by percentage were in:

■ Virginia (-39.2 percent, or -47,599)

■ Maine (-26.9 percent, or -6,445)

■ West Virginia (-26.7 percent, or -2,093)

■ Louisiana (-25.6 percent, or -7,783)

■ Pennsylvania (-25.2 percent, or -31,306).

After Florida, the states with the smallest declines were:

■ Mississippi (-2.3 percent, or -628)

■ South Carolina (-4.5 percent, or -2,908)

■ Georgia (-4.9 percent, or -7,524)

■ Texas (-4.9 percent, or -22,839)

■ Arkansas (-7.1 percent, or -1,276)

So why are enrollments in Florida keeping pace while down sharply everywhere else? Experts say they don’t have a clue.

“I don’t know why,” was the response from Karen Pollitz, senior fellow at the Kaiser Family Foundation, which closely monitors health insurance trends across the nation.

The numbers are “interesting,” Pollitz said Thursday. “Who knows? Florida’s just having a good year.”

Analysts are more concerned about the nationwide decline in enrollment and whether it can be reversed in the final two weeks of open enrollment, which ends Dec. 15.

With no hard data to study yet, Pollitz suggested a number of factors might share the blame: Cuts to the federal advertising and marketing budget, from $100 million during President Obama’s final year in office to $10 million now under President Trump, who campaigned on a promise to eliminate the controversial program. Trump’s decision to end the individual mandate, which imposed tax penalties on eligible consumers who did not buy health insurance. “Surveys show most people don’t know it’s gone, but those who do are definitely signing up less,” Pollitz said. The Trump administration’s deregulation of the short-term health insurance market, which makes it easier for companies to sell less-expensive coverage with fewer protections and fewer requirements to insure pre-existing conditions.

Pollitz also surmised that this year’s midterm elections, which took place during the second week of open enrollment, might have drawn consumers’ attention away from shopping for health insurance.

But all of those factors also affected Florida, which seems to have shaken them off.

In addition, enrollment decreases might be lower in states where the federally funded Medicaid program wasn’t expanded to provide free coverage for individuals with incomes up to 140 percent of the federal poverty rate, Pollitz said, because many consumers in those states have no other health-care safety net. In fact, Florida and the four other states with the smallest ACA enrollment decreases all did not expand Medicaid.

Perhaps, Pollitz said, enrollments are holding steady in Florida because the team of federally funded “navigators” who have been in place in the state since the first Obamacare enrollment in 2013 have laid a superior foundation in educating and reaching out to marketplace enrollees, of whom 92 percent qualify for federal subsidies that reduce a $595 monthly premium to an average $70.

Jodi Ray, who since Obamacare’s inception has overseen the state’s largest navigator program from her position as director of the University of South Florida’s non-profit Florida Cov-

ering Kids & Families program, said she doesn’t have any answers right now either.

Asked whether she’s surprised by the fourweek enrollment figures, Ray responded, “Yes, I am, to be honest.” Forced to reallocate her navigator resources after her operating budget was cut from $5 million to $1.2 million this year, Ray said she was prepared for the worst. “I was feeling a bit cynical. I’m not going to lie.”

The cuts meant she could only hire 59 navigators this year, compared with 152 last year, and could only send those navigators to half of the state’s 67 counties. In counties where she could not send them, enrollees who need sign-up help have had to rely on assistance via telephone and computer, she said.

”We are making the best out of what we’ve got,” she said.

Ray said she doesn’t want to declare victory just yet. The biggest enrollment surge has always occurred during the final two weeks. If signups keep pace with last year, that means about 1 million procrastinators will enroll between now and Dec. 15, for a total of more than 1.7 million.

Ray says she’s still not confident she’ll have enough help to meet the demand. But she acknowledged that the network of nonprofit organizations and private unpaid volunteers have likely helped prevent enrollments from declining so far.

Also likely to be playing a role, she said, is a large number of independent health insurance brokers, which she believes is in larger proportion here compared with other states, and the marketing muscle of the state’s largest health insurer, Blue Cross Blue Shield of Florida.

Better known as Florida Blue, the insurer is the only one that has offered ACA-compliant plans in all 67 counties since Obamacare began. While it has undergone growing pains, Florida Blue hires and trains part-time and seasonal sales and service agents each year to prepare for open enrollment, and offers signups at 23 walk-in service centers across the state, as well as 18 bilingual Sanitas Medical Centers operated by Florida Blue’s parent company, GuideWell.

Florida Blue also participates in more than 1,000 educational events annually, spokesman Doug Bartel said on Thursday. “I can’t speak for any other carriers, but I absolutely believe we are making a difference when it comes to educating Florida consumers,” Bartel said.

PATRICK SISON/AP Four weeks into the six-week open enrollment period for health insurance programs available under the Affordable Care Act, the number of Florida enrollments have held steady while declining sharply throughout the rest of the nation. Experts say they don’t know why.