Sun Sentinel Palm Beach Edition
Obamacare expanded significantly
Program has bounced back, grown to include more offerings in post-Trump era
What a difference five years makes. Donald Trump failed to kill Obamacare, and now it’s growing by leaps and bounds.
South Florida consumers who buy health insurance on the federal exchange created by the Affordable Care Act will find significantly expanded options when Open Enrollment for 2022 begins on Nov. 1.
In Broward and Palm Beach counties, 11 health insurance companies are now offering plans eligible for federal subsidies. In Palm Beach County. 10 companies are now competing, according to a list of companies approved by the Florida Office of Insurance Regulation to sell health insurance next year.
The increased competition means consumers will be far more likely to find plans suited to their individual needs, such as networks that include their favorite physicians, specialists and hospitals, health experts say.
Although specific plans and providers won’t be known until Open Enrollment begins, Cliff Eserman, a health insurance broker in Wilton Manors, said having more insurers to choose from doesn’t necessarily decrease consumer costs because most consumers receive federal subsidies to help them pay for their plans.
Rather, “for most Floridians, it’s about coverage of doctors and hospitals,” he said. “More competition allows people to not have to change doctors because their doctor is not in a particular network.”
The situation is a far cry from five years ago, when uncertainty about federal reimbursements and political fights over the survival of what’s commonly known as Obamacare compelled large national insurers to pull out of Florida and many other states, leaving just a handful of choices.
Enrollees in subsidy-eligible plans from 2016 to 2019, for example, had just three insurers to choose from in Broward County, after major companies like United-Healthcare and Cigna pulled out, citing doubts about long-term financial viability of continued participation.
Now both of those companies are back, along with Blue Cross Blue Shield of Florida, the only company that never left, and smaller insurers that entered the market later, including Bright Health, Oscar Insurance Co. and Sunshine State Health Plan.
Broward, Palm Beach and Miami-Dade counties will see the return of UnitedHealthcare and Coventry Healthcare, a subsidiary of Aetna. Sunshine State Health Plan Inc., owned by Centene Corp. will be available in Broward and MiamiDade but not Palm Beach.
In 2021, AvMed entered the subsidized marketplace, also referred to as “on-exchange.”
Cigna, which withdrew from Florida in 2015 citing high fraudulent billing from substance abuse treatment centers, has tiptoed back into the state, starting with Collier and Palm Beach counties in 2020, adding Broward and eight other counties in 2021, then adding Miami-Dade County for 2022.
“Specifically, we chose to enter markets where we have strong provider partnerships and are able to deliver competitive plans that connect customers to the coverage and plan features they value,” said Giselle Cushing, Cigna’s market president for South Florida, in an emailed statement.
Biden breathes new life into Obamacare
A big reason for the resurgence in participation can be traced to this year’s change at the White House.
Former President Donald Trump famously began his four-year term in January 2017 by signing an executive order “ending” Obamacare even though federal law prevented him from pulling the plug on individual health insurance policies purchased by millions of consumers, or on contracts with health insurers that sold those policies.
Failures by Republicans to overturn the 2009 Affordable Health Care Act in the Senate or to get it invalidated by the U.S. Supreme Court — along with Trump’s failure to develop a long-promised alternative — kept the system in place.
After taking office this year, Democratic President Joe Biden quickly expanded eligibility for federal subsidies for ACA plans and created a six-month special enrollment period that added 1.6 million to the 10.6 million who were covered by federal or state-run exchanges a year ago.
In Florida, about 400,000 new enrollees increased the number of enrollees in the state to 2.25 million by August, according to federal data, And in the tricounty region, enrollments increased by about 228,000 compared with the 951,000 who were enrolled at the beginning of 2021.
COVID-19 relief effort insures thousands more
Biden’s moves, funded out of the massive $1.9 trillion federal COVID-19 relief effort, included two major changes that took effect last spring and slashed premium costs for millions of people:
■ Any consumer who received a state unemployment benefit in 2021 became eligible for subsidies, including no-cost coverage, typically available only to those with incomes at the federal poverty level. That benefit is expected to expire at the end of the year.
■ People who earned 400% or more than the federal poverty level became eligible for subsidies thanks to a new policy that ensured they did not have to spend more than 8.5% of their income on health insurance. Previously, anyone making more than 400% were ineligible for subsidies, leaving them to pay full retail price on their premiums.
Eserman said that change helped one couple in their 60s who made just $73,000 and paid nearly $1,900 a month for their coverage reduce their monthly cost to between $200 and $300.
This benefit will remain in place through 2022, and the Biden administration is seeking to extend it indefinitely, said Krutika Amin, ACA analyst for the nonprofit health industry watchdog Kaiser Family Foundation.
Nearly all — about 98% — of Eserman’s 650 clients benefited from one of the changes, he said.
Nationwide, the measures also benefited enrollees who already qualified for federal subsidies and cost-sharing assistance. Average monthly premiums went from $105 to $63, Kaiser Family Foundation reported.
To more effectively spread the word about availability of subsidized health insurance, particularly for low-income and non-English speaking communities, the Biden administration restored funding for outreach programs back to pre-Trump levels.
Outreach budget restored
After discovering he couldn’t kill the ACA with the stroke of a pen, Trump did what he could to weaken its foundation. Those efforts included reducing the open enrollment period from three months to six weeks and slashing budgets of so-called “navigators” who promote Obamacare to uninsured populations and provide in-person and virtual assistance to guide re-enrollees through their choices.
In addition to expanding Open Enrollment to 11 weeks, Biden restored spending on outreach programs.
Jodi Ray, who oversees statewide outreach at the University of South Florida’s non-profit Florida Covering Kids & Families program, said her budget was increased from $1.6 million this year to nearly $12 million next year. The boost will enable her organization to grow from 60 navigators, some of whom don’t work year-round, to 200 year-round navigators.
The increased staff will ensure that the program can serve the growing ranks of insured Floridians and beat the bushes for those who remain uninsured, she said.
“We’re not going to reinvent the wheel, but we’re going to be doing a lot more of it,” she said. “More appointments, more calls, more requests for technical assistance. And if they don’t qualify [for an ACA plan], we make sure they’re connected to other resources.”