Yesterday marked the fifth anniversary the signing into law of the Affordable Care Act also known as Obamacare and while Florida Gov. Rick Scott might not be a fan over 1.5 residents of the Sunshine State enrolled for insurance through the national exchanges. That number was the largest enrolment of any state in the entire country in 2015 and it could put the state in dire trouble should the Supreme Court rule against Obamacare late this summer.
Here are the five states that enrolled the most people in coverage through there exchanges in 2015:
Florida (1.596 million);
California (1.412 million);
Texas (1.205 million);
North Carolina (560,357)
Ironically only California had its own healthcare exchange while all four of the other states chose not to opt into to the exchange program.
Nationally over 16 million people signed up or renewed their insurance through either Healthcare.gov or in one of the state run exchanges.
Between the Nov. 15, 2014 and Feb. 15, 2015 open enrollment period, 1,600,006 people in Florida signed up or were re-enrolled in a health insurance plan, according to the U.S. Department of Health and Human Services. Texas, with 1,189,316, had the second most signups for the period. California was second overall because of the number they had enrolled through their own exchange.
South Florida had the most signups among major metro regions in the country, with 756,137 consumers selecting or re-enrolling in a plan. Atlanta-Sandy Springs-Roswell had the second most selections or re-enrollments in the country, with 353,879.
“It’s surprising Florida has done as well compared to other states, and they will be looked at by folks who want to learn lessons to promote enrollment,” said Joel Ario, managing director for Manatt Health Solutions, a consulting firm, who worked for the administration setting up the exchanges soon after the law was passed.
“It is truly ironic that Florida leads the nation in enrollment … with leadership that has actively opposed the law,” said Leah Barber-Heinz, executive director of Florida CHAIN, an advocacy group involved in outreach efforts. “It shows true commitment on the part of many and it portrays an extremely high need for affordable coverage.
There are other reasons cited for Florida’s robust enrollment —including intense competition among insurers in several big counties and the high degree of coordination among the nonprofits and community groups which received federal grants to sign people up.
Another key factor is the state’s decision not to expand Medicaid under the law. That’s left consumers with incomes above the federal poverty level of $11,600 per year with no coverage option other than to buy a private plan — with help from sliding-scale government subsidies. About 800,000 Floridians who make less than the federal poverty level are shut out altogether because they make too little to qualify for subsidies for private plans, but too much to qualify for Medicaid.
In Florida, adults with children qualify for Medicaid only if their income is below 34 percent of the poverty level. Childless adults are ineligible. Florida is one of 22 states that chose not to expand Medicaid after the U.S. Supreme Court made that provision optional for states.
Jon Urbanek, senior vice president of Florida Blue, the state’s dominant insurer, credits Florida’s strong enrollment in private plans, in part, to the state’s decision not to expand Medicaid. He also points to the intense outreach by thousands of the carrier’s insurance agents. Florida Blue has conducted about 3,000 “town-hall” style meetings at its 18 retail centers. “We knew going in that this was going to be a face-to-face, get in the community type of action to build trust with people,” he said.
Florida has also gained from having an older population which is more likely to buy coverage than younger people, Ario said. That population is centered in a handful of urban areas such as Miami, Orlando and Tampa, making them easier to target, he said.