Affordable Care Act ACA Implementation State of Florida

State of Florida: Affordable Care Act (ACA) Implementation The Affordable Care Act (ACA) was designed to extend healthcare coverage to more Americans, ideally to cover all Americans. Yet the passage of the bill was relatively turbulent, and resulted in a somewhat inconsistent implementation of its fundamentals on a state-by-state basis.

Before the ACA, the state of Florida had one of the highest uninsured rates in the nation and after the implementation of the ACA and the healthcare exchange, “the uninsured rate has reportedly dropped from around 20% in 2013 to 15.2% in 2015,” although this rate is still higher than the national average of uninsured persons (Born, 2017, p.3). Florida is one of the states that has elected to have its citizens research and obtain healthcare coverage on the national exchange, rather than implement a state-specific healthcare exchange.

As noted by Norris (2018), using the most recent data available, Florida has the highest percentage of enrollees on the government exchange, an indication that a very low percentage of the state is able to obtain healthcare insurance through their employers, even when they do not qualify for Medicaid or Medicare—14.6% of all individuals enrolled in healthcare insurance programs purchased on the ACA website are in Florida.

It should be noted that fewer Floridians enrolled in ACA coverage on the national exchange in 2018 versus 2017, perhaps due to the less aggressive advertising for the healthcare exchange deadlines by the Trump Administration. The current administration initially vowed to gut or repeal the bill.

It has since largely let the ACA languish rather than aggressively attempt to repeal it, although there have recently been a number of legal challenges to undercut its provisions, most notably the individual mandate demanding all Americans have some sort of healthcare coverage or pay a penalty (with some exceptions).

But Florida, if anything, is even more committed to the provisions of the bill than ever before, given that the Department of Health and Human Services deemed that residents affected by Hurricane Irma located in a FEMA-approved disaster area would have an extended enrollment period until March 31, 2018 last year (Norris, 2018). As a result of Irma, the entire state was classified as eligible for assistance, due to weather-related effects (Norris, 2018).

Thus, the state’s unusually pervasive need for healthcare has been federally recognized, despite the current Administration’s hostility to the ACA, and residents continue to purchase ACA plans in large numbers. Initially, there were worries that cost premiums in Florida would skyrocket out of the reach of state residents because of the Trump Administration’s refusal to fund cost savings reductions (CSR) for ACA insurance plans (Norris, 2018). CSRs were provided by the federal government directly the insured (Norris, 2018).

“For eligible consumers, cost sharing reduction subsidies lower the out-of-pocket maximum — the total amount they pay for covered medical services per year. When they reach their out-of-pocket maximum, consumers’ insurance plans pay for 100% of covered services” (Chang, 2017, par. 7). One of the great initial criticisms of the ACA was that the deductibles for plans were so high, it was not considered worthwhile for many consumers to purchase coverage on a cost-benefit basis.

CSR were designed to effectively lower the deductibles, and make buying healthcare insurance more attractive as well as make healthcare more affordable in general. When it became clear that they could no longer rely upon CSR support, Florida health insurers raised their premiums. Only 6 insurance companies participate in the exchange, and only one fully covers the state (Norris, 2018).

This substantially limits Floridians’ choices in terms of the company they can select, although they do have options to select Bronze, Silver, or Gold plans depending on their healthcare needs (Bronze plans are the cheapest and have the highest deductibles; Gold plans are the most comprehensive but also have higher premiums). Currently, 91% of the state’s enrolled participants in healthcare plans receive some sort of subsidy for their healthcare and would likely struggle to pay premiums without financial support (Norris, 2018).

But there was an interesting paradox—although the Trump Administration hoped to weaken the ACA by eliminating federal CSR, it unintentionally expanded access to Floridians. The fact that insurers hiked their premiums so high, as much as 45% on average, meant that as the premium for the benchmark Silver plans rose, so did the number of consumer eligible for subsidies.

This expanded the number of consumers in Florida who qualified for additional support, given that the law states that consumers should not spend more than 9.5% of their income upon premiums (Chang, 2017). Interestingly enough, this cost the federal government more rather than less in the long run in Florida, although not all states saw the salutary benefit that Florida healthcare consumers on the exchange enjoyed.

At present, the average subsidy to Floridians receiving healthcare through the exchange is $363.99 and as a result of the change in funding approach, some healthcare consumers even saw their actual out-of-pocket total for premiums decrease rather than increase (Change, 2107). The greatest losers, of course were consumers who made slightly too much to qualify for subsidies at all, or approximately 7% of Floridians who buy their health insurance on the exchange (Chang, 2017).

Subsidies are available to consumers who are earning less than than two-and-a-half times the national poverty level, roughly $30,000 for an individual and $51,000 for a family (Chang, 2017). Florida is largely considered a red state, or a state which favors Republicans, despite its high poverty rate in many areas.

This current impact of the ACA is likely seen as a Republican victory in Florida, given that the state has been effectively buffered from the negative impact of anti-ACA leadership in terms of premium hikes, even while on a federal level the government can claim to still oppose the ACA. But the Florida legislature has still enacted a number of measures to make healthcare more accessible as well as more affordable to residents, and increased consumer protections.

For example, in 2016, Florida banned balance billing, which limited the ability of consumers to select healthcare providers (Born, 2017). The state legislature also required hospitals to identify before providing care if providers are in-network and to explain to patients in layperson’s terms what services were covered beforehand (Born, 2017). Such measures prevent consumers from being surprised by unexpected lab costs not covered by their insurance, or facing an unpleasant surprise to discover that although the hospital itself may be classified in-network, the particular provider they saw was not.

Hospitals have acknowledged the need to keep information current, both for their own reimbursement as well as to protect patients from unexpected costs. “Hospital experts agree there needs to be more clarity about whether a hospital is in a particular network…a hospital signed with a plan, but then later learned it was not part of the plan” (Born, 2017, p. 18). Other positive signs in Florida are that physicians and hospitals have shown a strong level of willingness to accept patients who have obtained coverage through the exchange.

There has been a greater trend to consolidation throughout the state, as healthcare operational costs have grown, but this has not impeded access to care, as much of the larger networks do accept the carriers which offer plans through the exchange, and accept those plans (Born, 2017). In the past, throughout the United States, there have been concerns regarding healthcare providers’ acceptance of Medicaid and Medicare, given these government-funded plans often reimburse costs at a much lower rate than private insurance plans.

The plans purchased through the exchange are from private providers, so physicians and hospitals have often seen a substantial net gain in terms of having more patients, and seeing patients more regularly for preventative procedures, versus procedures healthcare consumers have postponed seeking treatment for until they cannot do otherwise, as was the case.