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...

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…