There will be about 1 million in Florida without health insurance as 481,000 of the uninsured are illegal immigrants who are ineligible for health covers under the Affordable Care Act. One fifth of the 64,000 adults will not be eligible for the Medicaid program as the Republican leaders have refused to expand the Medicaid program.
Health-care advocates say the ongoing coverage gaps indirectly affect all Floridians by straining emergency services and raising insurance rates to compensate for the uninsured.
"You'll still have people going into emergency rooms for their care, which is something we really hoped would not happen," said Robert Bertisch, executive director of the Legal Aid Society of Palm Beach County, which received a federal grant to enroll patients. "We were thinking that with the Affordable Care Act most people would get covered and have private insurance so they wouldn't be using emergency rooms for their primary care."
After months of computer snags, thousands of Floridians now are streaming into the online marketplace set up to enroll in insurance plans. But Bertisch and other leaders of the enrollment campaign feel that young people would not take advantage of the tax credits offered and would not sign up
"We can't just have all the people with severe medical issues and disabilities on it," he said. "We have to get the young healthy people on it to make the cost work."
"What they'll do is what they do now: go to the emergency room as a no-pay," said Dawn Steward, who helps administer an enrollment campaign in Orange County. "That's the most expensive form of health care there is. And they will be sicker when they get there."
"We need the healthy people in the program as well as the unhealthy," Steward said. "That means all age groups."
One third of the people of Florida are eligible for tax credits and 23% are not available for subsidies but on the federal marketplace be available at lower premiums.
There are large numbers of illegal immigrants in Florida and the Congress had ruled against health insurance for them under the new law.
"In Florida we still have a large number of immigrants who are undocumented, and therefore left out of the possibility of even applying through the private marketplace," said Robin Lewy, director of education for the Rural Women's Health Project, which operates programs in Jupiter, Lake County and other parts of the state. "They are going to put off preventive care because of the cost. When they do seek services, their health is in a delicate state, and the costs are exorbitant."
Millions nationwide and hundreds of thousands of low-income people in Florida now qualify for Medicaid for the first time under the federal law. They do not qualify for tax credits for buying insurance because presumably they would be covered through Medicaid.
But Florida and some other Republican-run states refused to expand Medicaid, though Washington committed to pay for more than 90 percent of the cost. That leaves a big pool of people - 764,000 in Florida who remain caught in a coverage gap.
The main purpose of Obamacare is undermined in their goal to enroll all uninsured people for health care. "It seems to fall outside the dream of the Affordable Care Act," Lewy said.
Hannah Punitha (IRDA Licence Number: 2710062)
William E. Gibson, January 2014