MIAMI _ As Florida leads the nation once again in sign-ups for Affordable Care Act plans, experts say the health insurance marketplace known as Obamacare has stabilized in part because the Trump administration's efforts to undermine the law have backfired and made coverage more affordable for many.
After years of political wrangling, the health insurance marketplace set up under the Affordable Care Act appears to have stabilized in Florida, which leads the nation in sign-ups again this year by a healthy margin.
More than 1 million Floridians have signed up for plans on the ACA marketplace this year as of Dec. 7, nearly doubling the state with the second-highest total _ Texas, which has had about 538,000 sign-ups _ according to recent federal data from the Centers for Medicare and Medicaid Services.
Florida has led in sign-ups for several years in a row, a dynamic experts attribute to state lawmakers' decision not to expand Medicaid and the high number of uninsured people, among other factors. The window to enroll for coverage on healthcare.gov, which began Nov. 1, ends Sunday, Dec. 15.
"I think people are voting with their feet," said Anne Swerlick, health policy analyst and attorney with the Florida Policy Institute. "A lot of these are people who have previously been enrolled, and they've had the experience of having good, affordable coverage."
Since taking the reins of the federal government in 2017, the Trump administration has challenged the law in court, shortened the enrollment period and repealed the individual mandate requiring people to purchase health insurance, among other countermeasures.
But one of those moves ended up having an unintended side effect: drawing more federal dollars into the marketplace, said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation.
In late 2017, the Trump administration decided to stop making payments for a "cost-sharing reduction" federal subsidy created by the ACA to help reduce out-of-pocket healthcare costs for low-income families. Removing that subsidy created a ripple effect that resulted in much more affordable coverage for most consumers who qualify for a subsidy to pay their premiums.
"The cost-sharing reduction move was designed to hurt the market, but it ended up helping it," Hempstead said.
Though Florida leads the nation in ACA sign-ups, it also has some 2.7 million people under the age of 65 who are uninsured, according to the latest data from the Census Bureau.
About 694,800 of them would benefit from a federally subsidized "bronze plan," available at no cost on the ACA marketplace, according to a recent study by the Kaiser Family Foundation, a nonprofit that researches healthcare issues.
Rachel Fehr, who co-authored the study, said the Trump administration's cuts to healthcare marketplace navigator funding and other outreach efforts have contributed to the state's high rate of uninsured people, and help explain why so many are eligible for the bronze plans.
"I think a lot of people are simply not aware of these options," Fehr said.. "And it can be really overwhelming to go on to the marketplace and try to figure out what the best option is."
Though the plans have no monthly premium costs, Fehr cautioned that they often carry high deductibles, so consumers should check how much cost-sharing they'd be responsible for on the plans before choosing one.
Those who do use the ACA marketplace in Florida have seen their monthly premium costs stabilize after consecutive years of significant rate hikes by insurers. But people who don't qualify for federal subsidies are fleeing the marketplace, according to federal data released earlier this year.
"I think we've really shifted away unfortunately from this culture of coverage that was really strong after the Affordable Care Act was passed," said Swerlick, the analyst for the nonprofit Florida Policy Institute. "All these efforts to sabotage it and making it hard for people to get covered is pushing us backwards, as we see uninsured rates going up."
