ACA enrollment at all-time high in Florida despite support for Trump

Laveta Brigham

Tens of thousands in Palm Beach County go uninsured, while the heavily-Hispanic Miami-Dade County has the highest enrollment rate in the country. Wendy Rhodes   | Palm Beach Post Despite the fact that Floridians turned out in droves to help President Donald Trump and Republicans sweep the Nov. 3 elections, Obamacare […]

Tens of thousands in Palm Beach County go uninsured, while the heavily-Hispanic Miami-Dade County has the highest enrollment rate in the country.

Wendy Rhodes
| Palm Beach Post

Despite the fact that Floridians turned out in droves to help President Donald Trump and Republicans sweep the Nov. 3 elections, Obamacare enrollment in the state is at an all-time high. 

With just under a week to go before this year’s open enrollment period for the Affordable Care Act ends on Dec. 15, sign-ups in Florida are already up 32% over last year with nearly a million more individuals registering, according to the group Get America covered. 

The explosive growth in enrollment could be a result of the coronavirus pandemic, and the ensuing economic crisis, as more jobless Floridians seek health insurance coverage.

On Wednesday, in fact, U.S. Rep. Lois Frankel will host a virtual town hall to encourage people to seek coverage through ACA. The West Palm Beach Democrat notes the resurgence of COVID-19 cases and that the “many Americans losing their jobs and their health insurance” makes it “more important than ever that every American has access to affordable healthcare coverage through the ACA.”

Florida has led Obamacare participation almost since its inception. Miami-Dade County, which leads the nation as the county with the highest number of Obamacare enrollees, accounts for 457,666 of the state’s total of 1,913,975 enrollees.

One health insurer says interest in the program speaks to the need in the state and Palm Beach County, too.

Florida Blue, an insurance company that works in conjunction with Obamacare, reports that one in five adults in Florida fails to seek medical care because they cannot afford it. The company also reports that tens of thousands of Palm Beach County residents remain uninsured even though coverage is available to them through the ACA at no monthly cost. 

“These are individuals who could receive free yearly checkups, preventative screenings such as mammograms, and comprehensive blood work along with the security of knowing they are covered should an unexpected health issue arise – but they are missing out on this potentially lifesaving benefit,” said Jorge Martinez, senior regional communications lead for South Florida, in a statement.

Open enrollment for Obamacare through the Affordable Care Act runs through Dec. 15, even as the Trump administration seeks to have the law voided by the U.S. Supreme Court. The high court heard oral arguments last month in a case challenging the constitutionality of the individual mandate, which could call into question the entire ACA.

The popularity of the ACA among Floridians contrasts with the politics of Obamacare. While Floridians embrace the program, they have also supported politicians who are hostile to it.

More: Coronavirus: Florida adds more than 8,400 cases; 96 deaths reported

U.S. Sen. Rick Scott, who, as governor for two terms opposed expanding Medicaid to broaden ACA coverage, was re-elected in 2014 and then won election to the U.S. Senate in 2018. And President Trump, who made repeal of the ACA a centerpiece of his administration’s policies, won Florida in 2016 and then took the state in 2020 by an even larger margin.

So why did Florida, the state with the highest Obamacare participation rate in the entire country, support a president and congressional leaders who oppose the federal program which they have sought to access in overwhelming numbers? Particularly in the midst of an ongoing pandemic that has claimed the lives of almost 20,000 Floridians?

“The answer is, Trump has not campaigned in Florida on healthcare issues,” said Florida Rep. Rick Roth, a Republican from West Palm Beach. “If voters liked Trump, they believed Trump and actually believed he was trying to lower healthcare costs, trying to lower the cost of prescription drugs.”

And it is highly unlikely Trump voters were aware that Florida is part of a lawsuit to overturn the ACA and that Trump has taken that fight to the Supreme Court, he said.

“Trying to overturn something and overturning something are two different things,” Roth said. “It doesn’t make news that they filed the lawsuit, it makes news if they overturn it.”

One analyst said the “contradiction” between the popularity of the program and voting patterns appears particularly acute among Florida Hispanics.

“It’s a very strong contradiction,” said Jorge Duany, Director of the Cuban Research Institute at Florida International University in Miami. “This year I was surprised to find sort of a backlash on all issues including healthcare and other aspects of the economy. There was a tremendous support for all things Trump. I can’t really figure it out. The mood has changed.”

Duany said healthcare was not the only issue on which, for example, Cuban-Americans seemed to pivot from years past. But it is one that really sticks out. 

More: Grievance politics took root in South Florida, and it worked to a T for Trump

Even in Florida’s rural counties where uninsured rates can exceed 20%, Trump received as much as 80% of the vote. 

Like Roth, State Sen. Bobby Powell (D-West Palm Beach) thinks Floridians might not have understood precisely what Trump was up to. 

“Many people are not aware of who candidates are or their stance on particular issues,” Powell said. “They vote based on party or who they think they like or don’t like.”

However, healthcare was a front-and-center campaign issue for Democrats in this year’s elections.

Former President Barack Obama, along with President-elect Joe Biden, Jill Biden, Vice-President-elect Kamala Harris, her husband Doug Emhoff, and others pounded on the topic of healthcare in debates and rallies, warning voters in very specific terms what was at risk: affordable healthcare, coverage for pre-existing conditions, and the ability to keep children up to the age of 26 on their parent’s policies. 

Powell said the messaging from Democrats either wasn’t clear enough, or voters believed Trump’s unsubstantiated claims that he had a healthcare plan ready to replace the ACA. Or, maybe Republican’s just don’t like anything with Obama’s name tied to it, he said. 

“I think when people hear Obamacare they directly correlate it with President Obama and something he’s got something to do with,” Powell said. “When they hear ACA they think of something completely different, not realizing they are the same thing. 

Healthcare got lost in Democrats’ ineffective campaign messaging this year, Powell said, where in Florida, Republicans simply did a better job at getting their messages across to voters, even when it wasn’t accurate.

“People believe that Democrats want to take away your guns, which is not the case, but that’s been the message pushed out by some Republicans,” he said. “They say Democrats want to defund the police, which is also not the truth. But that can outweigh the message of ensuring affordable healthcare. People get caught up in talking points as opposed to reality.”

And there is good reason for that, said Peck. 

“It’s been really consequential that the Trump administration stopped outreach by 90%, meaning that over the last four years, there hasn’t been a single television ad advertising that open enrollment at is even happening,” he said. 

Still, in spite of Trump’s attempts to overturn and snub the program, the demand for ACA coverage remains “incredibly high,” Peck said, and Floridians are proactively seeking information about how to apply. 

One reason for this, he said, is because many Floridians cannot get the Medicaid coverage that other states offer. Medicaid is designed to be available for people who make too little money to afford health insurance, and Obamacare is designed to be there for people who make too much money to qualify for Medicaid, but still cannot afford insurance, he said. But Florida quashed the Medicaid part. 

“Florida is one of the states that has rejected Medicaid expansion,” Peck said. “That means the state has rejected tens of billions of dollars from the federal government that would help tens of millions of people in Florida get health coverage. It means the funds that would help low income people get covered never made it to Florida.”

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