Obamacare enrollment window opens to pandemic landscape of economic woes, legal threat

Florida entered the novel coronavirus pandemic in a precarious position, with the fourth-worst rate of people without health insurance in the country and as one of a dozen states with a Legislature that has so far refused to expand Medicaid eligibility for low wage-earners.

Now, advocates for expanding health insurance access are watching closely as the state on Sunday begins the six-week window for open enrollment on the insurance marketplace supported by Obamacare, a law facing an existential challenge in the U.S. Supreme Court — one that the state is signed onto as plaintiff seeking to overturn it.

About 13.2% of Florida’s population had no health insurance in 2019, according to the U.S. Census Bureau. Of those people, some 1.9 million signed up on the marketplace during open enrollment that year, despite the state having fewer “navigators” to help consumers deal with what can often be an overwhelming experience selecting health insurance plans on the Affordable Care Act marketplace.

That’s because federal funding cuts and the law’s embattled status have left the navigators with packed phone schedules and few opportunities to do in-person consults. That’s a trend that has held true again this year, even as the pandemic has brought new waves of people who need health insurance because they were laid off.

Jodi Ray, project director of Florida Covering Kids & Families, an ACA navigator group, said she’s seeing a lot more people who have moved in with family or friends in Florida after they lost their jobs in other states.

Pandemic leads to people losing their jobs — and health insurance

“People have been sitting on furloughed jobs and now all the sudden they’re getting layoffs and losing health insurance,” Ray said. “Whole families are losing the ability to be dependent on employment-sponsored insurance. It’s been really a complicated time.”

The pandemic has exposed a glaring downside of the U.S. healthcare system, especially in the state of Florida, where there are few options for low-income people in need of healthcare, said Alison Yager, director of policy advocacy for the Miami-based Florida Health Justice Project.

“We have seen that relying on an employer-sponsored healthcare system is fragile at best,” Yager said.

While advocates deal with a surge of people needing help in finding affordable healthcare access, they are simultaneously making their case for state lawmakers to invest in healthcare reforms that don’t depend on employment, particularly Medicaid expansion, which Democrats continue to push in the Republican-controlled Florida Legislature without success.

Under the ACA, states have had the option to expand Medicaid to cover people under the age of 65 and under the income cut-off of about $17,600 — or 138% of the federal poverty level.

In the midst of the pandemic, likely voters in Florida overwhelmingly favor expanding Medicaid, according to a new poll by the nonprofit Commonwealth Fund, which advocates for health insurance coverage expansion.

The Commonwealth Fund noted in a press release that “support for expansion was noticeably high in Florida (73%) and Texas (67%).”

“These two states have historically had among the highest uninsured rates in the country,” the group said. “Together they account for 27 percent of the nation’s uninsured population under age 65.”

Miriam Harmatz, executive director of the Florida Health Justice Project, said the pandemic “has shown us a huge need for Medicaid expansion.”

“In other states, if someone loses their job, they can go right onto Medicaid,” Harmatz said. “That’s not the case in Florida, tragically.”

Obamacare under legal challenge

In Florida, life without Medicaid expansion has proven difficult for years, but advocates are making a more immediate push to confront a legal challenge to the Affordable Care Act heading to the Supreme Court.

The state is one of 18 states suing for the repeal of the ACA law. The case scheduled to be heard by the Supreme Court on Nov. 10, a week after Election Day.

The Florida Health Justice Project is urging state Attorney General Ashley Moody to withdraw from the case, Texas vs. California, which will hinge on whether the entire law is invalid without the individual mandate in tact. The court is expected to rule on the case before it ends its term in June 2021.

The healthcare advocacy group is warning that a ruling that dismantles the law could have “potentially devastating consequences” as Florida continues to contend with the COVID-19 epidemic. On Friday, Florida’s confirmed cases reached 800,216. More than 16,720 people have died in the state since the pandemic began in the spring.

“The COVID-19 crisis has completely upended the conditions and premises under which Florida entered the lawsuit,” the group wrote in a letter to Moody’s office.

The state AG told Miami Herald news partner WLRN that it was not going to comment on the ongoing litigation.