WASHINGTON—
Florida will be burdened with huge gaps in health coverage -- leaving out hundreds of thousands of patients -- even if Obamacare overcomes its computer snags and entices people of all ages to sign up for insurance plans.
About 481,000 of the state's uninsured are illegal immigrants and remain ineligible for coverage benefits under the Affordable Care Act. And another one-fifth of the state's uninsured -- 764,000 adults – will be excluded from Medicaid coverage because state Republican leaders have refused to expand the program, according to a report released this week by the Kaiser Family Foundation.
Health-care advocates in South and Central Florida 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 remain concerned that many patients, especially young people, who could afford coverage or take advantage of tax credits will 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."
After months of computer snags, thousands of Floridians now are streaming into the online marketplace to enroll in insurance plans. But Steward and other leaders of the enrollment campaign remain concerned that many patients, especially young people, who could afford coverage or could take advantage of tax credits will not sign up.
"We need the healthy people in the program as well as the unhealthy," Steward said. "That means all age groups."
The good news is that the new health care law is at least partially closing some long-standing coverage gaps, the Kaiser study found.
About a third of Florida's uninsured are eligible for tax credits, which will help make insurance affordable. Another 23 percent are not eligible for subsidies but may benefit if the new marketplace generates competition that lowers premiums.
But the report found big coverage gaps in Florida, mostly because of the state's large numbers of illegal immigrants, who are excluded from subsidies and the online marketplace, and of low-income families who don't qualify for Medicaid or for subsidies.
Congress declined to include illegal immigrants under the new law, setting aside that controversial issue for another day, perhaps through immigration reform.
"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."
Meantime, proponents of the law thought they had covered large numbers of the uninsured by expanding eligibility for Medicaid.
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 Uncle Sam 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 net result partially undermines one main goal of Obamacare: to create near-universal coverage, which would widen the insurance pool, spread the risk of expensive care and help contain costs.
"It seems to fall outside the dream of the Affordable Care Act," Lewy said.
Wgibson@Tribune.com, 202-824-8256
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