Effort to overturn Obamacare could have widespread impact on health coverage in Florida

By: - July 11, 2019 7:00 am

More than 1.5 million Floridians could lose their health insurance coverage if Florida Attorney General Ashley Moody and the Trump administration are successful in repealing the federal Affordable Care Act.

It’s troubling news for those who want to keep what’s commonly known as Obamacare, which includes everything from coverage for pre-existing medical conditions to letting kids up to age 26 stay on their parents’ health plan.

But those families and taxpayers may not realize that Florida is moving to help kill the program.

Florida is part of a group of 18 Republican-led states, along with the U.S. Department of Justice, seeking to overturn the federal health-care act. Florida joined the lawsuit under former Attorney General Pam Bondi and Moody took it over when she became attorney general in January.

In December, a federal judge in Texas found Obamacare was unconstitutional because Congress in 2017 had eliminated a financial penalty for U.S. residents who declined to buy health-insurance coverage.

On Tuesday, the 5th U.S. Circuit Court of Appeals heard arguments in the case, which is likely headed to the U.S. Supreme Court after the appellate ruling.

Several outcomes are possible, including leaving all or part of the law intact. But if the main aim of the Republican-led lawsuit to repeal Obamacare is achieved, it would lead to a dramatic decrease in health-insurance coverage across the nation, according to a March report from the Urban Institute, a Washington, D.C. -based research group.

Nationally, the ranks of the uninsured would jump by nearly 20 million, or an increase of more than 65 percent, according to the report.

It would leave 3.9 million non-elderly Floridians without health insurance, a 1.56 million increase, the report shows. Florida would move from a state where 14.4 percent of non-elderly residents have no insurance to a population where nearly one in four have no health-care coverage.

The lack of health insurance would increase the demand for “uncompensated care,” such as sick, uninsured residents showing up at a hospital emergency room. In Florida, that demand would increase by about $4 billion if Obamacare is repealed, the report shows.

In addition to the loss of coverage, a full repeal of Obamacare would eliminate a host of popular benefits that have been in place since the law was passed in 2010.

It would remove the mandate that health insurance policies cover pre-existing medical conditions, such as diabetes. The Kaiser Family Foundation estimated in 2015 that some 3.1 million non-elderly Floridians had illnesses that could preclude coverage if it’s not mandated.

The repeal of the health-care law would eliminate the ability of children up to the age of 26 to remain on their parents’ policies. It would eliminate a set of mandated coverage benefits in health-care policies, including prescription drugs, maternity care, limits on out-of-pocket costs, mental health treatment and dental care for children.

“The consequences for Floridians would be devastating,” said U.S. Rep. Debbie Wasserman Schultz, a Broward County Democrat. The Democrat-led U.S. House of Representatives along with 20 states are defending the federal health-care act.

“What Floridians would lose is people with pre-existing conditions like me, a breast cancer survivor, would no longer be assured of having coverage, or not being dropped or denied of that coverage,” Wasserman Schultz said.

She said before the federal health care law took effect, she had met with breast cancer patients who were denied coverage or were left in a position of trying to decide whether to undergo radiation or chemo treatments because they could not afford the insurance co-payments for both.

“The Affordable Care Act made that angst a thing of the past,” Wasserman Schultz said.

Both in Washington and in Tallahassee, Republican leaders have said they would retain some of the more popular provisions of the health-care law, such as covering existing medical conditions, if the act is overturned by the courts.

“We’ll be ready to do what we need to do,” Republican Gov. Ron DeSantis told the Florida Phoenix in April when asked about the impact of overturning Obamacare.

The 2019 Legislature took a tentative step toward developing a replacement plan. But the new law falls far short of providing the mandated benefits of the federal health-care act at an affordable price for consumers.

The law only says if the federal health-care act is overturned or repealed, health insurers in Florida must still offer a policy covering pre-existing conditions. But it provides no guidelines on how much those policies will cost.

The problem of the replacement cost was illustrated in the Louisiana Legislature this spring. Lawmakers there advanced a bill that would require health insurers to cover pre-existing conditions and provide coverage to children up to the age of 26 if the Affordable Care Act is overturned.

But lawmakers dropped the effort when state analysts projected the legislation would result in “de facto premium increases” because of the loss of premium subsidies provided under the Affordable Care Act.

The federal premium subsidies make the insurance policies more affordable under the current law. But without the subsidies, the analysts said “the cost of the unsubsidized premiums would be passed on to consumers by insurers.”

The analysis projected $256 million in higher premiums in 2020, rising to $634 million by 2024. For comparison, Louisiana is a state that is about a fifth of the size of Florida.

A record number of 1.78 million Floridians signed up for health-insurance policies this year through the federal exchange created under the Affordable Care Act. Many of those policies included premium subsidies that are available to families earning up to 400 percent of the federal poverty level.

It can work like this for a family of four in Miami, according to healthinsurance.org: If they earn $70,000, the family can get a premium subsidy of $1,051 a month in 2019. The cheapest exchange plan would result in a $116 a month premium.

The repeal of the Affordable Care Act would have less of an impact in Florida when it comes to Medicaid coverage. Florida remains one of 14 states that has not expanded Medicaid coverage under the federal law.


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Lloyd Dunkelberger
Lloyd Dunkelberger

Lloyd Dunkelberger has been covering Florida government for over three decades. He’s reported and edited in Tallahassee for the New York Times Regional Newspapers group, Florida Politics, and the News Service of Florida. He grew up in Jacksonville and Palm Beach County and got his journalism degree at the University of Florida.