Florida: Obamacare’s biggest foe is its greatest success story

Florida led the nation in opposing the Affordable Care Act, filing the first lawsuit – one that ultimately landed on the steps of the U.S. Supreme Court. Now Florida leads in a surprisingly different direction. It has outpaced every other state in Obamacare enrollment in the federal marketplace.

After a slow start, Florida has led the crowd three straight months. About 442,000 Floridians enrolled by the February count, released this month. With that number, Florida outranks all states but California, which ran its own marketplace and has nearly 869,000 enrollees.

By way of comparison, Texas had 295,000 enrollees. It’s another big state with a political climate unfriendly to the law, and 8.8 million more residents than Florida. Texas has the nation’s highest proportion of uninsured residents. One in four of its residents has no health insurance compared with about one in five in Florida.

New York, which almost ties Florida in population, with 19.6 million residents, enrolled 245,000 residents. That’s a little more than half of Florida’s total.

Florida advocates credit their success to:

  • Close coordination among groups, in which one might identify uninsured residents and then hand off that information to another group trained to pick up the enrollment.
  • Tapping organizations with experience in health care enrollment.
  • An abiding belief that the work would help hundreds of thousands of Floridians get high-quality, affordable coverage.


“We are proud to have helped make Florida a consistent leader among the nation in bringing affordable, accessible health coverage to our community,” said Nicholas Duran, Florida director of Get Covered America. “We’ve doubled-down our outreach efforts in the last weeks and with less than (two weeks) of open enrollment left, we’re excited to continue this statewide trend.”

The enrollment success is all the more surprising because the health-care law is not particularly popular in Florida. A Florida Chamber of Commerce poll of likely voters in October found that 51 percent oppose Obamacare. Political pundits widely credited an electorate hostile to the far-reaching health care law for the recent defeat of former state Chief Financial Officer Alex Sink in her bid to become a member of Congress.

Laura Goodhue, vice president of public policy and communications for Planned Parenthood of South Florida and the Treasure Coast, said the numbers are proof that a core of the state supports and needs the law.

“It’s just really clear that with the high success rate of enrollment that Floridians really do want access to affordable health care,” she said.

Before advocates could begin enrolling, they had to overcome an information gap that was an even bigger hurdle than dislike of the law.

Gov. Rick Scott famously told Fox News’ Greta Van Susteren, after the Supreme Court upheld the law: “We’re not going to implement Obamacare in Florida.”

And as far as state leaders were concerned, that’s pretty much what happened.

Unlike places such as Oregon and California, which spent millions on advertising alone, Florida politicians made a conscious effort not to assist enrollment efforts.

Scott rejected funding so the state could run its own insurance marketplace or mount a public education campaign about the federal law.

Leaders also declined to dedicate state money to any kind of information campaign.

That left a vacuum that advocates had to fill.

Groups like Enroll America went door-to-door, often finding Floridians who didn’t know about the marketplace, an online space where they could buy insurance and perhaps get federal government assistance for it.

“The issue of the Affordable Care Act has somewhat been wrapped up in politics, but what you find, and the most fascinating thing is, when you’re actually talking to someone about their personal health care options, that flies out the door. You have real conversations with people who are really trying to figure this out,” explained Ray Paultre, Enroll America’s Florida organizing director. “People are generally receptive.”

Advocates started their work more than a year before the October enrollment launch. One contributer to their success is that organizers worked closely to make sure no one was duplicating efforts or holding competing events at the same time.

“Florida’s health care advocates have a strong, unified coalition with a focus on committing resources to every kind of public outreach and education we can think of to do,” said Leah Barber-Heinz, chief executive officer of Florida CHAIN, a health-care advocacy organization.

Advocates had to be nimble in their outreach efforts.

For instance, Planned Parenthood quickly realized that a lack of access and familiarity with technology was standing in the way of enrollment, Goodhue said.

So the national organization, which received some federal funding to train enrollment counselors, used its own money to buy door-to-door technology.

Armed with tablets, volunteers could help residents with the most basic steps, such as setting up an email account, which is needed to enroll. After getting people started on their doorsteps or in their living rooms, volunteers would hand them off to counselors throughout the community trained to walk them through enrollment one-on-one.

Advocates took a moment to celebrate the states’ top billing. But with just weeks left, it was only a moment. They are busy in one the nation’s largest states trying to fit in an as many appointments as they can to enroll residents.

“Our goal from the beginning is just to make sure as many people get coverage as possible,” said Eric Conrad, an Enroll America spokesman. “Obviously we’re on the way to do that, but the work’s never done.”

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