Hurricane Irma, political storms roil finish of health sign-up season

Between political tug-of-war over the Affordable Care Act and the aftermath of a hurricane, Florida consumers might be forgiven for thinking that signing up for 2018 health plans is starting to feel like running an obstacle course blindfolded.

An enrollment window for plans that was cut in half by the Trump administration officially ends Friday. But the winds of Hurricane Irma effectively keep it open until Dec. 31 for residents of Florida, the leading sign-up state, according to insurers, consumer-aid organizations and information provided on background by a federal official.

An email to a Palm Beach County resident Thursday from makes no mention of the extension, stating simply that the final deadline is at hand.

“OFFICIAL NOTIFICATION: The final deadline to enroll in a 2018 Marketplace plan is tomorrow, December 15 at 11:59 PM (PST),” the email says.

In another, separate program, the storm has also extended to Dec. 31 the deadline for Florida residents to choose or change Medicare plans.

One group that coordinates “navigators” who help people sign up for ACA plans said it prepared radio ads for West Palm Beach and other markets noting the Dec. 31 extension, but had a hard time persuading a station manager in Miami to run them. Reason: The manager could not find any confirmation the deadline was anything but Dec. 15.

“We’re still trying to push that you have up until the 31st,” said Islara Souto, statewide navigation director for the Epilepsy Foundation of Florida. “There’s a lot of confusion out there.”

After Dec. 15 — or technically, after 3 a.m. Eastern time on Dec. 16 — consumers who want to buy a policy have to call Marketplace Call Center at 1-800-318-2596. They cannot enroll online during the special extended period.

As for Medicare, the formal Medicare open enrollment period ended Dec. 7, but Irma means Florida seniors can sign up until the end of the month.

One company that provides Medicare Advantage plans, Humana, has been taking calls from seniors including a West Palm Beach couple displaced by the storm, said the company’s Palm Beach County market manager, Ken Szilagyi. Some people are only now returning after their homes were damaged, in some cases living with relatives in another state, he said.

Some “had to move out of the area temporarily,” he said. The company is keeping service centers in Boynton Beach and West Palm Beach fully staffed through the special enrollment period, he said.

Another wrinkle: People who have been displaced from Puerto Rico by Hurricane Maria might need to enroll if they plan to live long-term in Florida.

About 4 million Floridians are on Medicare.

Meanwhile, no state has more people under 65 signing up for health policies in the Affordable Care Act’s federal marketplace than Florida. The state has for several years led the nation, with a peak enrollment of about 1.7 million.

The state’s running total for 2018 stands above 1 million as of Dec. 9, nearly double No. 2 Texas and accounting for more than a fifth of the 4.7 million sum in the country as a whole. Big blue states like California and New York use their own state exchanges.

It’s not yet clear what final enrollment in Florida and throughout the country will turn out to be, but it appears set for a backwards tumble as the Trump administration has slashed the advertising budget 90 percent, reduced money for in-person assistance to help people sign up and left many consumers unsure about what comes next.

Now throw in a wild card from Congress. It is finalizing a tax plan that GOP leaders said Wednesday would eliminate the penalty for not having insurance. A resolution could come as early as next week if the plan wins enough final votes in both chambers.

The tax bill will “repeal Obamacare’s individual mandate tax, delivering relief to low- and middle-income Americans who have struggled under an unpopular and unworkable law,” said Senate GOP majority leader Mitch McConnell.

That is likely to have an effect on many last-minute insurance buyers, some of whom in past years have figured that if they have to pay a penalty — now $695 or more — they might as well put that money toward insurance. Now many might be tempted to wait and see what Congress does and when it takes effect.

The Congressional Budget Office has projected eliminating the penalty will cause 13 million Americans over a decade to drop or avoid health insurance they might have otherwise bought.

If that many healthy, younger consumers bail out of buying insurance, premiums for remaining Obamacare marketplace customers are likely to go up about 10 percent, budget analysts figured.

That could help reverse a trend that saw Florida’s uninsured rate drop from 16.5 percent in 2014 to 12.4 percent in 2016, said Allan Baumgarten, a health-market analyst based in Minneapolis who issues annual reports on state health markets.

“If the efforts of the Trump administration to undermine the ACA continue, I think we’re looking at all sorts of problems with the individual market, which will have spillover effects for hospitals and others in the system,” he said.

For example, hospitals in Palm Beach, Broward, Miami-Dade and Monroe counties were able to reduce by about 20 percent the days their beds were filled with people who couldn’t pay with insurance from 2014 to 2016, he said.

That helped stabilize their financial results, he said.

Now the trends are anything but certain in Florida, which ranks among the five states with the most uninsured people with more than 2.5 million. The number of people covered by employer plans has nudged up as the unemployment rate has dipped, but a big factor driving down the uninsured rate has been individual plans bought outside the workplace, from sources including the Affordable Care Act marketplace, according to figures Baumgarten cites.

If uninsured rates go up again, hospitals, insured customers and taxpayers will likely get stuck with a higher bill to cover those who don’t have insurance or enough personal savings to pay, analysts say.

“There’s so much uncertainty I wouldn’t even try to predict what’s going to happen next,” Baumgarten said.

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