It was another record year for Affordable Care Act enrollment in the US, with Florida taking the lead, once again.
More than 4.2 million Floridians signed up for the federal health care marketplace for 2024 coverage, a 31% increase from last year – and more than 54% from the year before.
“We expected it to be high,” said David Pizzo, West Florida region market president for Florida Blue, one of the state’s leading providers of marketplace plans. “We look forward to seeing the final numbers to see where the growth came from and which parts of the state it came from.”
Enrollment in the federal health care marketplace has been on the rise nationwide since the pandemic. The new subsidies, introduced through the American Rescue Plan, offered expanded coverage options for families above the federal poverty level. The subsidies were later extended through the Inflation Reduction Act and are now set to expire in 2025.
Florida has the highest enrollment of any state. In 2023, Hillsborough County had the seventh-highest enrollment in the nation, behind five other Florida counties and two in Texas. Data showing 2024 enrollment by county has not yet been released.
Much of the state’s continued growth is due to population growth in recent years, experts say. But even because of its growth, Florida has one of the highest enrollment rates, with numbers higher than the largest states with the most residents.
The increase in enrollment is also “definitely consistent with the fact that we haven’t expanded Medicaid,” said Katie Roders Turner, executive director of the Family Healthcare Foundation, adding that the pandemic made it clear that people’s jobs and employment statuses change, sometimes quickly.
“For so many people, the federal marketplace may be their only option for affordable coverage,” she said.
In 2023, more than 911,000 Floridians were removed from the state’s Medicaid rolls after pandemic-era protections ended. Experts say some of those individuals entered the federal health care market.
This year’s increase was nearly double the change from 2022 to 2023, but was little surprise given the state’s rising cost of living, said Pizzo and Estella Gray, Florida Blue’s senior regional communications manager. Gray also noted that there are more workers in the Florida economy who own small businesses or work many part-time jobs that do not come with insurance.
“We’ve seen inflation and we’ve seen how the economy has affected our team members,” she said. “We have received calls from people who needed help with food; we’ve done backpack giveaways and things where we’ve had to support families.”
“We’re not completely shocked that enrollment numbers are going up,” she added. “Because we know health care is unaffordable in this country.”
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Meanwhile, education about market offerings has also improved over the years, Pizzo said. More people are realizing that they are eligible for subsidies.
Jeannie Moran, 56, lived without health insurance for years. She ran several businesses—she was a real estate broker, a mortgage broker, and she ran a legal document service—but she still didn’t think she could afford insurance. She did not know, until recently, that she was entitled to market subsidies.
“Every time I talked to someone, I got more confused,” Moran said.
But this year, she signed up for a Marketplace plan with Florida Blue after speaking with one of the provider’s representatives.
“I felt such a sense of relief,” Moran said. “Before, when I had insurance a while ago, I always checked myself. But then it came at a time when insurance was so expensive. It was just one of those things that you have to do without…But now, I’m happy, I’m safe.”
To qualify for subsidies in the federal marketplace as an adult, a policyholder must have a projected income of 100% of the federal poverty line. For example, this means that an individual must make at least $14,580, while a family of four must make $30,000. If they expect to earn less than that, they may not qualify for subsidies or meet the state’s strict Medicaid standards. Adults without children are not eligible for Medicaid in Florida, regardless of income.