Obamacare remains popular in Republican stronghold 13 years after US law was passed

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Lídice Hernández opened an insurance agency last year on a busy street, affixing to the front a logo that has become deeply familiar in South Florida: a white sun rising over the red stripes of the American flag, all surrounded by a large blue circle.

“Obamacare” is written below.

Similar signs are common on some of Miami’s main thoroughfares, nearly 13 years after former President Barack Obama’s health policy, the Access to Health Act, became law and critics branded it with his name. Everywhere you look, especially during the November-January application period, you’ll see: Obamacare, Obamacare, Obamacare.

“If we don’t use it,” explains Hernández of the nickname, “people don’t know we sold it.”

And in Miami people want a lot of that. At first glance, the show’s massive popularity in South Florida remains one of its most intriguing points. The evidence is visible in all of the Obamacare logos used – on shop windows, trucks, flags and billboards – to sell health insurance.

Florida has far more people enrolled in the federal health insurance market created by the Access to Health Act than any other state, a distinction that has held since 2015. Driving those numbers has been the Miami area, where older Hispanics and Republican-leaning seemed reluctant to embrace government-subsidized health insurance when the law was enacted. At the time, the program sparked some of the fiercest partisan battles in the country’s recent history.

In particular, some Miami residents who fled Cuba and other Latin American countries were angered by the law’s requirement – later scrapped – that people have health coverage or face a penalty, which critics condemned as “socialism”. “.

The region has leaned more towards the Republicans since then, turning red [cor associada ao partido] in the gubernatorial race last year for the first time in two decades. However, in 2022, the two locations with the most enrollment in ACC coverage nationwide were in Doral and Hialeah, cities west and north of Miami known for their right-wing Venezuelan-American and Cuban-American communities. American. And the county with the most entries in the country remained Miami-Dade.

“It’s ingrained in our community,” says Nicholas Duran, a former Democratic state representative who worked for a nonprofit group that encouraged Americans to enroll in Obamacare plans and now works for health insurer Aetna. “It’s stuck.”

So does the ubiquitous logo, which began as a symbol of Obama’s 2008 presidential campaign, according to Sol Sender, who designed it. It was never intended to represent health care law, she said, calling its use by enterprising insurance agents “simply organic.”

Which is not to say that policyholders, while pleased to have coverage, are always satisfied with their plans. Gisselle Llerena, one of Hernández’s clients, says she couldn’t get her insurance company to approve a doctor-recommended test. “I have an MRI pending from a century ago,” Llerena, 50, says in Spanish as she visits Hernandez’s office. “But the insurance doesn’t want to cover it.”

Still, Ivan A. Herrera, CEO of the Miami-based insurance agency UniVista, which prominently advertises Obamacare plans, says he has seen plenty of evidence that coverage has helped people.

“I know clients who have had open-heart surgery. They never went to the doctor, never had a blood test, never visited a specialist. And now they can take care of themselves.”

About 2.7 million residents of the state of about 22 million signed up for a plan through the federal insurance market, created by the health law, in 2022. Compared with Texas, which has about 30 million inhabitants but only about 1.8 million subscribers, “Florida is like a health law monster,” says Katherine Hempstead, policy adviser to the Robert Wood Johnson Foundation, a health charity.

The average monthly premium last year for state residents with market plans was US$611 (R$3,109); for those who qualified for federal subsidies, the average was $552 (R$2,809) a month, slightly higher than the national average, according to the Kaiser Family Foundation.

Early federal data suggests enrollment is up again in 2023, with 15.9 million national options for the plan in the federal and state-administered market, including nearly 3.2 million — one-fifth of the total — in Florida.

The fact that Obamacare has become a part of life in Florida is also impressive, given the initial opposition to the law led by Rick Scott, then Republican governor. Scott, now a senator, barred “browsers” — those who helped people apply for coverage — from the state Health Department offices in an attempt to undermine enrollment.

The Republican-controlled state legislature failed to expand Medicaid, the federal health insurance program for low-income people, as allowed under the Affordable Care Act, making Florida one of only 11 holdout states.

About 790,000 currently uninsured Florida people would be eligible for expanded Medicaid, according to Kaiser; without it, other low-income residents have turned to the federal market for subsidized coverage, which is one reason Florida has so many applicants.

Obamacare is also popular because the state is home to many retirees under age 65 who are not yet eligible for Medicare, the federal health insurance program for seniors. Others opt for the plan because they’ve recently moved and may be between jobs—many employers don’t offer Florida workers robust benefits that include health care coverage.

Hernández, who voted for Obama in 2008 but later registered as a Republican, lamented that Congress had not updated the health care bill to make more people permanently eligible for subsidies to help cover his insurance premiums. (The subsidies were temporarily expanded through the American Rescue Plan and the Reducing Inflation Act and are in effect through 2025 — one of the main reasons for recent enrollment increases.)

But she says she is pleased that Republican lawmakers have stopped trying to repeal the law. “Obamacare needs to be fixed,” she says. “But when I saw how easy it was to get it, I thought, ‘Oh my God, people don’t know this. Why don’t more people understand it?'”

She and her family are now insured through the program.

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