Editor's Note -
If anybody had trouble navigating to the Shkreli Awards, given out by the Lown Foundation, here is another link -
https://lowninstitute.org/projects/2022-shkreli-awards/
Sorry if you had any problems.
- SPC
Why Republican Politicians Still Hate Medicare
The Republicans who now control the House will soon try to slash Social Security and Medicare. They plan to achieve this by holding the economy hostage, threatening to create a financial crisis by refusing to raise the federal debt ceiling. The interesting questions are why they want to do this, given that it appears politically suicidal, and how Democrats will respond.
Before I get into the puzzles, let me start by pointing out that the plot against the social safety net isn’t a conspiracy theory. The general shape of the scheme has been widely reported for months. The arithmetic is also clear: It isn’t possible to achieve huge reductions in the budget deficit, while at the same time depriving the I.R.S. of the resources it needs to go after tax cheats, without deep cuts in popular social programs.
And beyond all that, we now have it in black and white — well, blue on blue. CNN has obtained a screenshot of a slide presented at a closed-door Republican meeting on Tuesday. The first bullet point calls for balancing the budget within 10 years, which is mathematically impossible without deep cuts to Social Security, Medicare and Medicaid. The second calls for reforms to “mandatory spending” — which is budget-speak for those same programs. And the final point calls for refusing to raise the debt limit unless these demands are met.
So the plan isn’t a mystery. I would add only that if Republicans try to assure currently retired Americans that their benefits wouldn’t be affected, this promise isn’t feasible — not if they’re serious about balancing the budget within a decade.
But where is this determination to gut programs that are crucial to well over 100 million Americans coming from? These programs are, after all, extremely popular — even among Republican voters.
It’s true that self-identified Republicans say that they are vehemently opposed to “socialism.” But when an Economist/YouGov poll asked them which programs they considered socialistic, none of the big-ticket items made the cut. Social Security? Not socialism. Medicare — which is, by the way, a single-payer national health insurance program, which we’re often told Americans would never accept — also isn’t socialism.
Unfortunately, that poll didn’t ask about Medicaid, a program targeted at lower-income Americans that many Republicans consider a form of “welfare.” Even so, a Kaiser Family Foundation survey found far more Republicans approving of Medicaid than disapproving.
One reason even Republicans support major social programs may be that G.O.P. support comes disproportionately from older voters — and most of America’s social spending goes to seniors. This is obviously true for Social Security and Medicare, which kick in primarily when you reach a minimum age. But it’s even true for Medicaid: Most of Medicaid’s beneficiaries are relatively young, but almost two-thirds of the spending goes to seniors and the disabled, many in nursing homes.
The attitude of the Republican rank and file, then, seems to be that big government is bad — but when we get down to specifics, don’t cut you, don’t cut me, cut that fellow behind the tree. Which means that the priorities of the new House majority are wildly out of line with those of its own voters, let alone those of the electorate as a whole.
And history says that attacks on the safety net come with a heavy political price. George W. Bush’s attempt to privatize Social Security in 2005 surely played a role in the Democratic takeover of Congress in 2006; Donald Trump’s attempt to kill Obamacare helped Nancy Pelosi regain the speakership in 2018.
So where is the push to gut Social Security and Medicare coming from? Ronald Reagan left the White House 34 years ago. The modern G.O.P. seems much less animated by small-government ideology than by the desire to wage culture war. And there’s no necessary connection between culture war and right-wing economics. For example, France’s anti-immigrant National Rally has, in effect, staked out an economic position somewhat to the left of the Macron government.
Put it this way: Advocating a welfare state for white people might well be politically effective. But in America, it’s a road not taken.
Here’s what I think is going on: Even now many, perhaps most Republicans in Congress aren’t culture-war zealots. Instead, they’re careerists who depend, both for campaign contributions and for post-Congress career prospects, on the same billionaires who have supported right-wing economic ideology for decades. They won’t stand up to the crazies and conspiracy theorists, but their own agenda is still tax cuts for the rich and benefit cuts for the poor and middle class.
And the culture warriors go along because they basically aren’t interested in policy substance.
I’m not completely sure that this analysis is right. But all indications are that at some point this year the Biden administration will have to deal with a full-scale effort at economic blackmail, a threat to blow up the economy unless the safety net is shredded. And I worry that Democrats still aren’t taking that threat seriously enough.
https://www.nytimes.com/2023/01/12/opinion/why-republican-politicians-still-hate-medicare.html
Editor's Note -
I challenge anybody reading the following article that is so full of spin jargon from Northern Light that it blows one's mind, to extract any real meaning from it. Is anybody out there able to re-state it in language that is actually meaningful?
- SPC
Northern Light Health announces partnership estimated to save $1 billion
by Jennifer Osborne - The Ellsworth American - January 11, 2023
ELLSWORTH — Northern Light Health announced last week that 1,400 of its workers will become employees of Optum, an information and technology-enabled health services business based in Eden Prairie, Minn.
The Portland Press Herald reported that the deal would save the Maine health-care provider an estimated $1 billion over the next decade.
“These employees will continue to support Northern Light Health and become part of the Optum workforce of 220,000 people with a mission to help people live healthier lives and make the health system work better for everyone,” said Northern Light spokesperson Suzanne Spruce.
“Optum brings immense size and scale to Northern Light that we could not accomplish on our own,” Spruce said. “Partnering with Optum in this way will allow Northern Light Health to leverage that scale to lower cost. For example, in supply chain, we will be able to negotiate pricing based upon global contracts.
“Another example is in revenue cycle, where Optum will share their processes to help us improve the scheduling and billing experience for patients,” Spruce said. “Likewise, Optum is excited to add the expertise of our talented Maine workforce to their team. It is a win, win, win for Northern Light Health, Optum and our staff.”
The staff that are part of the transfer to Optum are those in Revenue Cycle Management, Information Systems, Inpatient Care Management, Analytics, Project Management Office and Supply Chain for Northern Light Health, Spruce said.
“The only clinical facing staff are those in Inpatient Care Management,” Spruce said. “So this has zero effect on TeamHealth, emergency departments, inpatient/outpatient care or other hands-on patient care areas and practitioners. Most of the roles that are transitioning are very important operational support functions — again only care management has direct care clinicians.”
UnitedHealth Group, the parent company of Optum, is also enthusiastic about the deal.
“We are privileged to partner with Northern Light Health and build on their success by helping to transform the health care experience for patients, providers and communities across Maine,” said Dan Schumacher, chief strategy and growth officer of UnitedHealth Group, which is headquartered in Minneapolis.
UnitedHealth Group formed Optum in 2011 by merging its existing pharmacy and care delivery services into the single Optum brand, comprising three main businesses: OptumHealth, OptumInsight and OptumRx, according to a press release the company issued at the time. Optum serves employers, government agencies, health plans, life science companies, care providers and individuals and families offering products in data and analytics, pharmacy care services, health care operations and delivery, population health management and advisory services.
The change will occur in March 2023.
“As part of Optum, these team members will have access to more state-of-the-art tools, technologies, processes, skills development training opportunities and new opportunities for advancement,” Spruce said.
“Both Northern Light Health and Optum are committed to ensuring a smooth transition for these team members and to building an exceptional experience for patients, providers and staff,” Spruce said.
After March 26, Northern Light Health will have about 10,850 employees.
The partnership is driven in part by finances.
“Fiscal year 2022 was a hard year and our situation is not unique, it’s a reflection of what is happening in health care throughout Maine, across the country and around the world,” Spruce said. “Much like in other businesses or even in our own personal budgets, in the past year alone, rising costs have affected nearly everything, including higher costs in supply chain and labor costs — including continued need for expensive temporary labor — rises in the cost of medicines, and other expenses. We also continue to experience a shortage in the local workforce, like many other industries. We experienced a loss of $131,717,000 in FY22.”
Northern Light also cited the COVID-19 pandemic as a factor in financial issues.
“Throughout the COVID-19 pandemic Northern Light Health was driven by a Culture of Yes and we demonstrated that by ensuring our communities had continued access to safe care and by making vaccinations and COVID-19 testing easily accessible,” Spruce said. “We also took steps to ensure the health, safety and other needs of our staff through minimum wage adjustments, accelerated hiring, addition of new staffing agencies/solutions, partnerships with local suppliers for PPE and more. These were the right choices, but also added to deeper deficits which we now need to correct.”
Northern Light Health stated in the press release that it would work together with Optum to improve business processes through investment in leading-edge technology and innovation. “This will enable Northern Light Health to access new tools and more resources that ultimately will enhance the patient experience and enable providers to focus on patient care,” Spruce said.
“Optum and Northern Light Health are both values-driven and people- and community-focused,” said Timothy Dentry, president and CEO of Northern Light Health. “Optum brings innovation and expertise to a broad range of support services that will help us manage some operational functions so we can focus on what we do best — care for the people of Maine.”
Northern Light Health said the partnership will:
- Improve the scheduling and billing experience for patients and providers.
- Advance digital capabilities to improve the patient and provider experience.
- Leverage new technology and tools to ensure patients are getting the right care, at the right time, and in the right place, and
- Use data and analytics to anticipate and respond directly to patient, community and staff needs.
- https://www.ellsworthamerican.com/news/northern-light-health-announces-partnership-estimated-to-save-1-billion/article_22093ee2-911f-11ed-a4a9-3b15d40e2c52.html
Editor's Note -
As to the previous clipping, I don't how shifting costs from one big corporation (Northern Light) to another (Optum) saves money.Does anybody out there have any ideas?
- SPC
UnitedHealth Group's 2022 Earnings are in, PBMOptum outperforms health insurance divisionby Wendell Potter - Wendell Potter Now - January 13, 2023https://substack.com/redirect/772af907-c628-4a37-b662-bf9ba08696f6?j=eyJ1IjoiYnAwOSJ9.ymGWovNlrm4ZeJMOn08TYEM16Mf6peqOTfC4rWiyZG0 |
Letter to the editor: Single-payer could ease hospitals’ growing financial stresses
Turning to a for-profit for financial help, as Northern Light Health is doing, won’t mitigate factors like billing- and insurance-related costs.
Turning to a for-profit for financial help, as Northern Light Health is doing, won’t mitigate factors like billing- and insurance-related costs.
The Jan. 6 Press Herald article describing Northern Light Health’s turn to a for-profit corporation – Optum, which had a $101.3 billion profit in 2019 – for financial help highlights hospitals’ growing financial stresses.
One of the factors contributing to these stresses is the cost of managing billing in our multi-payer system. According to an article in BMC Health Services Research, 8.5% of hospital revenue goes towards these so-called billing- and insurance-related expenses. Northern Light’s revenues, in the 2021-2022 fiscal year, were noted to be $2 billion, suggesting they may have spent around $170 million on billing- and insurance-related expense that year.
That same BMC article puts billing- and insurance-related expenses in the “single-payer” Medicare and Medicaid systems at about 3.1%. If Northern Light were operating in such a system, then they could have spent only $62 million on that expense, a savings of some $108 million (comparable to the projected $100 million savings with Optum).
Uncompensated care is another stress. I couldn’t find Northern Light’s figures for that, but according to the American Hospital Association, the cost to nonprofit hospitals of uncompensated care averages 13.9% of total expenses. If Northern Light’s total expenses approximate their revenues their uncompensated care would cost $278 million, an amount single-payer would eliminate.
Savings like these would certainly help with their $132 million operating losses. My figures may be off, and we don’t know what single-payer costs to hospitals might be, but I would hope Northern Light would study the single-payer approach, rather than just rely on a for-profit corporation.
Daniel C. Bryant, M.D.
former staff physician, Mercy Hospital
Cape Elizabeth
Deer Isle nursing home misses funding deadlines for reopening
by Ethan Genter - Bangor Daily News - January 12, 2023
Though the shuttered Island Nursing Home in Deer Isle submitted an application to reopen with the state this week, its hopes of getting $700,000 from seven area towns may dissolve after missing several municipal deadlines.
The Island Nursing Home delivered its application to the Department of Health and Human Services on Monday, a step forward in its attempt to come back as a residential care facility. To help finance the reopening and revive the crucial community service, the home said it was going to ask Deer Isle, Stonington, Sedgwick, Brooksville, Blue Hill, Isle Au Haut and Brooklin to each pitch in $100,000.
But the home has missed deadlines to submit town meeting funding requests in Deer Isle, Stonington, Blue Hill and Sedgwick, putting its chances of raising a significant portion of its $3 million reopening fundraising goal in limbo.
“How could you keep missing these benchmarks and deadlines,” said Kathleen Billings, the Stonington town manager. “It makes it awfully hard to have any confidence in leadership.”
Island Nursing Home is aware that it missed deadlines in the communities and is planning to reach and see if there can be any flexibility.
“A lot of [the reopening plan] depends on how fundraising goes,” said Dan Cashman, a spokesperson for the home. “The goal is to make sure this facility is able to reopen as directed by the state, but also to make sure it’s sustainable.”
So far, about $275,000 has been pledged to the home’s effort to start a 32-bed residential care facility. The funding from the towns is seen as a piece in the overall puzzle to opening a home that could maintain itself long term, according to Cashman.
“Every piece is important and vital, but at the same time it’s not $700,000 or nothing,” he said.
Though deadlines have passed, there may be some hope for funding requests to get before voters.
The Blue Hill Select Board has some discretion to put items on the warrant, even if items are late, said Town Manager Nick Nadeau. But, having the ability to add it and wanting to are two different things.
“It’s a huge ask,” Nadeau said. “We have to look at our budget.”
In Deer Isle, the nursing home was supposed to gather 118 signatures for its petition to get on the town meeting warrant. Jim Fisher, the Deer Isle town manager, said the home’s late paperwork only had 116 certified signatures, as well as some formatting issues. The Select Board could use some discretion and vote to include it, but Fisher did not expect the board would want to bend the rules in this instance.
In Stonington, the home collected enough signatures, but didn’t get them to the town on time. With the proper signatures collected, it is possible the funding request could go to a vote at a future referendum or special town meeting, Billings said.
The nursing home hopes to have a decision from DHHS by late February. If a conditional license is granted, the home could hire an administrator and staff to prepare to renew its license. The home has been eyeing a July 1 opening date.
The home has sent pleas for fundraising to mailboxes across the region, reached out directly to potential large donors and businesses and has been working with state legislators to raise reimbursement costs in Maine. And while it’s uncertain if the town funding request will even go before four of the towns, the home could still get some cash from Brooksville, Brooklin and Isle Au Haut.
But nothing is certain in those towns either. In fact, Isle Au Haut Select Board member Peggi Stevens said the tiny island community hasn’t even gotten a formal request for the $100,000. If one does make it to the island, she wasn’t sure the town could afford such an expense.
“I don’t think it’s feasible,” she said.
‘Chaotic’ Scenes Inside 2 New York City Hospitals During Nurses’ Strike
Nurses have remained on the picket lines this week at Mount Sinai Hospital and Montefiore Medical Center, which have been less full but still tumultuous as they operate with skeletal staffs
by Sharon Otterman - NYC - January 11, 2023
Ambulances have been diverted, elective procedures canceled and as many patients as possible have been discharged as Montefiore Medical Center in the Bronx grapples with a nurses’ strike that stretched into its third day on Wednesday.
With 3,500 nurses off the job, the hospital has called in temporary nurses, and the mayor asked people to dial 911 only when necessary. The emergency room waiting area has been largely quiet.
But conditions deeper inside one of the borough’s main hospitals — and in another of the city’s major hospitals, Mount Sinai in Manhattan, where another 3,600 nurses are on strike — are even more tumultuous than usual, patients and staff members said, as a crew of temporary and redeployed workers tried to care for people in the nurses’ absence.
“It’s very chaotic,” said Ana Hare, 60, who was being discharged from Montefiore on Tuesday morning after six days in the hospital for treatment of a heart condition. She said she had waited until 11:30 a.m. that morning to get her 9 a.m. medicine, in contrast to the smooth care she had received at the start of her stay.
On the picket line in New York City’s largest nurse strike in decades, nurses said they were worried about conditions inside. But they were outside the buildings for now, they said, because they wanted to improve care so they could keep patients safer in the longer term. At Montefiore, a vital safety-net hospital in the northeast Bronx, nurses said one of the main reasons they were striking was that tumultuous was too often the norm.
Ana Villeda, an emergency room nurse, said her work environment often resembled a New York City parking garage, with rolling stretchers stacked several deep. In order to reach patients, nurses have to pull down the rails of the stretchers to squeeze between them.
Because of a shortage of poles for intravenous fluid bags, nurses sometimes have to hang the bags from the walls and curtains. One nurse can have as many as 15 patients, and even more when covering for a colleague who is on break.
“You pile the patients in,” she said. “You can have a psychiatric patient screaming while you are intubating a patient, right next to each other. It’s so dangerous.” Last week, she said, one man with abdominal pain had waited in a chair for three hours before staff members realized he was having a heart attack. “You do the best you can,” she said.
Nurses, both at Montefiore in the Bronx and at Mount Sinai in Manhattan, said they were hoping that they could alleviate chronic understaffing by negotiating contracts that mandate that managers adhere to minimum staffing levels.
This is the first contract being negotiated since before the pandemic began, and understaffing, long an issue, has grown as a problem as hospitals have failed to replace nurses who have left, either to pursue higher-paying jobs or because of trauma and burnout after several Covid waves. Both Mount Sinai and Montefiore have hundreds of open nursing positions, which managers blame on the national nursing shortage but which the union believes could be filled by increasing pay and improving working conditions.
“What do we want?” the nurses chanted outside Montefiore on Tuesday. “Safe staffing!”
At Montefiore, nurses and managers returned to the bargaining table for continued talks on Wednesday. At Mount Sinai’s main campus on Fifth Avenue, talks had been stalled since early Monday, with each side blaming the other for the inaction. Negotiations also resumed there on Wednesday, Mount Sinai said.
Both hospitals said that they were open for business and that patient safety remained their top priority. An outpatient center across from Montefiore’s main campus was busy on Tuesday, and patients continued to trickle into both the pediatric and adult emergency rooms.
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“Contingency plans remain in place to ensure our hospitals remain open,” the hospital said in a statement.
Lucia Lee, a spokeswoman for Mount Sinai, acknowledged that the situation was “impossible” but said the hospital was coping, thanks to the support of the staff members who were still at work. “We are weathering through it,” she said. “We are trying to be resilient.”
The main campus of Mount Sinai is down to about 525 patients, from its typical 1,100, as patients are transferred to Mount Sinai West and Mount Sinai Morningside, where union agreements have already been reached, she said. “This is a strike crisis, and we are responding to it,” she said.
One nurse manager at Mount Sinai, who asked that her name be withheld to protect her job, described conditions over the past two days that she felt had been dangerous for patients. She said that managers had been told that more temporary travel nurses would be hired to help cover for the striking nurses but that many of them apparently did not show up and that the working conditions for those filling in were not sustainable.
Across the hospital, nursing managers have been pressed into service as floor nurses, even those who have not dealt directly with patients for a long time, she said. Some don’t know how to use all the equipment, so they are leaning heavily on the travel nurses who are there, she said, and the travel nurses are not familiar with all of the equipment, either.
Both hospitals originated from 19th-century Jewish philanthropic efforts, and both have undertaken breakneck expansion efforts over the past decade. But they are very different institutions.
Facing Central Park, Mount Sinai draws many patients from both East Harlem and the Upper East Side, but also from elsewhere in the city. More patients have commercial insurance, rather than government-sponsored Medicaid, which means that the hospital is paid better for each patient than hospitals in other boroughs, where more patients tend to have lower-reimbursing Medicaid.
A decade ago, Mount Sinai merged with another network of hospitals that included Beth Israel and the two campuses of St. Luke’s Roosevelt, emerging as one of the largest hospital systems in the city. The strike affects only the main Mount Sinai campus.
Montefiore, the largest hospital system in the Bronx, has tried to emphasize that its financial position is very different from those of other hospitals negotiating with the nurses’ union. There are strikes at three campuses, including the Moses campus, its main site. Medicaid patients outnumber those with commercial insurance by two to one. In a statement last week, a Montefiore vice president, Joe Solmonese, noted that the system had lost $200 million last year, while some of the major hospital systems negotiating with the nurses’ union were running at a profit.
But Montefiore has also expanded over the last decade, acquiring several hospitals in Westchester County and the lower Hudson Valley. More recently, job postings at Montefiore have indicated that it is planning to open “a concierge/executive medicine” service, based at Hudson Yards, a pricey neighborhood on Manhattan’s West Side, in search of more patients with commercial insurance.
After contracts between the New York State Nursing Association and about a dozen private hospitals in the city expired on Dec. 31, eight hospitals have come to tentative agreements or ratified them. All of the hospitals have agreed to wage increases that total about 19 percent over three years, an offer also on the table at Montefiore and Mount Sinai.
But there remain sticking points. At Montefiore, nurses want the management to address the problem of overcrowding in the emergency department and the practice of boarding patients in hallways for long stretches, said Judy Sheridan-Gonzalez, a nurse on the negotiating committee. They also are asking for hiring bonuses to attract new nurses and better enforcement of patient-nurse ratios.
“We want to be with our patients,” said Michelle Gonzalez, a Montefiore nurse. “We want be taking care of our community, but give us the resources that we need to do that.”
At Mount Sinai, nurses are asking for nurse-to-patient ratios that have an enforcement mechanism so they cannot be ignored. Currently, nurses may file a protest letter when they are asked to care for more patients than in the last union contract. The management then signs the letter. This happens so frequently that the letters are sometimes referred to as “wallpaper,” the nursing manager said.
To deal with the nursing strike, Mount Sinai transferred fragile premature infants out of the newborn intensive care unit. Doctors and physician assistants are pitching in. Some said that for now, staff members appeared to be managing to care for the patients, but not easily.
Olivia Early, who trains hospital workers to operate electronic medical records software, said on Tuesday that the scene inside Mount Sinai the day before had been “chaotic,” as patients received care from a visibly stretched staff that included fill-ins from other Mount Sinai sites and doctors thrust into “nurse-like roles.”
But despite the scramble, Ms. Early said she had seen no lapses in patient care in the wing where she was working on Monday. “There’s none yet, thank God,” she said.
Joseph Goldstein and Sean Piccoli contributed reporting.
Sharon Otterman covers health care and the pandemic for the Metro desk. A reporter at The Times since 2008, she has also covered religion and education, and won a Polk Award for Justice Reporting for her role in exposing a pattern of wrongful convictions in Brooklyn. @sharonNYT
New York nurses end strike after reaching tentative deals with hospitals
Staffing was among the chief points of contention
Obamacare Is Everywhere in the Unlikeliest of Places: Miami
A decade after the Affordable Care Act’s federal health insurance marketplace was created, its outsize — and improbable — popularity in South Florida persists.
by Patricia Mazzei - NYT - January 11, 2023
MIAMI — Lídice Hernández opened an insurance agency last year on a busy street, affixing to the storefront a logo that has become deeply familiar in South Florida: a white sun rising over the red stripes of the American flag, all encased in a big, blue O.
“Obamacare,” it read underneath.
Similar displays are common along some of Miami’s main thoroughfares, almost 13 years after President Barack Obama’s signature health policy, the Affordable Care Act, became law and critics branded it with his name. Everywhere you look, especially during the open enrollment period that runs from November to January: Obamacare, Obamacare, Obamacare.
“If we don’t use it,” Ms. Hernández explained of the moniker, “people don’t know that we sell it.”
And in Miami, people really want it.
On its face, the program’s outsize popularity in South Florida remains one of its most intriguing data points. The evidence is visible in every Obamacare logo deployed — not just on storefronts but on trucks, flags and billboards — to sell health insurance, as agents in the crowded local market jockey to enroll people. This year’s open enrollment period ends on Sunday.
Florida has far more people enrolled in the federal health insurance marketplace created by the Affordable Care Act than any other state does, a distinction that has been true since 2015. Driving those numbers has been the Miami area, where older, Republican-leaning Hispanics appeared loath to embrace government-subsidized health insurance when the law was enacted. At the time, it ignited some of the most pitched partisan battles in the nation’s recent history.
In particular, some Miamians who had fled left-wing leaders in Cuba and other Latin American countries chafed at the law’s requirement — later eliminated — that people have health coverage or face a penalty, which critics decried as “socialism.”
The region has only tilted more Republican since then, flipping red in the governor’s race last year for the first time in two decades. Yet in 2022, the two ZIP codes with the most enrollees in Affordable Care Act coverage nationwide were in Doral and Hialeah, cities west and north of Miami known for their right-leaning Venezuelan American and Cuban American communities. And the county with most enrollees in the country remained Miami-Dade.
“It’s ingrained in our community,” said Nicholas X. Duran, a former Democratic state representative who used to work for a nonprofit group that encouraged Americans to enroll in Obamacare plans and now works for the health insurer Aetna. “It’s stuck.”
So is the ubiquitous logo, which got its start as the symbol for Mr. Obama’s 2008 presidential campaign, said Sol Sender, who designed it. It was never intended to represent the health care law, Mr. Sender said, calling its co-opting by enterprising insurance agents “just pretty organic.”
Which is not to say that policyholders, while glad to have coverage, are always happy with their plans. Gisselle Llerena, one of Ms. Hernández’s clients said she had been unable to get her insurer to sign off on a test her doctor recommended.
“I have an M.R.I. pending from a century ago,” Ms. Llerena, 50, said in Spanish as she recently dropped in on Ms. Hernández’s office in a modest strip mall. “But the insurance doesn’t want to cover it.”
Still, Ivan A. Herrera, the chief executive of the Miami-based UniVista Insurance agency, which caters to Hispanic people and prominently advertises Obamacare plans, said he has seen plenty of evidence that the coverage has helped people.
“I know customers who have had open-heart surgery,” he said. “They never went to the doctor. They never had a blood test. They never visited a specialist. And now they can take care of themselves.”
Each year, Mr. Herrera’s business has “doubled the amount of people that we have in Obamacare,” he said. “Obamacare is massive.”
About 2.7 million Floridians out of the state’s population of about 22 million enrolled in a plan through the federal insurance marketplace, which the health law created, in 2022. Compared with Texas, which has about 30 million people but only about 1.8 million enrollees, “Florida is like an A.C.A. monster,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, a charity focused on health.
The average monthly premium last year for Floridians with marketplace plans was $611, and for those who qualified for federal premium subsidies, the average amount was $552 per month, slightly higher than the national average, according to the Kaiser Family Foundation, a nonprofit health policy group.
Early federal data suggests enrollment has jumped again for 2023, with 15.9 million plan selections nationally in the federal marketplace and those run by states, including almost 3.2 million — roughly one-fifth of the total — in Florida.
That Obamacare has become part of the fabric of Florida life is also striking given the state’s early opposition to the law, led by Rick Scott, then the Republican governor. Mr. Scott, who is now a U.S. senator, barred “navigators” — those who helped people sign up for coverage — from state health department offices in an effort to undermine enrollment.
The Republican-controlled State Legislature has not expanded 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 Floridians would be eligible for expanded Medicaid, according to Kaiser; without it, other low-income residents have turned to the federal marketplace for subsidized coverage, which is one reason Florida has such high enrollment.
Obamacare is also popular in the state because it is home to many retirees who are younger than 65 and not yet eligible for Medicare, the federal health insurance program for older people. Others opt for the health insurance because they have recently moved from other states and may be in between jobs. And many employers in the state do not offer working Floridians robust benefits that include health care coverage.
“In South Florida especially, you’ve got a lot of people who are working in entertainment or restaurants, where they don’t have an offer of health insurance,” said Karoline Mortensen, an associate dean and professor of health management and policy at the University of Miami. That is especially true for Hispanics, she added.
When the federal health insurance mandate lapsed, Dr. Mortensen found that some Latinos dropped their coverage, suggesting that they had gotten insurance only because they were required to. But Hispanic people still continued to get medical care at far higher rates than they had before the federal marketplace was created in 2013, she said.
The Kaiser Family Foundation estimates that Florida is the state with the second-highest percentage of eligible people who have enrolled in an Affordable Care Act plan, said Cynthia Cox, a Kaiser vice president.
She credited local leaders and insurance agents with promoting the law’s benefits, even when the state did not. Similarly, Dr. Mortensen referenced a moderate Republican state senator who, when the federal marketplace opened, urged his constituents to enroll.
Ilse Torres, an insurance agent in Miami, said she had educated her clients “bit by bit” that Obamacare is not health coverage, as many of them assume, but rather a law that created a federal marketplace and required insurers to cover pre-existing health conditions.
After Republicans in Congress tried but failed to repeal the law during the Trump administration, Ms. Torres said, the marketplace stabilized, drawing more major insurers and attracting new policyholders.
Ms. Hernández, who voted for Mr. Obama in 2008 but later registered as a Republican, lamented that Congress had not updated the Affordable Care Act to make more people permanently eligible for subsidies to help cover their insurance premiums. (Subsidies were temporarily expanded through the American Rescue Plan and the Inflation Reduction Act, and are in effect through 2025 — a major reason for the recent enrollment bumps.) But she was pleased, she said, that Republican lawmakers had stopped trying to repeal the law.
“Obamacare needs to be fixed,” she said. “But when I saw how easy it was to get it, I was like, ‘Oh my God, people don’t know about this. Why don’t more people get it?’”
She and her family are now insured through the program.
Susan C. Beachy and Sheelagh McNeill contributed research.
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