When Pedro Peña lost his job as a restaurant cook at the start of the coronavirus pandemic, he applied for Medicaid to replace his job-based insurance. A diabetic, Peña understood the importance of being covered.
But the Miami resident was repeatedly turned down for public health insurance because Florida is among the dozen states that have not expanded Medicaid to low-income adults.
Peña, 62, didn't realize the Affordable Care Act still existed since he had stopped hearing about it. But late last year, his friends and family suggested he reach out to Epilepsy Florida to see if he could sign up.
Shirley Dominguez, one of the navigators at the nonprofit group, enrolled him in a Florida Blue plan with no deductible that costs $41 a month after federal subsidies. Peña, who is afraid to return to work during the pandemic, quickly found a "wonderful" primary care physician and secured his diabetes medication.
"I am very grateful to God to get insurance," said Peña, who noted Dominguez's help was crucial since he found the enrollment process to be very complicated. "At my age, I need to make sure I have access to doctors."
Peña is among the millions of Americans who have selected 2022 coverage on the Affordable Care Act exchanges, many for the first time. More than 13.8 million people have picked plans on the federal and state marketplaces -- 2 million of them new to Obamacare for 2022.
That's an increase of 21% in sign-ups through the federal exchange, Healthcare.gov, as of December 15, from the same time a year ago.
Even more notable, however, is the popularity Obamacare is enjoying in many of the states that didn't expand Medicaid. Florida, which has the highest number of people picking plans at nearly 2.6 million, has seen interest soar by nearly 23%.
And in Texas, which has the highest uninsured rate in the nation, 1.7 million residents have selected policies, up roughly 33% from last year.
Open enrollment ends Saturday, though consumers can sign up during the year if they meet certain criteria, such as losing job-based coverage.
More federal support
The surge in interest in the Affordable Care Act comes as the Biden administration and the Democratic-led Congress have pumped more resources into the 9-year-old program. That's quite a change from the four years under the Trump administration, which deeply slashed funding for marketing and enrollment assistance and cut the sign-up period in half to six weeks.
The hefty enhancement of Obamacare's federal premium subsidies, part of the Democrats' $1.9 trillion coronavirus relief package enacted last March, is helping drive consumers to sign up for plans.
This year, enrollees pay no more than 8.5% of their income toward coverage, down from nearly 10%. And lower-income policyholders receive subsidies that eliminate their premiums.
Also, those earning more than 400% of the federal poverty level are now eligible for help for the first time.
But this generous aid expires after 2022, leading some consumers and experts to worry about what will happen next year when premiums would likely rise. President Joe Biden's Build Back Better plan would extend the subsidies through 2025, but it remains stalled in the Senate.
Beefing up marketing and outreach
To let Americans know about the extra assistance available now, the Biden administration has launched an extensive outreach and marketing campaign.
"This year, our levels really were unprecedented, particularly focused on underserved and harder-to-reach areas," Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, told CNN. "It made a real difference in how much people were aware of coverage. Then the increased affordability made a huge difference with the number of people who were able to find plans for premiums under $10."
The agency is teaming up with local groups to spread the word, restarting its Obama-era Champion for Coverage program with more than 2,600 community organizations, more than doubling its size. CMS is concentrating its media efforts on local markets and has added six additional languages to its marketing campaign.
"The noise over the last couple of years is something we really did have to cut through," Brooks-LaSure said of the uncertainty that had plagued the health reform law. "Yes, the Affordable Care Act is still here, and it's more alive than ever."
The agency is not disclosing the size of the marketing budget.
The Biden administration is also pouring money into enrollment assistance -- which serves the dual purpose of reaching folks in local communities and helping them sign up for plans. Roughly 60 navigator organizations have received about $90 million in funding to educate and aid consumers in enrolling in the 33 states served by the federal exchange.
The remaining states run their own marketplaces, including outreach and enrollment efforts.
The extra funding makes a big difference, navigator groups say. The number of navigators has quadrupled to more than 1,500 this year, with assistance available in nearly every county served by the federal exchange.
Epilepsy Florida, which is in its ninth year as a navigator, is now able to serve eight counties in South Florida and the Treasure Coast with 26 staffers, including several who speak Creole. They have helped 755 people enroll through early January, said Islara Souto, who directs the organization's navigation program.
She expects to see a crush of clients in the final days of open enrollment on Friday and Saturday. Epilepsy Florida is also holding an "all hands on deck" telethon on Saturday to help people secure coverage.
During the sign-up period for 2021 coverage, the organization only had seven staffers working in four counties who enrolled 526 people.
It could afford to expand because its budget grew to $2.3 million for the current year from a skeletal $125,000 for the prior one.
"Now we have money and the capacity," Souto said. "It's just a matter of outreach and education, getting this information to consumers and letting them know they have this opportunity."
The coronavirus pandemic has also deepened Americans' appreciation of health insurance.
"Covid-19 has brought a different type of awareness of our physical health," said Daniel Bouton, senior director of health and wellness at the United Way of Metropolitan Dallas, which is assisting in Obamacare sign-ups for the first time. "What we see from our clients is that they are health conscious. They see health insurance and access to health insurance as a layer of protection for their health and their family and their wallet."
The United Way decided to offer navigator services this year for the first time because North Texas had no one helping people enroll during the Trump administration. The organization, which has received a little over $3 million in funding for the year, has used its large network of community and corporate partners to spread the word. Its outreach campaign includes knocking on doors, radio and television spots, newspaper ads and billboards.
Every time Bouton appears on Univision to talk about the Affordable Care Act, the navigators' phones start ringing more, he said.
Word of mouth is also essential.
Netra Webb, 59, thought she would be uninsured in 2022 -- a distressing situation since the Dallas resident has health issues. But the insurance plan offered by her new employer was too expensive, so she just planned to go without coverage.
But then a friend from church referred her to the United Way. A navigator set her up with a Blue Cross plan in one day.
Because of the high cost of her work-based options, she qualified for premium subsidies. She's paying $120 a month, has a $1,500 deductible and is able to continue seeing the same doctors.
"It was a great relief," said Webb, who works full time as a security guard. "The marketplace just made it great for me all the way around. My copay, my medicine, everything about it was great."
In the Tampa area of Florida, the Family Healthcare Foundation has its hands full this enrollment season signing up people who recently moved to the Sunshine State, those changing jobs or retiring, and young adults who can no longer stay on their parents' plans, among others. The organization works closely with the Children's Board of Hillsborough County's Family Resource Centers, which support many new residents, as well as local hospitals and community health care centers.
The enhanced subsidies are particularly important to early retirees since their coverage can be very expensive, Katie Roders Turner, the group's executive director, said.
Ed DeBerri had hoped to retire from his job as a criminal defense investigator for the state of Florida last year at age 62, but he didn't know if he could afford health insurance on his own.
The Dade City resident checked in with a Family Healthcare Foundation navigator a year ago and realized he could swing it. DeBerri left his job in September and now has what he calls an "excellent" United Healthcare plan with no deductible for about $50 a month, which is what he paid for coverage while employed.
Now, he can devote more time to the philosophy and theology classes he teaches at Saint Leo University and to an update of his 1985 book "Catholic Social Teaching."
"Without the ACA, I wouldn't be able to retire at 62," he said. "I would have had to wait for Medicare at 65."