Florida tops Obamacare sign-ups; Texas lags

State and federal health care exchanges have enrolled more than 9.5 million people, according to data out Tuesday, meeting their target a full month before the enrollment period closes. Success has varied widely across the country, according to a USA TODAY analysis of new ZIP code-level HealthCare.gov data.

The data show that aggressive outreach in South Florida helped that state account for nearly a seventh of all people who have selected plans on the exchanges. In the areas of Texas with the largest share of uninsured adults, insurance enrollments have lagged.

Within the 35 Texas ZIP codes where at least a quarter of adult residents are estimated to be uninsured, total enrollments are up just 8.9% from last year, while the five Florida ZIP codes with similar populations are up 23%, the analysis shows.

"The Affordable Care Act is a national law, but how people are experiencing it depends a lot on where they live," says Larry Levitt, senior vice president at the Kaiser Family Foundation.

Tuesday, Department of Health and Human Services officials announced that as of Jan. 18, more than 9.5 million people had enrolled or re-enrolled for health insurance on federal and state exchanges. Officials had estimated that 9 million to 9.9 million people — up from 6.7 million in the exchanges' first year — would choose plans before the Feb. 15 deadline for 2015 coverage.

HHS figures showed that 35% of the enrollees were younger than 35, and 87% qualified for tax credits to offset premium costs.

Texas, which has the largest population of uninsured residents of the 37 states on HealthCare.gov, has enrolled 30% of its estimated potential marketplace population, while Florida has reached 51%, according to a report out last week from the Kaiser Family Foundation.

Nearly three-quarters of Florida's largest marketplace ZIP codes — those with at least 2,000 enrollees — have seen enrollments increase at least 20% over last year's numbers, according to the USA TODAY analysis. Outside West Palm Springs, four ZIP codes saw increases of at least 40%.

In Texas, it's a very different picture. Just west of downtown San Antonio, nearly 27% of the adults living in the 78207 ZIP code are uninsured, according to estimates from Civis Analytics and Enroll America, a non-profit group that does Obamacare outreach. Data released last week from HealthCare.gov shows that as of Jan. 16, the area had seen a net gain of only 15 plan selections this enrollment period — an increase of less than 1%.

Texas faces obstacles that may contribute to its differing enrollment, says Enroll America's national spokesman, Justin Nisly. The state has unusually "onerous training requirements" for the federally funded enrollment assistants, known as navigators, and the state is so large it can be harder for people to find someone to assist them in person, he says.

Last year, Texas started very slowly, then saw 60% of its enrollment in the last month of the enrollment period, so the picture could change, Nisly says.

Although not everyone who is uninsured would qualify for federal health insurance — undocumented immigrants, for instance, are ineligible — the Kaiser report estimates that 2 million uninsured residents in Texas who qualify have not enrolled in Obamacare.

Texas isn't alone in struggling to get the uninsured signed up. According to the Kaiser report, several other states — including Alaska, Nevada, Ohio and Louisiana — have enrolled only a quarter of their potential customers.

Much of the variation rests on the success of the federally funded "navigator outreach" program, Levitt says. Private groups paid to do outreach, advertise and help with the sign-up process make a huge difference in getting the uninsured to sign on, he says.

"This is a very confusing law, so people are much more likely to enroll if there's someone trusted in their community to provide a helping hand throughout the process," Levitt says.

Florida benefited from a ripple effect of nearly 1 million enrollees in the first year of sign-ups, says Nick Duran, Enroll America's Florida director. People, especially the heavily Hispanic populations in South Florida and the Tampa area, told family members, friends and fellow churchgoers about their plans and often helped them enroll, he said.

Lakewood Township, N.J., was another bright spot: It saw its enrollment numbers more than double from 2014 to 2,059. Representatives from Ocean Health Initiatives, which runs four federally qualified health centers, including one in Lakewood, helped people sign up. It sent "certified assistance counselors" to places of worship and libraries to sign people up, says Beatriz Patino, outreach and enrollment coordinator.

Because of the large Hispanic population, Patino says, all of the centers' assistants are bilingual, and the agency promoted enrollment on the Spanish-language TV network Univision.

"I feel very proud," Patino says. "We worked really hard, even before the first year started talking to everyone in the community, working nights and weekends."

New Jersey has enrolled more than a third of all potential customers, according to the Kaiser report.

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