MIAMI — Dalia Carmeli, who drives a trolley in downtown Miami, voted forDonald J. Trump on Election Day. A week later, she stopped in to see the enrollment counselor who will help her sign up for another year of health insurance under the Affordable Care Act.
“I hope it still stays the same,” said Ms. Carmeli, 64, who has Crohn’s disease and relies on her insurance to cover frequent doctor’s appointments and an array of medications.
Mr. Trump and Republicans in Congress are vowing to repeal much or all of the health law, a target of their party’s contempt since the day it passed with only Democratic votes in 2010. If they succeed, they will set in motion an extraordinary dismantling of a major social program in the United States.
But for now, with open enrollment for 2017 underway, people are steadily signing up or renewing their coverage, and in conversations last week in South Florida, many refused to believe that a benefit they count on would actually be taken away.
Florida helped hand Mr. Trump the presidency when he narrowly won the state, but it has also provided more customers for the federal health insurance marketplace than any other state. This makes Florida a window to the complex and delicate task Mr. Trump and congressional Republicans face in deciding whether to scrap the entire law, which has brought coverage to more than 20 million people, and what to replace it with.
Even though Gov. Rick Scott fiercely opposes the law, more than 1.5 million Floridians were enrolled in marketplace plans as of March, the last time the Obama administration released data. And some of the problems that have plagued the marketplaces in other states have been less of an issue here: The premium increases and overall prices have been lower than average, and at least in urban areas, a number of insurers are still participating.
Jay Wolfson, a professor of public health and medicine at the University of South Florida, said that while many Floridians would be happy to see the law disappear, and the state’s Republican leaders have never shied away from attacking it, failing to come up with a substantive replacement could be politically risky.
“The question I think we all have is, how do they transition out of it?” he said. “How do they do it without dumping millions of people off the edge of a cliff?”
Despite the law’s problems, including sharp premium increases for next year, millions of people, including many in states that Mr. Trump won, have come to depend on it. Texas, North Carolina and Georgia, like Florida, have large numbers of people insured through HealthCare.gov. And 16 states that now have Republican governors or governors-elect expanded Medicaidunder the law, including Indiana under Mike Pence, now the vice president-elect.
The Obama administration said last week that over the first 12 days of open enrollment, plan selections in the states that use the federal marketplacewere up by about 5 percent compared with the same period last year. Some of the states that run their own marketplaces have reported brisker business: In Colorado, sign-ups are running 30 percent higher than they were at this point in the last open enrollment period, according to Kevin Patterson, the chief executive of the state’s marketplace.
If the pace continues, hundreds of thousands more people could be added to the insurance rolls, even as Republicans discuss alternative legislation that could drop millions.
“Even with the whole situation, it’s been a great start,” said Odalys Arevalo, an owner of Sunshine Life and Health Advisors, an insurance agency that she said has enrolled tens of thousands of Floridians, mostly working-class Hispanics, in health law plans over the past three years. She added, however, that people were confused and were asking many questions about the future of the law.
Nonprofit groups with federal grants to enroll the uninsured are conducting an ever more strategic search for them — working, for example, with the consulates of Mexico, Colombia, Brazil and Uruguay in Miami to identify “lawfully present” immigrants who might want coverage (they qualify for subsidies under the law, even without citizenship) and with a small American Indian tribe in the Panhandle.
“We’re in the here and now, and nothing has changed at the moment,” said Karen Egozi, the chief executive of the Epilepsy Foundation of Florida, repeating a new mantra among the group’s 90 enrollment counselors. As of Tuesday, they had signed up 277 people for insurance since Nov. 1, when enrollment began, she said, compared with 193 over the same period last year.
In South Florida, a teeming mix of retirees who may not have reachedMedicare age, hotel and restaurant workers and recently arrived immigrants working for small, homegrown businesses has helped ensure robust enrollment in the subsidized plans offered through the marketplace. While the Republican leaders of the state have refused to expand Medicaid, individuals with annual incomes of about $12,000 to $47,500 qualify for subsidies that pay some or most of the cost.
Ninety-one percent of plan holders in Florida this year receive premium subsidies — a higher percentage than in any other state — and 71 percent also have reduced deductibles, a benefit available to people at or below 250 percent of the poverty level.
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