A System at Odds: The Unintended Consequences of Affordable Care

Abstract

This paper investigates a growing crisis in Florida's healthcare safety net, where homeless individuals are being enrolled in Affordable Care Act (ACA) marketplace insurance plans that come with deductibles and copays they cannot afford. Through case studies from Fort Lauderdale, the piece reveals how insurance agents, incentivized by commissions and residuals, target vulnerable populations. However, this enrollment automatically disqualifies them from critical, no-cost services provided by federal grants. The analysis exposes a fundamental flaw in the interaction of three federally funded systems: Medicaid, HCH grants, and subsidized marketplace plans. The consequence is a bureaucratic catch-22 where signing up for "free" insurance dismantles a person's existing access to truly free care. The paper highlights the roots of the problem, such as financial incentives, a lack of regulatory oversight, and systemic design flaws that prioritize enrollment over actual healthcare access, ultimately exacerbating health crises.