Obamacare Is Everywhere in the Unlikeliest of Places: Miami

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 Hispanics 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.