In 2011, Florida had the second highest percentage of residents in the country who lack health insurance, according to U.S. Census Bureau data released late last month. Meanwhile, Monroe County's uninsured rate was ninth highest of Florida's 67 counties.
Overall, 24.8 percent of Floridians under the age of 65, or 3.8 million people, didn't have health insurance in 2011, the most recent year for which the Census Bureau has compiled figures. Only Texas, with an uninsured rate of 25.7 percent, was higher.
In the Florida Keys, where the economy is heavily tied to service industry jobs that often do not come with health benefits, 27.5 percent of the under-65 population, or more than 16,000 people, lacked health coverage in 2011.
The uninsured rate among Keys children under age 19 was 15.6 percent, tied for sixth highest in the state. Most of the Florida counties with a higher percentage of insured people are rural and heavily agricultural.
One exception, however, is Miami-Dade County, in which 34.4 percent of the population didn't have health insurance. Only rural Hendry County, at 35 percent, had a greater proportion of uninsured residents.
For Monroe, the 2011 figure represents a slight improvement over 2010 census data, which showed that 28.7 percent of residents under the age of 65 were uninsured.
That latest data comes four months after the Florida Legislature decided against expanding Medicaid to an estimated 1.1 million people under the Affordable Care Act, commonly known as Obamacare.
Gov. Rick Scott and the Florida Senate, however, did back an alternative measure during the spring session that would have distributed $50 billion in federal aid over a decade to low-income residents for the purchase of private health insurance. But Republican leaders in the state House, wary of taking Obamacare funds, refused to take the measure to the floor for a vote.
They instead authored a more limited plan that would have used up to $300 million in state money to purchase health insurance for approximately 130,000 people.
State Sen. Dwight Bullard, D-Miami, who represents the Keys in Tallahassee, called Floridians' lack of health insurance an "emergency" during an interview last week.
Like other advocates of accepting the federal funding, he said he'd like to see the state Legislature reconsider the matter this year.
"What we'd really like to do is to get the House to convene between now and January so we don't leave those dollars on the table," Bullard said.
But state Rep. Holly Raschein, R-Key Largo, who supported the House Republican plan, sounded a less urgent note in an email last week from her home state of Alaska, where she was vacationing.
"[C]ommittee meetings begin this month and we will continue to meet consistently until March when the regular session begins," she wrote. "I am confident that this issue will receive a great deal of attention in the months leading up to session."
Because her district, which also includes portions of southwest Miami-Dade County, has one of the highest rates of uninsured, Raschein said she is acutely aware of the need to address the issue.
She said she'd be open to considering a version of the Senate plan if her House colleagues are comfortable with it.
Meanwhile, October will mark the opening of a state-organized private insurance exchange that is required under Obamacare. The exchange is intended to serve as a competitive marketplace to bring down insurance rates for individuals.
Another provision of Obamacare, which could have a significant impact on the many uninsured Keys service industry employees, has been delayed a year. Companies with 50 employees or more now won't be required to offer insurance coverage until at least 2015.
Bullard said one of his goals through the fall is to get as many people signed up for insurance through the exchange as possible. He said he would hold sign-up events throughout his four-county district, including the Keys, where he hopes to partner with Raschein.
Florida senators are eligible for a $180 per month state-subsidized family health care plan. The plan for House members costs $30 per month for a family.