Florida's Health Care Crossroads: The Affordable Care Act's Uncertain Future
Florida stands at a critical juncture regarding health care. The state has the highest number of people enrolled in Affordable Care Act (ACA) plans, with nearly 4.7 million residents relying on this coverage. However, the enhanced subsidies that have made these plans affordable are set to expire at the end of the year, leaving many Floridians in a state of uncertainty.
The Potential Impact
Estimates suggest that up to a third of Floridians with ACA plans could drop their coverage due to rising costs. This includes individuals like:
- Françoise Cham, a 63-year-old self-employed resident of Miami, who fears she may not be able to afford coverage until she qualifies for Medicare.
- Heather Slivko-Bathurst, a 37-year-old resident of Key West, who expects to switch to a less comprehensive plan offered through her employer.
Demographics and Demand
Florida's demographics play a crucial role in its high demand for ACA plans. The state is home to many:
- Low-wage service workers
- Gig economy workers
- Early retirees
These groups do not have access to employer-sponsored insurance or Medicare. Additionally, Florida is one of only 10 states that have not expanded Medicaid, further limiting health care options for low-income residents.
Government Marketplaces and Subsidies
The ACA established government marketplaces where individuals can purchase private insurance with the help of federal subsidies. Enrollment in ACA plans surged during the pandemic when Congress increased these subsidies. However, the enhanced subsidies are set to expire on December 31, and a partisan standoff over their extension is contributing to the ongoing government shutdown.
Political Discussions and Consequences
The uncertainty surrounding the subsidies has reignited political discussions about the ACA in Florida. Politicians are once again talking about the Affordable Care Act, 15 years after its implementation and several election cycles after it faded as a campaign issue. Miami-Dade County, which has the highest concentration of ACA enrollees, has shifted politically and now votes Republican, as does the state overall.
Democrats and Republicans
- Democrats in Florida have been vocal about the expiring subsidies, warning of the potential consequences for residents. Open enrollment for 2026 plans is set to begin on November 1, and insurers have already started notifying enrollees about significant premium increases. The biggest impact will likely be felt by older individuals at the lower end of the middle class, who could see their premiums rise from a few hundred dollars a month to over $1,000.
- Republican leaders, including Governor Ron DeSantis, have criticized the enhanced subsidies, arguing that they benefit insurance companies at the expense of taxpayers. They suggest that comprehensive coverage provided by ACA plans may not be worth the cost. However, some Republican members of Congress whose districts have high ACA enrollment rates have called for a solution to the impending crisis.
Medicaid Expansion
Many Floridians with ACA plans would be eligible for Medicaid if the state expanded the program. Efforts to put Medicaid expansion on the ballot have been delayed until the 2028 election due to recent changes in state law. In the meantime, Floridians are bracing for the potential fallout from the expiring subsidies, with some already exploring alternative options for health care.
