No other state has a greater percentage of people — about 4.6 million Floridians or 25% of those under 65 — getting health care insurance through the government-backed Health Insurance Marketplace.
A deal to end the longest federal government shutdown in history left out the extension of Obamacare subsidies — and that omission will hit the Sunshine State harder than any other.
No other state has a greater percentage of people — about 4.6 million Floridians, or 25% of those under 65 — getting their health care insurance through the government-supported Health Insurance Marketplace created by the 2010 Affordable Care Act. Most who get the government-sponsored health insurance qualify for the enhanced subsidies that appear as a premium tax credit.
And those credits — which were at the core of the 41-day-old government freeze — are all but certain to expire come Jan. 1, 2026.
Mary Mayhew, president and CEO of the Florida Hospital Association, says that cessation will put 1 million Floridians at risk for losing access to health insurance coverage. She’s still holding out hope and urging Congress to act.
“Without access to this premium assistance and the coverage it provides, hardworking Floridians who own and support small businesses will lose access to primary care and other comprehensive health care services,” said Mayhew, who once served as a senior health administrator under the first President Donald Trump administration.
How do the Obamacare subsidies work?
The government-subsidized health insurance marketplace was designed specifically for those workers without access to employer-sponsored health insurance in mind, and Obamacare’s popularity in Florida reflects the state’s large number of small businesses and gig workers.
When a person buys an Obamacare health insurance policy, they also simultaneously apply for the subsidy. The subsidies are tax credits but they can be — and typically are — taken upfront and paid directly to the health insurance companies. At that moment, the Obamacare enrollee gets a reduction in their premium.
The amount of tax credit the applicant receives depends on family size, income, age and location. The amount that a family must pay for their health care insurance is capped at 8.5% of its annual, household income. Those earning less than 400% of the poverty level would likely pay less.
A family of four, with two older adults, living in Palm Beach County and earning $130,000 a year, for example, would see their $921-a-month health insurance premium they are currently paying for a Silver Plan rise to $3,158 a month, according to the KFF Health Insurance Marketplace Calculator.
Subsidies started in throes of COVID-19
The enhanced subsidies, which expanded middle class families’ eligibility, had been added in 2021 as the country staggered from the effects of the COVID-19 epidemic and then were renewed in 2022 as part of the Inflation Reduction Act in 2022.
Enrollment in the health care insurance plan that President Barack Obama introduced has increased exponentially with those subsidies, which increased eligibility. Before 2021, no one making more than 400% of the poverty level (more than $128,600 for a family of four in 2025) could qualify for the subsidies.
These subsidies were set to expire under President Donald Trump’s “One Big Beautiful Bill,” which advanced many of his administration’s fiscal priorities, including extending 2017 tax cuts from his first term, a crackdown on undocumented immigrants and a 2024 campaign promise of lessening taxes on tips.
Bad news arriving already for health care premiums in Florida
Holly Bullard, chief strategy and development officer for Florida Policy Institute, a research organization, called the subsidies’ expiration and the attendant rise in health care premiums “the biggest threat to Floridians’ well-being.” If the healthier people currently enrolled in Obamacare drop their insurance, prices will go to go up for all health insurance consumers, Bullard predicted.
“Floridians are already considering leaving the state in large numbers due to the affordability crisis,” Bullard said. “This lack of action only exacerbates the extreme stress millions of our neighbors are experiencing.”
The increase in subsidies made it possible for the Farley family in Boynton Beach to get health care insurance at a price they could afford.
Now they’re learning how it might be taken away if they don’t tighten their belts even more.
Kara Farley, a 40-year-old mother of four and a cancer survivor, has been watching the proceedings in Washington, holding out hope that it won’t really happen as she tries to calculate how she and her husband can keep their health insurance.
She’s already gotten the notice that they must find a way to squeeze out an extra $200 a month if they want to keep their health care insurance. Their premium is expected to rise to $340 a month from $140, as it stands now.
They will still qualify for some health care subsidies through the Health Insurance Marketplace on their $50,000 annual income, but the price tag has Farley hesitating on whether they’ll be able to keep it. They are already a frugal family — only one car for the six of them and no cable TV, said Farley, who works in a midwifery practice.
“It feels like a whole lot of fighting for nothing,” she said of the efforts she made to tell her story of finding ovarian cancer during a trip to the hospital emergency room and the financial chaos she was plunged into before the family qualified for the subsidy that made insurance affordable.
The state’s congressional delegation are among those she contacted.
“My heart is in my throat,” Farley said. “I feel like the hope of something happening is being taken away.”
On whether she’ll be able to make the new payments and keep her insurance, she says she is not sure.
In Deerfield Beach, Chaz Stevens, 61, reported about $15,000 in income last year — which puts right at the federal poverty line. He got a notice from Blue Cross/Blue Shield that the policy he got through the Health Insurance Marketplace will be increasing from $414 a month to $2,700.
“For the exact same plan I’ve been on for years,” said the small business owner, who took time off from working to care for his ailing parents. ”I have a roof over my head for the moment. I’m one medical event from losing that.”
Experts: Obamacare has tempered health care inflation
The loss of the current level of subsidies is likely to make the whole system less healthy, increasing the number of people going without insurance along with the bad debt and charity care hospitals will be forced to provide, industry observers say.
The way things have evolved in the last four years, the whole system has become more accountable pushing employers to provide valuable insurance and people to buy it, according to an executive at a major insurance brokerage based in Fort Lauderdale.
“I do think there will be a large amount of people in this country who are not going to have insurance if they do away with those subsidies,” said Arthur Novoseletsky, a senior vice president and senior benefits consultant in employee benefits for Brown & Brown, one of the largest independent insurance intermediaries in the country. “Ultimately, those individuals will still need to seek care, and they’re just going to use those public health hospital systems where it’s still going to cost taxpayers money.”
The end of these subsidies will hurt the middle class, both for those buying insurance and those who get it from their employer, Novoseletsky said projections show.
Premiums are going up for everyone in anticipation of the number with health insurance decreasing, he said. On the individual policy side, rates will go up 18% to 20% without counting the individual effect of losing one’s subsidy and employee health plans’ costs will be going up in the low double digits, Novoseletsky predicted.
Jay Wolfson, who holds numerous appointments at the University of South Florida Health, including interim dean at the Taneja College of Pharmacy, senior associate vice president of USF Health and senior associate dean at the Morsani College of Medicine, said that before 2021’s enhanced subsidies were added, but after Obamacare became law, some enrollees were paying up to $24,000 in deductibles and premiums before coverage kicked in.
Losing the current level of subsidies — which the Congressional Budget Office predicted would have added $350 billion to the national debt over the next 10 years had they been made permanent — will expose a hard truth about health care costs, Wolfson predicts.
“There was never a long-term, economically sound, ‘culturally competent’ (in terms of principles of our capitalist system) plan and model to pay for this with anything other than tax dollars,” he said.
Anne Geggis is the insurance reporter at The Palm Beach Post, part of the USA TODAY Florida Network. You can reach her at ageggis@gannett.com.Help support our journalism. Subscribe today
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