More significant changes in the health insurance market occurred in Florida under the Affordable Care Act (ACA). Republicans in Congress allowed enhanced federal subsidies for ACA plans to expire in January. Millions of Americans then faced a difficult calculation: pay premiums that often doubled or tripled, or drop coverage and accept the financial risk of going uninsured.
Months later, Congress has taken no action to replace the expired assistance. The effects have moved from premium notices into household finances and medical decisions.
Some families are absorbing higher insurance costs by cutting other spending. Others face large medical bills. People without coverage are also postponing physician visits because they fear what treatment will cost.
Florida has experienced one of the clearest effects. The state’s large population of gig workers, entrepreneurs and small-business owners depends heavily on coverage sold through the federal health insurance marketplace.
Figures first reported by The Associated Press showed roughly 440,000 Florida residents dropped their Affordable Care Act plans this year, more than in any other state. Separate figures put the number leaving the marketplace at roughly 443,000.
People who retained insurance face another problem. Grocery bills and gasoline prices remain expensive for many households, while health insurers are projecting another year of double-digit premium increases.
Florida recorded the largest number of residents affected by the enrollment decline, though rising healthcare costs extend far beyond the state.
Healthcare affordability has also become a campaign issue in Florida. The Republican-controlled state recently redrew congressional districts in a way that strongly favors Republican candidates.
Republican candidates in the midterm elections have focused on reducing fraud in federal health programs. Democrats are asking voters to change control of Congress, arguing that a Democratic majority would restore the expired ACA subsidies.
Nearly a year later, the subsidy issue receives far less attention in Congress. The administration says its affordability strategy includes efforts against healthcare fraud and agreements with pharmaceutical companies. Congress, meanwhile, hasn’t approved major legislation aimed at reducing healthcare costs.
Florida’s dependence on ACA coverage is unusually high (see A Californian’s Guide to Open Health Insurance Enrollment: 3 Things to Know).
The state has large numbers of workers in construction and hospitality, along with self-employed people and employees of small businesses.
Florida’s Republican-led legislature also never expanded Medicaid, leaving fewer low-income adults eligible for the safety-net program. Those factors helped make Florida the country’s largest Affordable Care Act market.
More than 3.8 mn people in the state are enrolled in ACA plans. Florida therefore accounts for roughly one-fifth of all marketplace enrollment nationwide.
Cynthia Cox, a vice president at healthcare research nonprofit KFF, said most of the roughly 443,000 Floridians who left the marketplace are likely uninsured.
For many consumers, the ACA marketplace is a “place of last resort” for obtaining health coverage, Cox said. Leaving it often means there isn’t another employer plan or public program available.
Enrollment statistics capture only part of the financial pressure. Some Floridians kept insurance, though maintaining coverage required major changes to household spending.
Some uninsured Florida residents have turned to nonprofit medical providers instead.
