Approximately 4.7 million Floridians are currently insured through health plans obtained from the Affordable Care Act (ACA). As debates continue in Washington over federal subsidies, many in Florida face uncertainty regarding their health insurance coverage. This situation has arisen amid a prolonged government shutdown that could become the longest in U.S. history.
When the ACA was enacted in 2010, it aimed to reduce the number of uninsured Americans, which stood at about 48.2 million people, or around 18% of the U.S. population under 65. Fast forward to 2023, the number of uninsured Americans has nearly halved, now at 25.3 million, representing 9.5% of the total population.
The ACA expanded access to health insurance through three primary strategies. First, it enforced penalties for individuals who did not obtain insurance until 2018, as well as for businesses with over 50 employees that failed to provide affordable health plans. While these fines aimed to incentivize healthy individuals to enroll, their impact on overall insurance coverage was minimal, except for enabling young adults aged 19 to 25 to remain on their parents’ plans, significantly reducing the uninsured rate in this demographic.
Second, the ACA facilitated the expansion of Medicaid for low-income Americans, a move intended to cover those employed in low-wage jobs. Although the expansion was initially mandatory, a 2012 Supreme Court ruling allowed states to opt out. Currently, 16 million Americans benefit from this expansion, but states like Florida have chosen not to participate.
The third key change involved the establishment of health insurance subsidies for low- and moderate-income individuals who do not qualify for Medicaid or employer-sponsored insurance. This initiative led to the creation of a private health insurance marketplace, with over 24 million Americans currently relying on these subsidized plans.
Florida stands out with the highest enrollment in ACA marketplace plans among states, with approximately 27% of its under-65 population covered, compared to the national average of 8.8%. Of those enrolled, 98% receive some form of subsidy. This reliance is attributed to several factors, including a low employer-based insurance rate of 40%, which is the lowest in the country. Additionally, Florida has a significant number of self-employed individuals, along with a large seasonal workforce in the tourism sector.
The state also has fewer residents enrolled in Medicaid, with only 11% of individuals aged 44 to 64 participating, compared to 17% nationally. Florida’s restrictive Medicaid eligibility criteria further exacerbate this situation, as it ranks last in expenditures for adults under 65.
The potential loss of ACA subsidies will have significant ramifications for Florida residents. If Congress fails to renew these subsidies, the average premium for marketplace plans is expected to rise by more than 100%, from $74 to $159 per month. A worker earning $28,000 annually would see their premium jump from $27 to $130, while a person making $35,000 could face an increase from $86 to $217 monthly.
Florida currently has the third-highest uninsured rate in the country at 13.4%. If federal subsidies vanish and premiums skyrocket, a surge in the number of uninsured Floridians is likely. This could particularly impact younger, healthier individuals, leading to higher premiums for those who remain insured.
The outcome of the ongoing federal discussions remains uncertain. However, the implications for states such as Florida, which have not expanded Medicaid and heavily rely on marketplace plans, could be severe if federal subsidies are cut.
Robert Applebaum, a gerontologist specializing in the U.S. health care system, highlights the critical nature of these developments, noting the potential for increased uninsured rates and financial strain on low-to-moderate income families if subsidies are eliminated.
