May 5, 2022

Federal Policymakers Must Act Now to Prevent Premium Spikes and Massive Health Coverage Losses for Floridians

People in the health care coverage gap, young adults, and children in Florida are at serious risk of becoming uninsured after federal public health emergency ends

ORLANDO, Fla. - More than 1 million Floridians could lose their health care coverage and become uninsured and many others could see their health insurance premiums skyrocket without quick federal action. New analyses from the Center on Budget and Policy Priorities explains that federal policymakers can help protect Floridians from losing health coverage and prevent steep premium increases later this year when the American Rescue Plan Act’s (ARPA’s) Premium Tax Credit enhancements expire.

Florida ended its state public health emergency (PHE) on May 3, 2021. However, since March 2020, as a condition of getting increased federal Medicaid funding during the pandemic, the state must maintain Medicaid coverage for most enrollees regardless of changes in their income or other circumstances. This protection will stay in place for the duration of the federal PHE, which was extended for 90 days on April 12, 2022. The end date for the PHE remains uncertain.

However, when the federal PHE ends, Florida will resume its regular Medicaid processes and will have up to 14 months to review the entire Medicaid caseload to see whether those currently enrolled remain eligible. It’s an enormous task that could cause more than 1 million Floridians to lose Medicaid coverage, including many children. Some who are still eligible for Medicaid will lose coverage due to complications like paperwork issues, outdated contact information, and staffing shortages. Others will no longer be eligible for Medicaid.  While some in this group will find coverage in the Affordable Care Act’s (ACA’s) marketplace, others will become uninsured without action by Congress.

In Florida, which is one of only 12 states that has not expanded Medicaid to all adults with low income,  many people in the health care coverage gap —  those with income below the poverty level who still cannot qualify for Medicaid under the state’s low income threshold —  will become uninsured without federal action. This will include large numbers of young adults who have turned 19, and parents whose income has risen above the state’s extremely low income thresholds. A Florida parent with two children cannot make more than $582 a month to qualify for Medicaid.

Additionally, affordability issues could prevent many people from getting marketplace coverage when the federal PHE ends. In ARPA, temporary premium enhancements were included that reduced or eliminated premiums for marketplace enrollees and prompted a surge in enrollment in the ACA marketplaces, with 2.7 million Floridians enrolling. If the expanded premium tax credits expire as set under current law, premiums will spike for many, and not only will people who no longer qualify for Medicaid at the end of the PHE face significant challenges affording the cost of marketplace coverage —   so will current marketplace enrollees. For example, a Floridian who makes $60,000 will see their cost for premiums rise by an average 36 percent while those making $15,000 will see an increase of 2,500 percent.  Over 3 million people currently enrolled in the marketplace across the country would lose coverage and become uninsured.

Sadaf Knight, CEO of Florida Policy Institute, said: “Floridians are already facing things like skyrocketing housing costs and food insecurity —  adding ‘losing health care coverage’ onto that pile will put a lot of people in this state in a very bad position. We need to ensure that Floridians can get life-saving prescriptions and medical services. Unfortunately, state leaders have refused to expand Medicaid, denying people paid low wages access to affordable health care coverage. We strongly urge federal lawmakers to close the Medicaid coverage gap and permanently extend enhanced premium tax credits.”

Alison Yager, executive director of Florida Health Justice Project, said: “Record numbers of Floridians have been newly covered by Medicaid over the past two years. That means access to coverage for those who would otherwise be forced to make impossible choices between healthcare costs and basic expenses like food and rent. Congress must ensure that these families do not lose access to coverage when the public health emergency ends.”

Scott Darius, executive director of Florida Voices for Health, said: “Giving workers, caregivers, parents, and students the security of health coverage is key to the continued recovery of our state and national economy.”

An economic package that Congress considers through the fast-track process known as reconciliation is the best chance, and possibly the only chance, to enact legislation before the enhanced premium tax credits expire and before the PHE is set to end. This is Congress’ best opportunity to protect coverage and ensure Floridians maintain access to affordable coverage.

Forthcoming economic legislation should:

  • Permanently extend enhanced premium tax credits to help Floridians who are no longer eligible for Medicaid afford private coverage, and to protect those currently enrolled in the Marketplace from paying higher premiums and potentially becoming uninsured.
  • Permanently close the Medicaid coverage gap for the 425,000 uninsured Floridians with income below the poverty line but no pathway to affordable health coverage because the state has refused to adopt the ACA’s Medicaid expansion.
  • Provide stable Medicaid coverage to children and postpartum people by requiring that all states cover one year of uninterrupted coverage at a time.

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