July 18, 2025

Raising the Alarm on the Oncoming Tidal Wave of Health Care Coverage Loss for Florida

Author's Note: Since publication of this blog on July 18th, 2025, the Congressional Budget Office has released updated projections for coverage loss due to H.R. 1 and the approaching expiration of enhanced premium tax credits. FPI is in the process of updating this publication to reflect the new data and subsequent new analysis from KFF.

The federal reconciliation bill signed into law on July 4, 2025, includes significant cuts to Medicaid, which will have devastating impacts on Floridians’ health and well-being. Many of the provisions to undo Medicaid protections in H.R. 1, or the “One Big Beautiful Bill” Act, are set to take effect at varying points over the next few years, meaning the full scope of impacts will be delayed. However, H.R. 1 also includes changes to the Affordable Care Act (ACA) Marketplace that will take effect sooner— notably, allowing the enhanced subsidies for people receiving insurance coverage through ACA plans (Enhanced Premium Tax Credits, or EPTCs) to expire at the end of 2025 and creating more hurdles to enrollment. Together, the cuts to Medicaid and cuts to ACA Marketplace subsidies set Florida up for an impending health care coverage disaster. (See Figure 1.)

Since 2015, Florida has had the highest number of individuals utilizing the ACA Marketplace to gain health insurance. The enhanced premium tax credits passed in the American Rescue Plan Act in 2021 and extended in the Inflation Reduction Act through 2025 allowed for more people to utilize the ACA Marketplace and considerably lowered premium costs. Because of these improvements, Florida’s ACA Marketplace enrollment has risen to a record-setting 4.7 million people, or over one in five Floridians. 

Because Florida has historically benefited the most from the premium tax credits and ACA Marketplace, Florida is also the state that will be most harmed by the new restrictions and subsidy cuts. Congress has not elected to extend these enhanced subsidies, which will expire at the end of this year, and has enacted new rules and requirements that will make it harder for people to get and stay on Marketplace plans. According to KFF, the combined impact of these changes to the ACA Marketplace and cuts to Medicaid will result in a staggering 2.3 million people in Florida losing their health insurance. Of these 2.3 million Floridians, 2.2 million (96 percent) are projected to lose their insurance because of the ACA Marketplace changes that will begin in January 2026. According to Wakely/Health Management Associates, non-expansion states can expect to see 53 percent to 64 percent coverage loss for ACA Marketplace plan participants due to federal Marketplace changes and the expiration of the tax credit enhancements. This will be felt even more acutely in certain Florida regions, including South and Central Florida. (See Figure 2 for county-level coverage loss data and Figure 3 for zip-code level.)

Because Florida has historically benefited the most from the premium tax credits and ACA Marketplace, Florida is also the state that will be most harmed by the new restrictions and subsidy cuts.

Figure 2.

*Estimate by Wakely Consulting Group/Health Management Associates of the lower end of projected coverage loss for ACA Marketplace plans for non-expansion states.

Figure 3.

As a state that has not expanded its Medicaid program, Florida will be particularly hard hit by this coverage loss. Floridians with low income — people between 100 and 138 percent of the federal poverty level who do not qualify for Medicaid — have relied on the Marketplace for health coverage, especially on the enhanced subsidies. In fact, in 2025, 51 percent of enrollees on ACA Marketplace plans, or 2.4 million people, have incomes below 138 percent of the federal poverty level, which is also the eligibility threshold if a state expands Medicaid (see Figure 2 for county-level estimates). This indicates that a major policy solution at Florida's disposal to respond to the oncoming health crisis, whether legislatively or through a ballot initiative, is to expand Medicaid.

As a result of H.R. 1’s cuts and new rules, Florida’s rate of uninsured individuals will double, going from a historic low of 10.7 percent in 2023 to a catastrophic high of 19.7 percent starting in 2026. (See Figure 1.) The impacts will be stark — and will reverberate far beyond the doctor’s office. For one, the level of uncompensated care for health care providers, or the cost of providing care for people without insurance who are unable to afford payment, is poised to skyrocket. One analysis pegged this number at $5.2 billion for Florida — the most in the nation. This is going to have a devastating impact on health care providers across the state, especially ones that serve low-to-moderate income and rural communities. 

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