Florida Faces Health Insurance Crisis as ACA Tax Credits Expire in 2025

Florida is facing a significant health insurance challenge as the enhanced premium tax credits under the Affordable Care Act (ACA) marketplace are set to expire at the end of 2025. These credits, expanded during the pandemic, currently help about 2.2 million Floridians afford their health insurance, especially working families and younger retirees. Without congressional action to extend these subsidies, many Floridians will experience substantial premium increases and a rise in the uninsured population.

Florida has the highest enrollment nationwide in ACA marketplace plans, with 4.7 million enrollees, while Miami-Dade County is particularly dependent, with over half of its population relying on ACA coverage. The expiration of tax credits could lead to premium hikes between 18% and 41% in Florida, with predictions that the uninsured rate could surge by up to 50%. ZIP codes such as those in Doral and Hialeah are among the most affected.

Beyond premium cost increases, recent changes through legislation such as H.R. 1, known as the 'One Big Beautiful Bill Act,' introduce stricter rules to ACA eligibility and reduce Medicaid coverage, which will impact millions across Florida. The legislation tightens income verification, restricts enrollment periods, and excludes some immigrant populations from ACA marketplace eligibility, compounding affordability and coverage issues.

Approximately 2.4 million Florida residents with incomes below 138% of the federal poverty level rely on the ACA marketplace because they do not qualify for Medicaid or employer-sponsored insurance. Small businesses and gig workers also benefit significantly from these affordable plans. Cuts to Medicaid under H.R. 1 also threaten hospital funding, which could have broader implications for healthcare infrastructure in the state.

Florida's ability to mitigate this crisis is limited since Medicaid expansion—which could cover up to 3.7 million additional residents—is unlikely due to political resistance. The state's congressional delegation's support of restrictive legislation leaves many uninsured or at risk. Advocacy groups stress the urgent need for congressional intervention to extend subsidies and maintain Medicaid funding to prevent what may become a significant health coverage crisis in Florida, especially in Miami-Dade County.