440,000 fewer Floridians are enrolled in ACA marketplace plans since subsidies expired

A popular tax credit that helped 22 million Americans afford premiums for health insurance plans purchased on Affordable Care Act marketplaces expired at the end of 2025. Since Congress failed to renew the expanded credit, hundreds of thousands of Floridians have dropped their insurance plans.

Cat Jaramillo is a self-employed consultant in Miami. In 2025, she had a Cigna insurance policy through the marketplace and paid about $188 a month out of pocket for premiums. As a person living with ADHD and kidney problems, she was able to afford her medication and her visits to healthcare providers with coverage in the policy. 

In 2026, the combination of annual price increases and the expiration of the enhanced subsidies made renewing her coverage impossible. “I wanted to keep the similar plan and be able to access the same medications,” Jaramillo told the Florida Independent. “It would have jumped up to paying $1,045 a month, which is astonishing. It’s higher than my mortgage, so it was just not feasible. It’s not possible. So I had to forgo, I had to just let go of the health insurance.”

She’s not the only one facing the difficult decision to either pay skyrocketing premiums or go without health insurance: According to a July 2026 AP analysis of Centers for Medicare and Medicaid Services data, 4,292,372 Floridians were enrolled in an Affordable Care Act marketplace plan as of February 2025. By February 2026, that number had dropped by 442,785, to 3,849,587.

In 2021, Congress passed and President Joe Biden signed a law that temporarily expanded eligibility for subsidies for ACA marketplace insurance policies and increased the size of the benefit for those who were already eligible. A year later, the enhanced tax credits were renewed through 2025. With the expanded credits, enrollment in marketplace insurance plans more than doubled nationwide between 2021 and 2025. 

The GOP-led Congress in 2025 allowed the subsidies to expire; President Donald Trump had said he was against renewal. In Florida, out-of-pocket costs for ACA marketplace policy premiums increased by 58%, from an average of $67 a month in 2025 to $106 in 2026.

Julee Ellison, a 62-year-old small-business owner in Parrish, saw her monthly payment increase from $768 last year to almost $1,700 this year. For now, she said in a phone interview, she is paying the higher cost and hoping her economic situation doesn’t get worse: “We have the money, but it’s stretched us super thin. That’s for sure. I do know a lot of people, and a lot of them are small-business owners. They don’t even have insurance anymore. I mean, especially this year, I know a lot of people who have canceled or just not renewed because it’s just not affordable for them, and that breaks my heart.” Because her new plan has higher co-payments for medical tests, she said, she recently opted to skip two of the three her doctor suggested rather than pay $3,000 on top of her monthly premium.

A bill on extending the tax credits through 2028 passed in the House in January by a 230-196 vote, but it has not received a vote in the Senate. A similar three-year extension bill fell short of the required three-fifths supermajority in that chamber in December 2025, receiving 51 votes for and 48 against.

Florida Democratic Reps. Kathy Castor, Lois Frankel, Maxwell Frost, Jared Moskowitz, Darren Soto, Debbie Wasserman Schultz, and Frederica Wilson, as well as Republican Rep. Maria Elvira Salazar, voted for the three-year extension.

Republican Sens. Ashley Moody and Rick Scott voted against the extension, as did Republican Reps. Aaron Bean, Gus Bilirakis, Vern Buchanan, Kat Cammack, Mario Diaz-Balart, Byron Donalds, Neal Dunn, Randy Fine, Scott Franklin, Carlos Gimenez, Mike Haridopolos, Laurel Lee, Anna Paulina Luna, Brian Mast, Cory Mills, Jimmy Patronis, Greg Steube, and Daniel Webster. Republican Rep. John Rutherford missed the vote.

In a December Fox News appearance, Moody claimed that the subsidies were riddled with billions of dollars in fraud and that they forced working people to pay for healthcare for millionaires. She backed a GOP alternative bill that would not have extended subsidies, instead opting for expanded health savings accounts. “You’re going to see very different proposals on the Democratic side. You’re going to see them come in and go, We want to take on the Coach [Tim] Walz playbook of, We know there’s all kinds of fraud, but we want to keep doing the same thing and stick our head in the sand. And you’re going to see the Republican plan, which is, Look, we’ve thought a lot about this. We’ve put pen to paper, and this is our best scenario right now, temporarily, to propose a fraud-free, actually affordable healthcare plan.” 

“When we stop funneling tax dollars for subsidies to insurance companies and instead provide families safety-net support through a Trump Health Freedom Account — an HSA-style account — we put the power of decision-making into the hands of families to choose a plan that best fits their needs,” Scott wrote in a Dec. 1 Fox News op-ed. “Americans will always make a better choice for their families than the government will.”

That bill also failed in the Senate, by a 51-48 vote.

“Rising insurance rates are another sign that Florida’s health care system is becoming increasingly unaffordable. We see this in the numbers – more Floridians are being forced to go without the coverage they need, and that puts pressure on safety net programs and services that face cuts brought on by federal and state policies,” Acadia Jacob, interim executive director of the organization Florida Voices for Health, said in an email. “The consequences are already felt each and every day across Florida’s communities, from hardworking seniors and families to caregivers, young adults, and people with disabilities. Lawmakers have the power to ease this burden, but that requires making affordable, accessible health care a priority.”

Jaramillo said that without insurance, getting care and the medications that work for her becomes more difficult. “I went a couple of months without being able to access healthcare,” she recalled. 

The prescription drug she had successfully used to control her ADHD, which had required just a $5-a-month co-pay under her insurance plan, became unaffordable, she said: “The Vyvanse without insurance was like $200. So we had to change that medication.” 

Jaramillo has since found more affordable care through Community Health of South Florida. That facility is a Federally Qualified Health Center, a nonprofit provider funded by public and private donations and offering care to patients regardless of their ability to pay. While she called the clinic a lifesaver, she noted that she has had to adjust to all new doctors: “I had an ongoing relationship for years with my primary and my psychiatrist, so this is kind of like starting from zero, so that you kind of lose that connection, which is so important to your health. But they’re there, so that’s like a lifeline that I’m extremely grateful for.”

Ellison said that she believes people are starting to realize that the expiration of the credits hurts everyone, not just those who purchase ACA marketplace plans: “All the people that get employer health insurance, it’s going to cost them because insurance is still going to keep going up. Their portion’s going to go up. You’re going to have hospitals close because they don’t have the patients that they would have had, because people won’t go to the doctor, or like me, won’t go get tests. They don’t know they’re sick. It’s just a really, really bad cycle and not the direction that this country should be going at all.”

“Like most people my age, at 62 years of age, you want time to slow down,” Ellison added. ”You want to be able to enjoy every moment you can because time goes so fast. And here I am, like probably a lot of others, saying, Damn, 65 cannot come fast enough. And hopefully, Medicare is still going to be around by the time I turn 65.”