Sticker shock looms for Florida residents relying on Affordable Care Act

TAMPA, Fla. — Debbie Collins makes her living cooking and selling funnel cake, corn dogs and deep-fried Oreos at festivals around Tampa Bay and beyond.

It’s not a job that comes with health insurance.

Like many self-employed workers, Collins relies on the Affordable Care Act for medical coverage for herself and husband, Joe Collins, 59.

Next year will be tougher.

Collins, 62, receives tax credits that made her premiums this year free. Starting January, an equivalent plan will cost $174 per month, likely forcing her to switch to one with higher out-of-pocket expenses.

Insurance is vital for her husband who has diabetes, heart and kidney issues. The best plan that lets him keep seeing his specialists will cost $193 per month, almost $100 more than they pay now.

“I know everything is going up,” said Collins, who lives in Wesley Chapel.

Affordable Care Act open enrollment began Nov. 1. Americans who rely on the federal marketplace for health insurance face greater cost increases than ever before.

Premiums are set to rise by an average of 26%, according to an analysis by KFF, an endowed nonprofit which provides research on health issues. At the same time, enhanced tax credits that subsidized health care premiums during the pandemic are set to expire Dec. 31, meaning premiums could double for many.

Those higher costs will put coverage out of reach for millions, health care advocates warn. Florida, which leads the nation with 4.7 million enrollees, could be hardest hit.

Around 1.4 million Floridians could lose health insurance in 2026, a possible 6% hike in the state’s uninsured rate, estimates by KFF show.

The upheaval comes after U.S. Census data showed the number of uninsured Floridians rose by about 120,000 in 2023 after the state resumed Medicaid eligibility checks that were paused during the pandemic.

“Those initiatives back to back are moving the potential for a surge in uninsured individuals where we had had a lot of wins with getting people covered,” said Katie Roders Turner, who helps Tampa Bay residents navigate coverage as executive director of the Family Healthcare Foundation. “People are having to make decisions about having to afford their food; health care may not be their highest priority.”

The possible loss of subsidies has led to the longest government shutdown in U.S. history, with Democrats saying they won’t vote to reopen the government unless the enhanced tax credits are extended.

Those who are self-employed or work for small businesses who don’t provide employer-sponsored insurance may have to cover the full increase. Older people who are not yet eligible for Medicare could have to pay premiums up to three times higher than younger people.

Americans who earn more than 400% of the federal poverty level will no longer get tax credits nor benefit from a provision that capped premiums at roughly 10% of their income.

“That is a population that may end up having more sticker shock than most others,” Roders Turner said.

Republicans have argued that the expiration of tax credits will return the program, also known as Obamacare, to how it operated before the pandemic.

The Congressional Budget Office estimates that keeping the tax credits would increase enrollment by 3.8 million but add $350 billion to the federal deficit over the next 10 years, spending that House Speaker Mike Johnson described as a “boondoggle,” according to a NBC News report.

“When you subsidize the health care system and you pay insurance companies more, the prices increase,” Johnson said.

Uncertainty over premium prices and the Trump administration’s decision in February to cut funding for the navigator program by 90% could mean that Affordable Care Act enrollment will drop in Florida for the first time since 2018.

Congress created the navigator program to give consumers impartial advice on picking the best insurance plan. The cut reduced funding from $100 million to $10 million nationwide.

In Florida, that means roughly 66% fewer navigators assisting Floridians during enrollment, said Xonjenese Jacobs, director of the Covering Florida navigator program.

It also means less paid advertisements to promote insurance through the Affordable Care Act, Jacobs said. Her group will try to make up for that with more social media promotion and outreach.

The number of navigators operating in the Tampa Bay region has dropped from 39 to 30. There would be fewer still were it not for a $860,000 grant from the Children’s Board of Hillsborough County to shore up efforts there.

Redington Beach resident Laura Reynolds got insurance through her nonprofit employer until this summer when she was forced to go on family medical leave for fibromyalgia. She was already being treated for rheumatoid arthritis and lupus.

Her medical leave ran out but her rheumatologist advised against her going back to work.

Her options after quitting were the Affordable Care Act marketplace or COBRA, a federal law that allows a worker leaving their job to continue their health insurance policy for a limited time but with no employer subsidy.

She enrolled in a marketplace plan in October. Her premiums were free because she was on short-term disability.

The same plan next year will cost her $468 per month, she said, a premium she can only afford because she will get help from her partner.

Without insurance, she would have to pay a minimum of $159 for every visit to her rheumatologist and $300 for bloodwork four times a year.

“There must be people out there who are in worst shape than I am who are not getting healthcare because they just can’t afford it,” Reynolds said. “You should never have to choose between your light bill, your groceries and your health insurance.”