Rosanne Dunkelberger
While much of the pain built into this year’s “One Big Beautiful Bill” is spread out over the next 10 years, there’s one aspect of the federal budget that a panel gathered by Florida Conservatives for Affordable Health Care agrees could send health care for working families off the cliff in just four months.
The Affordable Care Act (ACA) was created to subsidize those whose annual income was too high to be eligible for Medicaid, but not enough to pay high health insurance premiums — up to 200% of the federal poverty level, topping out at $62,600 for a family of four. In 2021, post-COVID, eligibility was upped to four times the poverty level, or $128,600.
Enhanced Premium Tax Credits, as the subsidy is known, were extended and are due to expire at the end of 2025.
And one reliable conservative voice is gung-ho on encouraging the federal government to continue the highest level of eligibility.
“This is an issue that I think impacts every single business in the state, said Brewster Bevis, president and CEO of Associated Industries of Florida (AIF). “We have members throughout every silo of the Florida business industry — tourism, financial services, agriculture, energy, you name it.”
Today, 4.7 million Floridians — one in five people — are getting premium assistance through the federal marketplace, the most in the nation.
Die-hard budget hawks in Congress might want to reconsider their opposition to anything Obamacare tout de suite, Bevis warns, because open enrollment begins Nov. 1 and insurance companies are already sending out notifications of significant premium increases for 2026.
“I worked on Capitol Hill,” he said. “It’s not until it’s in front of your face in a burning dumpster fire that you really start paying attention to these issues, but I think it’s incumbent upon us, and what we are doing with our partners, is going out and saying, ‘Look, this fire is lit. It may not be a burning dumpster fire yet. But in 2026, if this goes away, you’re going to be dealing with a lot of very dissatisfied and upset constituents who have no access to health care.”
Panelist Mary Mayhew, former Agency for Health Care Administration (AHCA) Secretary and now president and CEO of the Florida Hospital Association, put it another way:
“While the politics of the ACA have been heated over the years, there should be a unified political voice in support of the federal marketplace and the premium assistance in Florida,” she said. “Nearly 86% of those enrolled in Florida are between the ages of 18 and 65, and one of the things I want everybody to think about is: If not this, then what? There are a lot of false assumptions about what happens to individuals as these premiums skyrocket and they no longer have the benefit of this crucial premium assistance. They are not going to be eligible for Medicaid …. The individual market for decades here and around the country has been characterized as having been in a death spiral, meaning it became so unaffordable that even the insurance companies could not sustain access to the individual market, a critical reason why the federal marketplace was so important for individuals who are self-employed.”
The health policy organization KFF estimates that if the enhanced eligibility sunsets, an additional 2.3 million people in Florida would become uninsured.
And Medicaid and nonprofits won’t pick up the slack. Most of those jettisoned from the marketplace will earn too much to be eligible for Medicaid.
Community clinics are already stressed for funding, said Jonathan Chapman, CEO and president of the Florida Association of Community Health Centers, which represents 54 organizations offering primary care access throughout Florida.
“Community health centers can’t survive just treating uninsured patients,” he explained. “I know we’re here to talk about the marketplace and extending the credits … but so many of our other revenue streams are under attack as well now.”
Yes, said Bevis, extending the insurance subsidies will add to the federal budget.
Extending the enhanced premium tax credits is estimated to cost roughly $500 billion over 10 years.
“Speaking personally,” Bevis said, “we tee-tee money away on a lot of things that are absolutely inconsequential, but I think $500 billion is well worth having healthy individuals in our state and our country.”
