Meals, mortgage or medicine? Floridians on Obamacare are facing tough choices

The new year brought Kellie Brvenik a choice. She could pay to keep her cancer at bay, or cover life’s other necessities, like food and her mortgage.

Brvenik, 44, was diagnosed in 2024 with leiomyosarcoma, a rare and aggressive form of cancer. A property manager in Lake Worth Beach, she stayed at work through 10 weeks of radiation, “until it became unbearable,” and she’s since lived off a $1,952 monthly disability check.

It was financially manageable, if even just barely, thanks in part to the fact that her health insurance premium, purchased through the Affordable Care Act’s Federal Marketplace, was just $0.18 a month. In place since 2021, the ACA’s enhanced premium tax credits capped how much enrollees could be charged relative to their income. Eighty percent of plan holders, like Brvenik, had premiums of less than $10 a month in 2025.

But at the start of this year, Brvenik’s monthly premium jumped to nearly $142 after the credits expired.

“It’s rough,” she conceded.

That’s particularly so in Florida, said Matt McGough, a policy analyst who focuses on the Affordable Care Act, also known as Obamacare, at the health care research nonprofit KFF.

People between 50 and 64 were set to see especially steep premium hikes, and Florida has a relatively old population. Plus, many of its workers are seasonal or part time, meaning they might not receive health insurance through their jobs, and — critically — the state elected not to expand Medicaid eligibility, leaving many residents too well-off to qualify for government insurance but unable to afford to pay for their own.

For many, the math was already hard before the credits expired. KFF projected that for a 60-year-old couple earning $85,000 in South Florida, the elimination of the enhanced premium tax credits would spike their premiums by nearly 350%. For a 40-year-old making $32,000 a year, that figure was over 200%.

And nowhere are the effects of higher ACA premiums felt more than in Miami-Dade, which has the largest Obamacare enrollment population — more than 1 million last year, according to the Centers for Medicare and Medicaid Services — of any county in the nation.

Those inflated bills are eating into families’ budgets at a time when gas, grocery and housing costs are high and threatening to climb further, limiting many Americans’ ability to save money and build wealth.

Brvenik is one of 4.5 million Floridians who purchase health insurance through the ACA’s Federal Marketplace. And, like many of them, she’s now paying sharply more for the same coverage.

When she saw her new bill, Brvenik considered downgrading her plan, but she didn’t. A lesser one wouldn’t have covered many of her treatments. Her current plan barely covers them as it is.

Blood tests, hormone blockers — she needs both to monitor and contain the spread of her cancer, and she’s now paying more for each. Those aren’t covered and will run her hundreds of dollars a month.

“I’ve had to reduce the amount of times I can have [some of those tests],” she said. She’s also had to turn to food banks for help.

Congress anticipated those rising costs and debated extending the enhanced premium tax credits toward the end of last year. Democrats pushed for a three-year extension to the credits, while many Republicans favored either a one-year extension or none at all.

Split largely along party lines, the effort stalled in the Senate after passing the House. But some Republicans, like Miami-Dade Rep. María Elvira Salazar, crossed the aisle to push the three-year extension through the House. Her district has one of the highest Obamacare enrollment rates in the country.

“This isn’t partisan,” she said of her vote. “It’s human.”

Others, like Miami-Dade Rep. Mario Díaz-Balart, opposed the extension, citing instances of fraud and abuse. Ultimately, the tax credits were a “temporary Band-Aid,” he told the Herald, adding that the extension would cost taxpayers $80 billion over 10 years, citing a Congressional Budget Office report.

Sens. Rick Scott and Ashley Moody and Miami-Dade Rep. Carlos Gimenez, all of whom opposed the three-year extension, did not respond to requests for comment.

McGough, the health care policy analyst, noted that the credits can be revived at any time, if elected officials so desire.

“Congress is essentially what controls how much people pay toward their individual market premiums,” he said, “and it seems that this conversation has just fizzled.”

As a result, Obamacare premium limits reverted to their pre-2021 levels this year, meaning millions of Americans now pay more for their coverage.

Michael Pancier felt the sticker shock immediately.

Pancier, 60, is an attorney in Miami-Dade. He runs his own firm and for years has purchased health insurance through the Federal Marketplace for himself, his wife — who’s also self-employed — and their 21-year-old daughter.

In 2025, Pancier’s premium was $2,167 a month, roughly what it had been for years. This year, it nearly doubled. He now pays a monthly $4,201 for the same coverage — actually, worse coverage, since one of his doctors no longer accepts his plan.

“You gotta be kidding,” he recalled thinking when he saw his premium estimate. “You’re spending $50,000” a year.

It’s money he’d otherwise put toward his retirement account, home repairs, maybe a new car. “I’m going to have to hold off on some of that stuff,” he said.

Pancier had hoped to retire soon. Now, “I’m definitely not going to retire until I’m Medicare eligible” — meaning 65 — and even that depends on “how long these ridiculous premiums last,” since his wife and daughter might still rely on the Marketplace plan.

A recent KFF poll of Marketplace plan holders found that 81% said their health care costs have gone up, with more than half saying costs are “a lot” higher. Nearly three-quarters expressed anxiety about affording emergency care costs, and 55% said they either are or will be cutting back on household spending to afford health care costs.

Florida is particularly exposed.

The state is one of 10 that has never expanded Medicaid eligibility, leaving a coverage gap for residents who earn too much to qualify for government insurance but too little to comfortably afford higher premiums, said Aidil Oscariz, a policy consultant at Catalyst Miami, a Miami-Dade-based nonprofit that provides social services.

And a disproportionate share of Florida workers are employed in seasonal or part-time industries, like tourism, meaning fewer receive insurance through their employers. Only 40% of Floridians are covered by employer-based health insurance, compared to 49% nationally, according to data from the U.S. Census Bureau.

The state also skews older. The ACA allows insurers to charge adults ages 50 to 64 up to three times more than younger enrollees for the same plan, meaning they were already paying more before the subsidies disappeared.

“They’re facing a double whammy,” said McGough, the policy analyst.

The loss of subsidies has compounded with a record increase in the sticker price of unsubsidized plans.

“Those extended tax credits really made it so that the cost of the plans were far more affordable,” said Xonjenese Jacobs, director of Florida Covering Kids & Families at the University of South Florida College of Public Health.

Part of that affordability came from increased Obamacare enrollment.

Since the start of the year, almost 200,000 Floridians dropped their ACA Marketplace plans — one of the sharpest declines in the country — according to the Centers for Medicare and Medicaid Services.

And the people most likely to drop coverage, said McGough, are those who are younger and healthier — those who are more willing to gamble with going uninsured.

That leaves a sicker, older, more expensive pool of enrollees, which pushes up premiums for everyone.

“Hospitals must stabilize uninsured patients under U.S. law, even without compensation,” said McGough. “If the amount of uncompensated care is increasing, hospitals raise their prices to meet that — which actually raises prices for people who have insurance.”

The Congressional Budget Office found that the enhanced tax credits, had they passed, would have lowered premium costs by 5.7%, 9.0% and 3.3% in 2027, 2028 and 2029, respectively, thanks to the fact that “the people who enroll in the marketplaces would be healthier than would be the case without the extension.”

And those who drop their insurance might still get sick. “If it becomes much more difficult for people to access care, it creates more stress on an already strained system,” said USF’s Jacobs. “We’re going to see exacerbated health conditions for those who cannot manage their chronic conditions. We’re going to see higher mortality rates.”

But the ripple effects could reach beyond health care. Workers who rely on Marketplace plans may start choosing jobs based primarily on benefits rather than fit, McGough said. Small businesses, whose employees disproportionately rely on the Marketplace, could struggle to recruit and retain workers.

For Brvenik, the cancer patient, the health and financial pressures are one and the same.

“I hate relying on someone else for help. I want to be self-sufficient,” she said.

“I don’t wanna ask my parents, who are trying to get their finances in order to retire,” she added. “I mean, it kills me to tell them I can’t pay my mortgage this month.”

This story was produced with financial support from supporters including The Green Family Foundation Trust and Ken O’Keefe, in partnership with Journalism Funding Partners. The Miami Herald maintains full editorial control of this work.

©2026 Miami Herald. Visit miamiherald.com. Distributed by Tribune Content Agency, LLC.