Vaccines, Medicaid, and rural health dominated the health care debate

The past year saw a number of significant actions at the state and federal levels that could transform how health care is delivered and financed in 2026 and the years to come.

The consequences of these choices have yet to be fully felt by Floridians. But they definitely are on the near horizon.

In considering the most important Florida health care stories of the year, the Florida Phoenix reached out to associations that represent consumers, providers, insurers, beneficiaries, and think tanks.

Vaccines

Three months after Florida Surgeon General Joseph Ladapo and his boss, Gov. Ron DeSantis, announced their goal to eliminate all vaccine mandates from Florida regulations and statutes, the state held a public meeting in Panama City Beach in December to take input from interested parties.

For three hours, Florida Department of Health officials heard public testimony on proposed rules changes to remove requirements for children attending public and private schools to receive the hepatitis B, varicella (chicken pox), and haemophilus influenza B or Hib vaccines. The proposal also would eliminate from rule the pneumococcal conjugate vaccine for admission to a licensed day care facility.

The proposed rule also would broaden the religious exemption parents can use to refuse vaccines to include personal or philosophical opposition.

Additionally, the proposed rule would allow parents, guardians, and college and university applicants aged 18-23 to opt out of disclosing their vaccination status to the Florida SHOTS program. SHOTS is how the state collects vaccination data. The new language tracks a 2019 law change.

The changes, some argue, conflict with the DOH's statutory mission to operate a communicable disease prevention and control program that includes school immunization. The agency is charged by statute to ensure that "all children in this state" are immunized against vaccine-preventable diseases.

Health care lobbyist and Jacksonville attorney Christopher Nuland told the Phoenix, "People absolutely are in tither over both sides of the argument." He predicted litigation over the proposed rule changes "will bleed over into the [2026] legislative session."

Ladapo and DeSantis announced during a September press conference that they'd like to see all vaccine mandates eliminated. While the DOH has control over its rules, it cannot eliminate the statutorily mandated school vaccines – only the Legislature can do that. Florida law requires public and private school students to be vaccinated for polio, diphtheria, measles, German measles, whooping cough, and tetanus.

The surgeon general this past fall praised the Legislature and went so far as saying he "loves our lawmakers." But Ladapo also issued an ultimatum. "They're going to have to make decisions, right? That's the way that this becomes possible. So, people are going to have to make a decision. People are going to have to, have to choose a side. And I am telling you right now that you know the moral side is, it's so simple."

Developmental disabilities and Medicaid

People with intellectual and developmental disabilities now can remain on Medicaid once they qualify and no longer will have to renew annually. House Speaker Daniel Perez championed lifelong eligibility for these Medicaid beneficiaries, as well as for the aged who live in institutions or receive home and community services, during the 2025 session.

"Someone who has been diagnosed as being permanently disabled should not have to re-certify as being permanently disabled every year. Unfortunately, that person isn't going to be able to move away from that," Perez explained in June.

A legislative staff analysis notes that between April 2023 and February 2025, "approximately 534 disabled individuals lost their Medicaid coverage because they failed to provide information" to the state to make an eligibility determination.

Additionally, the Legislature expanded statewide what had been a limited managed care pilot program for people with intellectual disabilities via HB 1103, which DeSantis signed into law in June.

"When we look back at the successes of this session, we'll look back at this pilot program as one of our greatest victories. It probably will never be a headline, it's probably not anything that most people will fundraise off of or campaign off of. But what I can tell you, I think for me and when I'm long gone and everyone forgets who I am and the names of many people in this chamber, they will remember that we potentially got rid of the wait list" for Medicaid services for people with intellectual disabilities.

'Free kill' veto

A multi-year push to repeal what critics have called Florida's "free kill" law involving medical negligence made it past the 2025 legislative finish line only to be vetoed by DeSantis. The House chose not to initiate a veto override.

HB 6017 put an end to a 35-year law preventing parents of single, childless, adult offspring and adult offspring of single parents who die from medical malpractice from filing wrongful death suits against hospitals and physicians.

DeSantis scheduled a press conference to veto the bill, appearing alongside Ladapo, Lee Health President Dr. Lawrence Antonucci, and others who supported the veto.

"If this legislation would be enacted, it would lead to higher costs for Floridians, it would lead to less care for Floridians, and it would make it harder for us to keep, recruit, and maintain physicians in the state of Florida," the governor said.

DeSantis said he could be swayed to support ending the ban, though, if the Legislature placed limits on non-economic damages in all medical malpractice lawsuits, as well as limits on attorney fees. The caps that DeSantis covets are being pushed by organized medical, insurance, and business interests, but they were rejected during the 2025 session by a one-vote margin in the Senate. The caps, to date, have been a non-starter in the Florida House.

Like vaccines, this 2025 issue will spill over into the 2026 session, the last for DeSantis as governor. The House already has fast-tracked the issue. HB 6003 has cleared all its committees of reference and is ready for a House floor vote. The bill has attracted 73 lobbyist registrations. To date, no Senate companion has been filed.

Soaring health insurance rates

Since the inception of the Affordable Care Act (often referred to as Obamacare) exchange, Florida has led the nation in the number of people enrolling to purchase subsidized health insurance plans. Florida enrollment topped 4.7 million people for 2025.

Despite the millions who rely on the coverage, Florida insurance officials decided not to warn Florida residents enrolled in the exchange that their health premiums would go up.

Florida is not alone in these rate hikes – insurers nationwide are filing double-digit increases. A review by KFF, the health care analysis organization, of marketplace plans submitted by 312 insurers in 50 states and the District of Columbia shows that the median proposed increase for 2026 is 18 percent, more than double last year's 7 percent median proposed increase.

Insurers cited rising costs and use of services plus the loss of the enhanced advanced premium tax credits as the reasons behind the rate increases, according to KFF.

Although Montana State Auditor James Brown issued a statement Aug. 1 advising residents in that state of the impending increases, it's not clear what if anything Florida insurance officials were doing to get the word out to people before Nov. 15, when open enrollment for 2026 coverage began.

Small business owner Carlos Otero, 60, has relied on the Affordable Care Act for years. Otero in December said that to keep his 2025 health plan in effect for 2026 would have cost him 900 percent more. He called it a "surprise incremental increase."

Big Beautiful: Medicaid and rural health

Donald Trump's One Big Beautiful Bill Act orders roughly $1 trillion in Medicaid reductions over 10 years beginning in 2028.

Florida has not expanded Medicaid under the ACA, so many of the cuts to Obamacare expansion states don't apply here. But the state isn't completely spared, and the new law changes how the state finances supplemental Medicaid payments to 280 acute care hospitals, two federally designated cancer hospitals, faculty physician practices at medical schools, and faculty physician practices at public hospitals.

The supplemental payment programs are not funded with state general revenue dollars but rather through taxes providers impose upon themselves and intergovernmental transfers.

The reductions in supplemental payment programs won't come immediately. In fact, Florida Medicaid Deputy Director Brian Meyer told members of the House Health Care Budget Subcommittee the state expects the feds to approve a $7.8 billion plan to finance the supplemental hospital-directed payment program this year.

That's more than double the $3.3 billion for the program in the 2024-25 fiscal year. That money will bridge the shortfall between the state's Medicaid rates and the amount it costs hospital to provide the care.

But to comply with the law, the $7.8 billion for the program will be pared back by $3.2 billion over eight years, landing at $4.6 billion in FY 2034-35, according to Meyer's presentation.

Perhaps to lessen the blow, Meyer told members the $4.6 billion landing point for the program will be higher than the $3.3 billion in the program last year.

Compliance with the reductions will affect additional Medicaid supplemental payment programs that enhance the traditional payments to cancer hospitals, physician faculty plans at medial schools, and physician plans at public hospitals so they are closer to the average rates paid by commercial health insurers.

The cuts to the four direct-payment programs would total nearly $3.6 billion by FY 2034-35.

In addition to cutting Medicaid, the One Big Beautiful Bill Act establishes the five-year, $50 billion Rural Health Transformation Program, which provides states access to $10 billion in grants from 2026 through 2030.

The Centers for Medicare and Medicaid announced Monday that Florida will receive $209 million in federal funds to bolster rural health care for nearly 1.2 million people who live in 31 rural counties across the state.

Agency for Health Care Administration Secretary Shevaun Harris announced last month she'd like to have the rural health grant applications posted to the agency's website in January or February.

Senate President Ben Albritton also made rural health care a priority as part of his "Rural Renaissance" bill. While it didn't make it past the finish line during the 2025 session, the bill has been refiled for consideration for the 2026 session that begins Jan. 13.

SNAP

The One Big Beautiful Bill Act reduces federal spending on the supplemental nutrition assistance program by $156 billion over a decade. SNAP provides nutritional support for low-income seniors, people with disabilities living on fixed incomes, and other individuals and families with low incomes.

To reach that $156 billion target, the federal government is increasing how much it requires state government to contribute to administrative costs, upping that amount from 50 percent to 75 percent. That means Florida needs an additional $50.6 million next year to cover the costs of employees and call centers that are integral to the program's success. The new law also requires the states to contribute to the costs of the benefits, which will also drive up the state's costs.

In November, nearly 3 million residents who rely on SNAP lost their benefits during the federal government shutdown.