When Obamacare tax credits expire, don’t expect Medicaid to fill the gap in Florida

As Congress fights over the future of Affordable Care Act subsidies, the healthcare of millions of Floridians is on the line.

An impasse between congressional Democrats and Republicans over extending the tax credits has resulted in a federal government shutdown, with seemingly little momentum toward a compromise.

Florida could be the hardest-hit state when the tax credits expire at the end of the year, in part because the state has long refused to expand Medicaid. But as advocates raise alarms about Floridians on the brink of losing healthcare, the state’s Republican lawmakers say they are still firm in their opposition to expansion.

Rep. Sam Garrison, who will be House speaker for the 2027 and 2028 sessions, replied with a curt “no” when asked last week if he was open to Medicaid expansion.

“We’re going to be fiscally responsible, that’s our No. 1 responsibility,” Garrison, R-Fleming Island, said.

Nearly 4.5 million people in Florida get cheaper health insurance on their Affordable Care Act plans through enhanced premium tax credits, which are set to expire at the end of the year. And nearly half of Floridians who have Obamacare plans would be eligible for Medicaid if Florida expanded it, according to Centers for Medicare & Medicaid Services data.

As one of 10 states that haven’t expanded Medicaid, Florida’s program is limited. Adults without children cannot qualify for Medicaid coverage. Non-disabled adults with children must make about 27% of the federal poverty level to qualify — about $7,000 a year for a family of three.

Expanding Medicaid would allow adults with incomes less than 138% of the federal poverty level, or $21,597 for one person, to qualify for coverage. According to federal data, 2.4 million people in Florida who have Affordable Care Act plans are within that income level.

Holly Bullard, the chief strategy and development officer at the think tank Florida Policy Institute, said in a statement that Medicaid expansion is “a major policy solution at Floridians’ disposal.”

Bullard, who is also the co-chair of Florida Decides Healthcare, a group seeking to put Medicaid expansion on the ballot in 2028, said Floridians are facing “a health coverage gap, which is quickly going to become a chasm.”

“What is the excuse not to expand, especially when there is a major healthcare cliff approaching which Medicaid expansion could in large part alleviate?” Bullard said in a statement.

Francoise Cham, a 63-year-old in Miami-Dade County, said she didn’t have insurance for 25 years. Then she got a plan for her and her daughter, a 20-year-old college student, through the Affordable Care Act. She pays about $50 a month for both of their coverage.

In the past, Cham has tried to qualify for Medicaid. She said caregiving for her mother, who had dementia and died in 2019, and her brother, who was paralyzed and died in 2015, made it impossible for her to hold down a regular job. She now works as a substitute teacher in Miami.

But Cham said she had been told in the past that she didn’t qualify under Florida’s limited Medicaid criteria because she made too much money.

“I think the state of Florida, they’d rather just tell you to go to the healthcare marketplace because they don’t want to deal with it,” Cham said. “I think that’s their go-to.”

Cham will soon be eligible for Medicare. But in the interim, Cham said she’ll have to go without health insurance if her monthly premiums become too high once the tax credits expire.

“If it’s buying food or having insurance, I’m going to pick buying food,” she said.

A study from Urban Institute, a D.C.-based think tank, said that without the tax credits, Florida is estimated to see about $1 billion more in uncompensated care costs.

When former President Barack Obama pushed for the Affordable Care Act in 2010, Republicans vehemently opposed it. But with time, red states moved to take advantage of the program and expand Medicaid.

While Florida has expanded Medicaid access for postpartum mothers, state leaders have been firm about not broadening the program overall.

During a Republican presidential debate in 2023, Gov. Ron DeSantis said he was opposed to having “massive numbers of people on government programs without work requirements.”

But under the new legislation pushed by President Donald Trump, adults who qualify for Medicaid expansion will have requirements. Adults will have to complete 80 hours of work or community service a month to keep their coverage, with certain exemptions.

A spokesperson for DeSantis’ office did not return multiple requests for comment.

Even with work requirements soon to be in place, many Florida Republicans said they feel that the federal government’s offer of millions of dollars to finance Medicaid expansion is a bad deal.

Rep. Alex Andrade, the Republican chair of the Health Care Budget committee, said he doesn’t think “it’s a good idea for us to set up a financial system where we’re more dependent on the federal government.”

And Rep. Adam Anderson, the Republican chair of the Health Care Facilities & Systems Subcommittee, said in a text that Florida “is not a Medicaid expansion state” and that adding more people to Medicaid “is not the solution.”

©2025 Miami Herald. Visit miamiherald.com. Distributed by Tribune Content Agency, LLC.