The Affordable Care Act marketplace insurance plans many Floridians use are expected to become a lot less affordable next year under President Donald Trump's tax-spending package.
Among the changes Trump's "Big Beautiful Bill Act" made to American health care, one allows the enhanced premium tax credit to expire – effectively repealing it, said Erica Monet Li, a public health expert with the progressive-leaning Florida Policy Institute.
"We're thinking about all the ways where this bill was kind of not a direct appeal, it's death by a million cuts," Li said.
It's a big deal for Florida, which has the greatest number of ACA recipients in the country. There were 4.7 million plans purchased for the 2025 coverage period, according to the Centers for Medicare and Medicaid Services. That's up from 4.2 million in 2024.
What is the enhanced premium tax credit?
The tax credit is set to expire this year. Previously, Floridians could opt for the marketplace to send a tax credit directly to their insurance company, lowering the cost of their monthly premium.
The enhanced tax credit received a boost in 2021 during the COVID-19 pandemic, when the American Rescue Plan increased subsidized payments and increased the income limits so a household with an income above 400% of the federal poverty line could qualify.
But with the premium tax credit set to expire, customers can expect their premiums to rise by 90%, according to an estimate by KFF.
The average cost per year of marketplace health insurance is expected to rise from $588 to $1,116. About 97% of Florida ACA insurance users are predicted to be affected, Li said.
"Unfortunately, a lot of people are still not aware of what's going on, and they don't know this is happening," Li said.
Marketplace insurance is popular
ACA health insurance has grown popular in the last four years since the use of the enhanced premium tax credit.
A KFF analysis shows that subsidized enrollment in the marketplace rose 106% from 2020 to 2024. In Florida, enrollment has spiked by 134% since 2020, KFF data show.
A snapshot of CMS data shows that Florida, more than any other state, stands to lose the most from the expiring credit. Texas is the only state that comes close to Florida's total ACA enrollment count, with 3.9 million coverage plans – Florida has 800,000 more. The only other state with over 1 million plans is California.
"Florida is actually the state with the highest enrollment in marketplace coverage in the country, where we're not the largest state in terms of population, but we do have the greatest number of people enrolled," said Lynn Hearn, legal director of the Florida Health Justice Project. "Our residents have come to rely upon marketplace coverage in a very big way, and that's going to be a very painful discovery when they go to renew this year."
As a result, analysts are predicting the uninsured rate will rise. According to the Center for Budget Policy and Priorities, in combination with Medicaid cuts, about 2.4 million Floridians are expected to become uninsured in the next 10 years due to the tax-spending package.
"Florida isn't the strongest in terms of having good health care options available for people who are uninsured. But our safety net is the federally qualified health centers. I think that there is going to be more strain on those than ever," Hearn said. "They are going to become more and more important to our health care network, as is hospital charity care."
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