By skyforbes 
Despite a decade of progress, Florida’s refusal to expand Medicaid and rising costs leave millions without access to affordable care
By Senior Staff Writer, Edmond Thorne: 09/09/2025 10:21 EST
Fla. News Network — Across Florida, an estimated 3 million residents, or 15% of the population, face each day without the safety net of health insurance. This figure, one of the highest in the nation, represents a profound challenge for individuals, families, and the state’s broader healthcare infrastructure. In 2013, nearly 29% of Floridians under age 65 lacked health insurance. That number has since dropped to 15%, a major shift driven by the Affordable Care Act and its marketplace subsidies. Yet Florida’s uninsured rate remains one of the highest in the country, nearly 50% above the national average of 9.5%. With ACA and Marketplace subsidies being slashed, the number of uninsured in Florida is expected to surge.
The improvement is real, but the gap is stubborn. Florida’s refusal to expand Medicaid under the ACA has left hundreds of thousands of low-income adults ineligible for coverage. These are people who earn too much to qualify for Medicaid but not enough to afford marketplace plans, even with subsidies.
Who’s Falling Through the Cracks:
The uninsured in Florida aren’t a monolith. They’re restaurant workers, Uber drivers, landscapers, and freelancers. They’re young adults, gig workers, and small business owners. Many work full-time but don’t get coverage through their employers. Others face premiums that eat up a third of their income. Young adults are hit hardest. In 2025, 17% of Floridians aged 18 to 24 are uninsured, compared to 11.3% nationally. That’s not just a number — it’s a generation navigating college debt, gig work, and rising rent without a safety net.
Behind those numbers are everyday struggles: parents choosing between rent and doctor visits, young workers skipping checkups, and families terrified of medical bills that could push them into long-term debt. It paints a picture of vulnerability in a state where affordability pressures are already high.
The Cost of Going Without:
Skipping care isn’t just inconvenient; it’s dangerous and more expensive in the long run. Uninsured Floridians are more likely to delay treatment, avoid prescriptions, and ignore symptoms until they land in the ER. That’s not just bad for their health, it’s expensive and takes time away from emergency ER patients who need immediate emergency care.
Hospitals and community clinics are absorbing billions in uncompensated care. In 2024 alone, Florida taxpayers covered $2.6 billion in emergency care for uninsured patients. Safety-net providers are stretched thin, and the pressure is mounting. Medical debt is another silent epidemic. Without insurance, even a minor procedure can lead to years of financial strain and bankruptcy. A broken arm, a biopsy, a hospital stay, these aren’t just medical events; they’re financial shocks.
Policy Roadblocks and Political Realities:
Florida remains one of just ten states that haven’t expanded Medicaid. That decision has left nearly 800,000 residents in a coverage gap, according to the Florida Policy Institute. Efforts to change that are underway. A grassroots campaign, Florida Decides Healthcare, is pushing for a constitutional amendment to expand Medicaid via the 2026 ballot. If passed, the expansion could bring $14.3 billion in federal funding over five years and cover hundreds of thousands of uninsured Floridians.
But time is running out. The enhanced premium tax credits that made ACA plans more affordable are set to expire at the end of 20258. Without congressional action, premiums could spike by up to 90%, pushing 2 million Floridians off their plans by 2027.
The Bigger Picture:
Florida’s health insurance gap isn’t just a healthcare issue, it’s an economic one. Small businesses rely on the ACA marketplace to offer coverage. Without it, they struggle to attract and retain workers. And when people lose coverage, they lose access to preventive care, early diagnosis, and chronic disease management. That leads to worse health outcomes, higher costs, and more strain on the system.
Florida Forward:
The road forward isn’t simple. Medicaid expansion faces political hurdles. Federal subsidies are in limbo. And economic pressures, from housing to inflation, continue to squeeze working families. Still, there’s momentum. Advocacy groups, health foundations, and local leaders are pushing for change. They’re calling for expanded access, better subsidies, and smarter policies that reflect the realities of modern work and life.
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