In June, Florida chef Elijah Button was chopping an onion when his knife slipped and cut his middle finger to the bone.
It was his worst kitchen accident yet. but gave up his Affordable Care Act The 21-year-old man from St. Cloud bought a health insurance plan in January because he couldn’t afford the $100 monthly premium increase, leaving him with no money to pay for emergency care.
“Going to the hospital is just not an option,” he said, pointing with his finger, before preparing a barbecue for his uncle and aunt at his suburban home. “My first thought was, ‘How do I solve this problem?'”
Republicans in Congress let Increase federal subsidies As Affordable Care Act health plans expire in January, millions of Americans, including Barton, must decide whether to keep coverage that often doubles or triples in cost or risk going without coverage.
Months later, they faced consequences after lawmakers failed to act to replace the lost funds. Some people face tight budgets and high medical bills, while others avoid doctors because of concerns about cost.
Florida, with its large population of gig workers, entrepreneurs and small business owners, relies heavily on the federal health insurance market, and the state has become one of the most visible centers of impact in the country.
Figures first reported by The Associated Press show about 440,000 Floridians have dropped Affordable Care Act plans this year — more than any other state. Thousands of people who still have coverage are struggling to get by as necessities like groceries and gas remain expensive and health insurance companies anticipate another year. Double-digit premium increases.
While Florida’s residents have been hardest hit, its plight reflects broader concerns across the country about rising health care costs and the lack of meaningful policies to address them.
In deep red states, where congressional districts were recently redrawn to favor Republicans strongly, health care costs are a major campaign issue. Republican midterm candidates have been pushing for a crackdown on fraud to protect federal health programs, while Democrats have been urging voters to help Congress change hands so subsidies can be restored.
Patton, who is estranged from his parents, seeks help from his uncle when his finger bleeds. It healed with butterfly bandages, splints, and daily cleaning and dressing. But the scar still haunts Patton, a symbol of what else could go wrong.
“It feels like I’m living in a house of cards,” he said.
Florida’s Demographics and Politics Ground Zero for ACA’s Impact
Debate over expiring subsidies consumed Congress last fall, leading to a record 43 days of debate government shutdown Democrats insist on extending coronavirus aid, but most Republicans reject it.
Fast forward nearly a year, and lawmakers rarely bring up the topic anymore. The administration says it is addressing affordability issues through efforts to combat fraud and deals with drug companies, but Congress has yet to pass any major legislation to lower health care costs.
Florida has the largest Affordable Care Act enrollment in the nation, in part because of the state’s large population of construction, hospitality and small business workers and because the Republican-led Legislature never expanded the Medicaid safety net health program. The number of registered people is slightly over 3.8 million, accounting for about one-fifth of the total registered population in the country.
Of the approximately 443,000 Floridians leaving the market, most are likely uninsured, said Cynthia Cox, vice president of KFF, a nonprofit health care research organization. That’s because it’s often a “last resort” to get coverage, she said.
The data don’t tell the story of those who hold insurance. Tracy Rand is a licensed mental health counselor in Leesburg, Florida.
Since having her ovaries removed last year for a benign but painful tumor, she has developed severe menopausal symptoms that require medication, including an overactive bladder and hot flashes that cause severe headaches.
She organizes the more than 30 medications and supplements she takes every day in clear plastic containers, bottles tucked into drawers in her living room and on trays on her kitchen counter.
The 51-year-old downgraded her rating after her Affordable Care Act plan jumped in price this year from $55 a month to $1,100 a month. Her new plan has a higher deductible and copay and costs $160 a month.
To make it happen on a budget, Rand dropped out of the doctoral program she was working on, started buying groceries at cheaper stores, gave up her monthly dinners out with her husband, and stopped regularly meeting with friends at the ceramics studio where she painted.
It was a difficult adjustment, but necessary for her health.
Rand said the prospect of insurance companies raising rates again scares her.
“I don’t know what else we can get away with,” she said, covering her face with her hands. “I don’t know if we have to file for bankruptcy.”
Clinics for the uninsured are a saving grace — but they can’t accommodate everyone
In Orlando’s tree-lined, brick-and-brick South Colonial Township neighborhood, Tasha Watson found her lifeline. There is a clinic there called Grace Medical Home that provides comprehensive care to low-income, uninsured Floridians for $5 per visit.
Watson, 54, has a master’s degree in business administration but has been unable to find a job since losing her job two years ago. This means she has no health insurance. When she explored Affordable Care Act coverage, she was quoted $600 per month, which was well beyond her means.
At Grace, Watson learned her blood sugar was high and she needed to lose weight. Now, she walks laps around the backyard pool and focuses on fitness with tai chi tutorials on YouTube. She said she hopes everyone can have her experience.
“It’s very tough here,” she said. “That’s not enough.”
At the clinic, patients cycle in and out of a wide hallway lined with appointment rooms while doctors scan the shelves for free over-the-counter medications. The spacious building houses separate areas for dental, mental health, vision and pediatric care.
Related: Florida insurance company vice president sentenced to 3 years in prison for massive ACA fraud scheme
It’s one of 110 free or charity clinics in Florida, but it’s not enough to meet demand, CEO Stephanie Garris said. In an effort to treat more people in response to changes in the Affordable Care Act, it recently began opening a mobile acute care clinic for walk-in patients.
Garris said Grace Medical Home treated about 1,350 people last year. Each year, they admit about 350 new patients.
“Would I be willing to double it, triple it? Absolutely,” Garris said. “I just think in reality, with the large number of people we have who are uninsured, it’s just not possible.”
For U.S. Rep. Darren Soto, a Democrat defending his seat in a sprawling, now-redrawn district south of Orlando, health care costs are a campaign focus.
He said his district, which is close to theme parks, has the second-highest Affordable Care Act enrollment in the country, in part because many small tourism businesses are unable to provide health insurance to their employees.
“I hear it everywhere,” he said. His Republican opponent, Navy veteran and former Trump administration official Dan Greene, did not respond to emailed questions about the subsidies but emphasized the affordability of groceries and property insurance as campaign priorities.
Last year, Soto joined Democrats and some Republicans, including some in Florida, in voting to save the subsidies. The Republican majority rejected it and floated other ideas, including funding Americans’ health savings accounts. No similar law has been passed yet.
Patton, a Democrat in Soto’s district, said he is open to different health care cost reforms but said politicians are not moving fast enough.
“They keep making excuse after excuse,” he said. “I don’t have six months to a year to wait for you to pass the tests you need.”
Photo: Elijah Button, 21, poses for a photo in St. Cloud, Florida. (AP Photo/Jacqueline Martin)
The Associated Press’ Jacqueline Martin co-authored this report.
Copyright 2026 The Associated Press. all rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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