500,000 Floridians could lose health coverage without tax credits, study warns

More than 500,000 Floridians could lose their health insurance if Congress fails to extend tax credits passed through the American Rescue Plan Act, a new report warns.

The tax credits dramatically lowered premiums for millions of Florida families who this year obtained their health insurance through the Affordable Care Act. But those subsidies will expire at the end of this year as attempts by Congress to extend them have stalled.

If lawmakers cannot reach an agreement, premiums could rise by 53% in 2023, forcing millions of Americans to go without health insurance.

Florida would be one of the states hardest hit, according to a study by the Robert Wood Johnson Foundation and the Urban Institute.

Roughly 96% of the 2.7 million Floridians enrolled in the Affordable Care Act were eligible for the tax credits this year. Without them, a household of four with an income of $111,000 will pay hundreds of dollars more in premiums next year.

Families that earn above that limit would no longer be eligible for the program. They could face an average increase of about $2,000 per year in premiums if they have to purchase private insurance.

The likely impact, the study warns, is the number of uninsured in Florida could rise by 25%, from 2 million to 2.5 million. Families without health insurance typically forego critical preventative and early treatment of health issues until their condition forces them to seek emergency room care — the same strain on hospital resources and budgets that the Affordable Care Act was intended to relieve.

“This is going to happen not only (to) those seeking preventative care, but folks getting treatment for chronic health conditions,” said Jodi Ray, executive director of Florida Covering Kids & Families, a navigator program based at the University of South Florida. “A 53% increase on premiums could be very painful for a whole lot of families in the state of Florida.”

Opposition to extending the tax credits has focused on the cost. Extending them would increase the federal deficit by $25.3 billion in 2023 and by $305 billion over 10 years, the study says. House Democrats can extend the credits via a reconciliation bill to clear Republican opposition. But the fate of that program and many others depends on negotiations between President Joe Biden and West Virginia Sen. Joe Manchin to get the president’s social spending bill through the Senate.

U.S. Rep. Charlie Crist, D-St. Petersburg, has joined local health advocates in calling for an extension of the tax credits. He is one of six Democratic candidates vying to unseat Florida Gov. Ron DeSantis in November.

Crist was critical of DeSantis on a call with reporters focused on health care in late May. Florida is one of only 13 states that continues to reject a provision of the Affordable Care Act — passed over a decade ago — that would expand Medicaid eligibility to more than 400,000 of the poorest Floridians.

“The cost we have to pay for health care in America is absurd,” Crist said. “Any opportunity to reduce the burden on American citizens and, in particular Floridians, is essential for us to pursue.”

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In 2021, Florida lawmakers did pass legislation to make Medicaid available for for mothers and babies, extending their coverage from 60 days to a full year following childbirth. But Floridians who earn less than the federal poverty level of $13,590 are not eligible for Medicaid as they would be in states that have fully expanded Medicaid.

Since it took effect in 2014, the Affordable Care Act — often called Obamacare — has made health insurance affordable to more Americans by creating health insurance marketplaces and subsidizing the cost of premiums.

Until 2021, those subsidies were only available to those who made up to 400% of the federal poverty level, roughly $53,000 for a single wage earner. But that year, the American Rescue Plan Act increased the amount of the subsidies and made them available to many more Americans to help mitigate the economic effects of the COVID-19 pandemic.

It helped the program add 2.5 million more Americans this year, expanding nationwide enrollment to a record 14.4 million.

“People who previously turned away and looked at alternative options like short-term insurance were able to reconsider and saw a really affordable rate,” said Katie Roders Turner, executive director of the Family Healthcare Foundation, a Tampa nonprofit set up to help families and individuals in Hillsborough, Pinellas, Pasco and Polk counties find insurance.

She said a family of four that her group helped find insurance had just been hit with a $6,000 emergency room bill after their child developed a high fever because their short-term insurance policy included a large deductible.

Their household income was $130,000 per year, but they were still eligible for tax credit subsidies under the new criteria included in the Rescue Plan Act.

Temple Terrace resident Graciela Lopez said subsidies in the Affordable Care Act enabled her to afford the coverage she needs to cover life-saving treatment. She was diagnosed with breast cancer three years ago and had a double mastectomy. She sees an oncologist every three months and another specialist twice a year. She is also on daily medication that would cost $1,000 per month without insurance.

Most of the cost is covered through a marketplace plan offered by Blue Cross Blue Shield, which costs her $169 per month. Insurance also pays for a substantial portion of the daily medication she takes to lower hormone levels that could trigger her cancer.

She is worried she won’t be able to afford a substantial premium hike.

“If I change my insurance, I have to find different oncologists,” she said. “I have to keep my insurance as long as I can.”