Florida is at the center of health care battle leading the US in ACA enrollees

TALLAHASSEE, Fla. — With the 2026 midterm elections on the horizon, the future of Affordable Care Act (ACA) subsidies is shaping up to be a major flashpoint in national and state-level races — particularly in Florida, where millions could lose coverage if the expanded subsidies expire at the end of this year.

Originally introduced during the pandemic to make health insurance more affordable, the enhanced ACA subsidies helped drive enrollment to record highs across the country. But now, the clock is ticking on their expiration — and the consequences could be severe. If they expire, experts warn, premiums could spike by as much as 75%, leaving millions uninsured.

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In Florida — which leads the nation in ACA enrollment — the stakes are especially high.

“The bottom line is that Florida has the most to lose,” said Scott Darius of Florida Voices for Health. “Now, without the extension of those credits and the expected increase in the baseline insurance rates, KFF estimates that over two million Floridians will be priced out of ACA healthcare coverage.”

The looming cuts are also stirring political tensions. Reported by Politico, a Trump campaign pollster recently warned of a potential “political penalty” if the GOP-controlled Congress allows the subsidies to lapse — noting strong support even among Trump voters and key swing constituencies.

But some conservative lawmakers remain opposed. Fiscal hawks in the House Freedom Caucus argue the $300+ billion cost over ten years is unjustifiable now that the pandemic is over.

Meanwhile, Democrats and a new wave of candidates — including scientists and medical professionals backed by 314 Action, a group seeking to put more STEM professionals in Congress — are pushing to make health care the centerpiece of the 2026 election. One of them, Dr. Darren McAuley, a veteran and air surgeon running in Florida’s 15th Congressional District, isn’t holding back.

“This is not just fear-mongering,” McAuley said. “And I think to be honest, those same Republicans that spout that don't believe that it's fear mongering either.”

He also took aim at the GOP-backed “Big Beautiful Bill” that proposes nearly $1 trillion in cuts to Medicaid over a decade. “They tout that these cuts to Medicaid will save the government over a trillion dollars over the next decade, when the CBO is very clear that it's going to cost us 3.3 trillion dollars over the next decade,” he said.

But Republican Congressman Byron Donalds, currently running for Florida governor, defended the cuts in a May interview.

“We do have a two-tier system in Medicaid,” Donalds said, arguing the reforms would “get illegals off the program” and “actually provide the proper incentives… giving care to the people who are truly in need.”

Still, critics argue those savings would come at a steep cost — potentially stripping coverage from millions of Americans.

At the state level, a new Florida ballot initiative to expand Medicaid is gaining momentum. But hurdles remain: it still needs just under a million valid signatures, and the Florida Supreme Court must approve its language before it appears on the 2026 ballot.

For now, the health care fight is heating up — and voters may ultimately get the final say.