Medicaid coverage and enhanced credits in Affordable Care Act plans have been a safety net for many people. In Florida, over 4.3 million people received Medicaid benefits, and more than 4.7 million are enrolled in the ACA for health care coverage.
In Florida, about 2 out of 5 people benefit from ACA or Medicaid plans. But that will soon change.
The enhanced premium tax credits were implemented in 2021 as part of the American Rescue Plan Act. Among other things, the bill increased ACA subsidies to ensure people had access to affordable care during the COVID-19 pandemic.
The credits were originally set to expire at the end of 2022. But Congress extended them through 2025 as part of the Inflation Reduction Act. And now they are set to expire at the end of this year.
Year after year, enrollment in the ACA marketplace has steadily increased in Florida. The credits offer affordable options for families who might not otherwise qualify for Medicaid coverage and are not offered health care through an employer.
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If the credits are allowed to expire Dec. 31, many Floridians would be left with skyrocketing premiums. Some projections indicate an increase of more than 150% in annual health care costs.
This year, Congress passed the "Big Beautiful Bill Act." The Congressional Budget Office, a nonpartisan arm of the legislative branch that provides budget and economic information to Congress, estimates the law cuts nearly $1 trillion from Medicaid over the next 10 years. However, the cuts do not take effect until 2027, after the midterm elections.
Experts warn that if prices increase enough to price people out of coverage, the uninsured rate will also go up. Currently, the country's uninsured rate is at 8%, or about 26 million people, a near-historic low. The CBO estimates, on average, the number will increase by about 3.8 million per year if the tax credits are not extended permanently.
Democrats have been demanding Congress take up legislation to extend the tax credits in negotiations to avoid a government shutdown, but Republicans have not be receptive. A funding deal must be passed by Tuesday night to avoid the government stoppage.
WUSF's Meghan Bowman spoke with Tampa area physician Dr. Jennifer Caputo-Seidler about how the expiration of ACA credits along with cuts to Medicaid could impact Floridians.
"These programs are to protect people, to give people access to care, so that they can preserve their health," Caputo-Seidler said. "So with both of them now seeing major cuts (Medicaid and ACA), people are going to overall have worse care."
"It puts such a strain on the system, because now we're funneling people to emergency services, to hospital-based care, who could have been better served in other settings if they'd had the ability to get there with their insurance," she added.
The following is an excerpt from the conversation with Caputo-Seidler.
So, how will the cuts in the "Big, Beautiful Bill" impact Medicaid for Floridians?
We know that Medicaid services are going to decrease; what we don't know is which ones.
Medicaid covers a lot of children. Medicaid covers a lot of pregnancies, (and) Medicaid covers long-term care. Medicaid does a lot of mental health care and substance abuse disorder care, all of those things are areas where we could see cuts. The details we don't know yet.
I know that the enhanced tax credits are expiring, and then we have Medicaid, but they're separate and coincidental that it's happening at the same time. Can you break down what that'll look like in the state?
The fact that all of these things are happening, it just amplifies it. Because Medicaid and the ACA, these were all developed as the safety net.
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Out of sheer coincidence, at the end of this year, the subsidies for affordable care plans are expiring. That is going to have a huge impact come Jan. 1, because a lot of those plans that allowed people who make too much money to be on Medicaid and who aren't offered insurance from their employer and who otherwise were unable to afford insurance as an individual or as a family, their plans are going to become unaffordable.
Is this changing how doctors are going to run their practices?
It is definitely a big concern for practices for hospitals, because we know we're going to be bringing in less money, which means we're going to be able to offer less services to our patients. It is going to be hard to keep up with giving people the standard of care.
How's it impacting, like emergency services, or labor and delivery units?
So emergency services will definitely be impacted, because the emergency room is always a place you can go and get care and not get turned away, right?
When people start losing coverage, it's going to be hard to get in to go see a primary care doctor and have things taken care of proactively, unless you have a lot of cash on hand to pay for those things, which, again, most people don't have that right now.
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That means emergency room wait times go up because all of the emergencies. The people having heart attacks, strokes and car accidents don't stop, but now you also have people who are just looking to get their high blood pressure taken care of.
It's also way more expensive to get care in the emergency room than to get care in a primary care or specialist office. So it becomes a higher cost to the system overall to take care of people when we put them in that position.
Tell me a little bit too about those folks who say, "Well, I've got insurance through my employer, so I'm fine."
Those people, I think, will be the least impacted, but it's not going to be zero impact because the system itself is being strained. Even if you have good insurance, those wait times are going to go up when you call to say, "Hey, I need to see a neurologist." It's going to be hard for you to find somebody.
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If you find yourself in an emergency situation, you're going to be sitting in that same ER waiting room for six, eight, 10-plus hours because people have gone there as their last resort.
So, probably financially, people won't see an impact, but just in terms of access and care, everyone's going to be affected.
Want to join the conversation or share your story? Email Meghan at bowman4@wusf.org.
If you have any questions about state government or the legislative process, you can ask the Your Florida team by clicking here.
This story was produced by WUSF as part of a statewide journalism initiative funded by the Corporation for Public Broadcasting.
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