South Floridians are being held hostage by Congress’ healthcare inaction | Opinion

As the government shutdown over healthcare subsidies stretches past its third week, South Florida stands to be the big loser. No other place in the nation has as many people enrolled in Affordable Care Act insurance plans, and many of them rely on subsidies to help pay for them.

If the subsidies expire — the issue at the heart of the battle between Republicans and Democrats — an estimated 30% or more of Miami-Dade residents who have healthcare through the ACA, also known as Obamacare, will feel it. Estimates of how much premiums may go up range from 20% to 50%, according to health policy groups. As many as two million people in Florida will lose their coverage, according to Holly Bullard, chief strategy and development officer at the Florida Policy Institute and co-chair of Florida Decides Healthcare.

“This isn’t hypothetical anymore — it’s at our doorstep,” she told the Miami Herald Editorial Board.

Our members of Congress should listen. According to the Kaiser Family Foundation, four South Florida congressional districts are among the top five districts in the nation for Obamacare enrollment.

In U.S. Rep. Maria Elvira Salazar’s District 27, about 298,000 people are enrolled in an ACA insurance plan, KFF reported in October. In Rep. Carlos Gimenez’s District 28, the number is about 287,000. In District 26, Rep. Mario Diaz-Balart’s district, there are 258,000. And in Rep. Frederica Wilson’s District 24, about 290,000 people are enrolled. And about 24% of Florida enrollees under 65 get subsidies, according to a Washington Post analysis.

Florida has long been the national leader in ACA enrollment. This year, about 4.7 million people in the state get their insurance through the Obamacare marketplaces, more than any other state.

Florida, then, has a big stake in what happens in Washington. There have been some efforts to come up with a temporary solution on subsidies. Last month, 12 Republicans and seven Democrats co-sponsored a bill to extend the subsidies for one year — through the 2026 midterms. Miami’s Gimenez was a co-sponsor.

The bill wasn’t passed, and now, with the government shut down, ACA subsidies are still set to expire in January. The subsidies were passed as part of the 2021 American Rescue Plan Act (ARPA) during the Biden administration. Democrats have said they want to make the subsidies permanent; many Republicans want to do away with them.

A two-year extension of subsidies — an idea Bullard floated to the Editorial Board — would give enrollees more breathing room.

It would also give lawmakers time to find a sustainable solution, while keeping Floridians insured and not having to pay for a steep premium increase.

The debate is focused on the extension of subsidies for insurance premiums. But Republicans have made it clear they want to repeal the healthcare program even though it has become increasingly popular in this country — and in this community. Don’t forget, the ACA altered the healthcare landscape in ways that many Americans embrace: keeping kids on parents’ insurance plans until they are 26, stopping insurance companies from refusing to cover you if you have a pre-existing condition and preventing companies from dropping you when you get sick.

The shutdown battle is already adversely affecting insurance rates. Health insurance companies have set rates for 2026 assuming the subsidies will expire, Bullard said.

House Democratic Leader Hakeem Jeffries underscored the reality on Sunday, telling CBS Miami’s Jim DeFede, “There are hundreds of thousands of people in South Florida who are at risk of seeing their premiums, co-pays and deductibles skyrocket by thousands of dollars a year in ways that will make it unaffordable for them to be able to go see a doctor if the Affordable Care Act tax credits are allowed to expire.”

Miami cannot afford to be a casualty of Washington’s power struggle. Those who rely on the ACA marketplace for health insurance stand to lose the most, not lawmakers in Congress. The longer this standoff drags on, the more it becomes apparent that Floridians will pay — literally.

This story was originally published October 22, 2025 at 1:23 PM.