Florida Health Care Costs Climb as Obamacare Losses Hit Employers

A coverage collapse that doesn't stay in the marketplace

Florida built the country's largest Affordable Care Act marketplace. In 2026 it also posted the largest drop. An Associated Press analysis of federal data found that 442,785 Floridians who had marketplace coverage in 2025 were uninsured in 2026. That came after the enhanced premium tax credits expired at the end of 2025.1 By raw numbers, no state lost more people. In percentage terms, Florida's enrollment fell 10.3%, well below Ohio's 32.4% drop.4

The usual reading treats this as a problem for individual-market shoppers, meaning the self-employed, gig workers and early retirees. That reading misses most of the story. Across the coverage, the money that left Florida's marketplace hasn't disappeared. It is moving toward hospitals, and from hospitals toward everyone with private insurance, including the roughly 166 million Americans covered through work.20 The marketplace drop and the jump in employer health costs are one story.

How big the drop was, and why the numbers disagree

The size of the decline depends on what you count, and the data sources don't line up neatly. ValuePenguin's analysis of federal open-enrollment files shows Florida plan selections falling only 4.2%, from 4,735,415 to 4,538,772.6 Paid-up coverage in February tells a harsher story: about 4.29 million people in 2025 versus about 3.85 million in 2026.23 Many Floridians picked a plan during open enrollment and then never paid for it, or dropped it once the bills arrived.

The official explanation also differs. Federal officials said in a June report that some of the national decline reflects a crackdown on fraudulent or "phantom" enrollments.8 Sen. Ashley Moody has pressed the Justice Department to recover money paid out for fraudulent sign-ups.21 Fraud may explain part of the drop. But hospitals are reporting more uninsured patients through their doors, and that suggests real people lost real coverage. Removing phantom enrollees would not fill emergency rooms.

The cost shock behind the drop is well documented. Florida's Office of Insurance Regulation approved 2026 rate changes averaging 34.1% before subsidies, weighted by enrollment.23 A separate summary of the regulator's figures puts the average at 31.5%.31 Either way, sticker prices rose by roughly a third. ValuePenguin found Florida's average monthly premium rose from $641 to $806.6 Almost 95% of Florida enrollees get financial help, the second-highest share in the nation.9 Because Florida has not expanded Medicaid, the marketplace is the main way adults with incomes just above the poverty line can afford coverage.23

Hospitals take the first hit

The first place the coverage losses show up is hospital finances. The Florida Hospital Association surveyed its members. Uninsured inpatient admissions rose more than 20% in the first quarter of 2026 compared with a year earlier, the association's president Mary Mayhew said.8 She warned that 750,000 to 1 million Floridians could eventually lose coverage because so many depended on the enhanced credits.22

The effect is visible at the largest operators. HCA Healthcare, the nation's biggest hospital system, said lost exchange coverage cost it about $400 million before taxes in the second quarter, more than it expected. It now projects the hit will reach $1 billion or more this year.8 Fitch Ratings expects hospitals that rely heavily on ACA patients to struggle more in 2026.8

This is how a marketplace problem becomes an employer problem. Hospitals that treat more uninsured patients collect less for the same work. Over time, they make up the difference in their price talks with commercial insurers. Advocates for patients say the same thing: more people going uninsured pushes the cost of their unpaid care onto those who still have insurance.35

Employers face their steepest increase in two decades

Employer costs were already climbing before this. Mercer's preliminary survey of more than 1,800 employers projects total health benefit costs per employee will rise 8.2% in 2027. That would be the largest increase since 2003.41 The pace has sped up each year: 4.5% in 2024, 6% in 2025 and 6.7% in 2026.44 The 8.2% figure already counts the cuts employers plan to make. Without them, employers expect their current plans to cost 11% more.42

Other benefits firms put the number even higher. WTW projects 11.1% and Aon projects 9.5%.40 The forecasts disagree on the size of the increase, not the direction. A single-digit rise is the optimistic case.

The main causes named in the coverage are expensive new cancer therapies, consolidation among providers, and GLP-1 weight-loss drugs, which Mercer estimates add about one percentage point on their own.43 Mercer also lists AI-assisted billing software that produces more claims and higher-level claims, along with payment disputes under the No Surprises Act.44 Mercer also cites reduced government spending on health care as a long-term force keeping costs above inflation.41 That line does more work than it seems to. Lower public spending, including the subsidies that kept Floridians insured, means providers seek more revenue from private payers.

Workers will feel it directly. About two-thirds of employers with 500 or more workers expect to raise employees' share of premiums. And 59% of employers plan cost-cutting changes such as higher deductibles.42 The starting point is already high. KFF's 2025 survey put the average family premium at $26,993, with employers paying more than $20,000 of it.20

Florida's small businesses are squeezed hardest

Small firms are under the most pressure. Florida's remaining small-group insurers have proposed average increases of about 11.4% for 2027.32 Nationally, the median proposed increase among 295 small-group insurers is 14%.19 Small firms already make workers pay more of the cost. Employees at companies with 10 to 199 workers pay an average of 36% of the family premium, compared with 23% at larger firms.19

For a small Florida employer, the options are poor. It can absorb a double-digit increase, pass more of it to workers through paychecks and deductibles, or drop coverage altogether. Dropping coverage would push workers into the same weakened marketplace that lost hundreds of thousands of people this year. That marketplace is also getting more expensive again. Twelve insurers filed 2027 rates in Florida, with proposed changes from 3.87% at Centene Venture Co. to 39.14% at AmeriHealth Caritas.1 Several carriers are leaving, including Cigna, Molina and Sunshine State Health Plan. Florida Blue, operating as Blue Cross and Blue Shield of Florida, is returning.1 Most proposed increases fall between 10% and 25%.5

Shrinking pools make prices rise further. Fewer enrollees leave fewer people to share costs, so rates go up for those who remain.6 Insurers expect younger, healthier people to leave and an older, sicker pool to stay behind.40

The next wave is already scheduled

The pressure on Florida isn't over. The 2025 federal tax-and-spending law adds Medicaid work requirements starting January 1, 2027. The Congressional Budget Office projects the law will leave 10 million more Americans uninsured by 2034.7 Florida could see about 590,000 more uninsured residents under those changes.7 Each newly uninsured patient adds to the unpaid care that hospitals try to recover from commercial payers.

Washington's response so far has been small next to the problem. The House passed a three-year extension of the enhanced credits in January 2026, 230 to 196. The Senate never took it up, and a bipartisan compromise fell apart in February.24 The Treasury has started mailing one-time $500 refund checks to more than 950,000 HealthCare.gov customers who paid full price, Florida among them. Critics note that fewer than one in 20 marketplace enrollees will qualify.10 Health care is now a central issue in Florida's Senate race. Democratic challenger Angie Nixon is attacking Moody and Sen. Rick Scott for letting the credits lapse.1

The bottom line

The evidence supports a clear conclusion. Florida's marketplace losses are not a separate story about low-income shoppers. They are one source of the cost pressure now reaching employer plans. Federal subsidies once spread the cost of insuring millions of Floridians across all taxpayers. With those subsidies gone, much of that cost is landing on employers and their workers, mostly through higher hospital prices.

No source here measures exactly how much of the employer increase comes from uninsured care. Drug prices, provider consolidation and billing practices clearly matter too, and anyone claiming a precise share would be overstating what is known. But the direction is clear. Open enrollment begins this fall in both the marketplace and the workplace. Florida workers who never bought an ACA plan will still pay part of the cost of its decline through higher premium deductions and deductibles.