Why is healthcare so expensive in Florida?

Demographics and chronic disease

Florida has one of the oldest populations in the country. Retirees and the chronically ill use more healthcare services. That drives insurer costs up, and those costs get passed to everyone else through higher premiums.

On top of that, Florida has high rates of diabetes, heart disease, and other chronic conditions. Treating chronic disease is expensive. When a state's population carries a higher disease burden, the cost of insuring that population rises.

Limited competition and rural access

Many Florida counties have limited insurer competition on the ACA marketplace. Fewer insurers means less price pressure. Residents in those counties pay more because there are no alternatives.

Rural Florida is hit especially hard. Rural hospitals are closing at higher rates in non-expansion states like Florida than in states that expanded Medicaid. Roughly 69 percent of rural hospital closures from 2014 to 2024 occurred in non-expansion states.^[4] When a rural hospital closes, the nearest ER might be an hour away. People delay care. When they finally seek it, the condition has worsened. That drives costs up across the system.

Hurricane exposure and reinsurance

Florida sits in the hurricane zone. Hurricanes disrupt medical infrastructure. Clinics lose power. Hospitals evacuate. Pharmacies flood. All of that disruption has a cost, and it gets built into premiums through reinsurance pricing.

Insurers operating in Florida face higher reinsurance costs than insurers in states without hurricane exposure. Some of that flows into health premiums. Some flows into property insurance. Either way, Florida families pay more.

Policy: refusal to expand Medicaid

This is the biggest driver of Florida's high costs that government could fix tomorrow. Florida is one of 10 states that have not expanded Medicaid under the Affordable Care Act.^[5] The federal government pays 90 percent of the cost of the expansion population in perpetuity.^[6] Florida has declined.

That decision leaves approximately 266,000 Floridians in a coverage gap. They earn too much to qualify for Florida's very narrow Medicaid eligibility but too little for ACA marketplace subsidies.^[2] Those 266,000 people still get sick. Many end up in the ER with conditions that could have been treated earlier and cheaper. Hospitals eat the cost as uncompensated care. Florida already pays a $2.17 billion Low Income Pool every year to partially offset that burden.^[7]

If Florida expanded Medicaid, much of that burden would shift to the federal government at a 9-to-1 match. Hospitals would have fewer uninsured patients. The cost of uncompensated care would drop. That would relieve pressure on premiums for everyone else.

Expiration of enhanced premium tax credits

The Inflation Reduction Act of 2022 extended enhanced ACA premium tax credits through 2025. Those credits made marketplace coverage affordable for most Floridians. About 4.63 million Floridians selected a plan for 2025, more than any other state, with subsidies averaging $740 per month and bringing the average post-subsidy premium to about $62 per month.^[8]

The enhanced credits expired December 31, 2025. The average marketplace premium payment is expected to more than double in 2026 as a result.^[1] The Urban Institute estimates roughly 4.8 million more Americans will become uninsured without the credits. Florida will see a disproportionate share of that loss because Florida has the highest marketplace enrollment in the country.

This is a federal policy failure, not a state one. But it lands on Florida families all the same.

What David Jolly would do

David Jolly's healthcare plan addresses Florida's cost crisis through two major moves. First, expand Medicaid to cover the 266,000 Floridians in the coverage gap at the 90 percent federal match rate. Second, scale up Federally Qualified Health Centers in all 67 counties to deliver primary care regardless of ability to pay, building on Florida's existing network of County Health Departments with 255 sites.^[9]

The FQHC expansion is designed to triage patients before they reach crisis. Studies estimate per-patient costs are 24 percent lower for Medicaid patients at Community Health Centers compared with other outpatient settings,^[10] and a 2023 NACHC analysis estimates Community Health Centers save the U.S. healthcare system approximately $24 billion annually by reducing emergency department visits and avoidable hospitalizations.^[11]

Together, Medicaid expansion and FQHC scaling would reduce uncompensated-care costs, stabilize rural hospitals, and bring down premiums for everyone. The pieces exist. The federal match is available. The question is whether Florida chooses to use them.