More than 1M Floridians will exit individual ACA plans. Those who don’t leave will pay more

With the federal government shut down amid an impasse over Affordable Care Act subsidies, Florida policymakers are bracing for more uninsured people under the age of 65 and higher costs for those who keep coverage.

Yet with just over two weeks before open enrollment, questions loom, and answers about the way forward are in short supply.

Alexis Bakofsky, the Deputy Commissioner of Life and Health Insurance for Florida’s Department of Financial Services, painted a grim picture that could see rates increase by 34.1% year over year before subsidies are factored in.

“That’s not a typical rate we’d see for this market,” she said of the hike, which could lower enrollment by “25-30%” according to estimates she had heard.

Currently, 4.7 million Floridians have ACA individual insurance, meaning 1.4 million people could be uninsured in 2026 who had coverage this year.

Asked for data and details about who might leave the market by Rep. Hillary Cassel, Bakofsky said that information existed, but she didn’t have it handy at the meeting.

Indications are that people in better health may make up the enrollment decline, Bakofsky said, given that zero-cost policies during the pandemic “created a rapid enrollment growth,” including from people with “zero or very low claims” that kept rates “at or below medical trend.”

While she calls the market “competitive,” with four carriers or more accessible to 95% of Floridians, Bakofsky acknowledged “significant financial headwinds that are causing a meaningful decrease in competition and caused some carriers to decrease their footprint.”

“Enrollment increased ~0.4M from 2024-2025 to a total market size of ~4.6M, but is on the decline and expected to drop significantly during 2026 Open Enrollment with the expiration of enhanced subsidies & Federal Rule implementation,” read a PowerPoint presented to the House Health Care Facilities & Systems Subcommittee Tuesday.

Some providers are expected to raise prices more than average. Sunshine State Health Plan, Inc. is projecting a 51.5% premium hike. Centene and Molina each project increases of more than 40% on average due to a “more acute risk pool.”

Per the PowerPoint, subsidized policyholders (97% of the market) are “relatively immune from the increases” but “are impacted by the expiration of the enhanced subsidies” on plans purchased on the Exchange, based on how close to the federal poverty line they are.

“Subsidies are in place so a consumer won’t see the full impact of the rate increase,” she said. “The amount that they pay is subtracted from the subsidy.”

Legislators weren’t all sold.

Democratic Rep. Robin Bartleman said she expects “a ton of calls from people who can’t get insurance,” and wondered what the plan is from the Office of Insurance Regulation (OIR) and other state officials.

“This crisis is going to happen, and we’re all going to get blamed. And your office, two and a half weeks open enrollment begins, and letters haven’t gone out. Nor have you given them any warning, because if they don’t open that letter and just assume they’re getting their coverage, their 51% increase is going to renew without their knowledge and they’re not going to be able to change that. So don’t you feel you at OIR have a responsibility to gear up for this,” Bartleman said.

“You need to be doing robocalls, you need to be sending personal letters out and say, ‘Open immediately.’ So what is your plan?

Democratic Rep. RaShon Young noted that the trend could create “adverse selection” for the risk pool, specifically for minority communities.

Meanwhile, Chief Actuary Kyle Collins observed that increased “market morbidity” is creating a death spiral for the market as it was until now.

“With the subsidies expiring, members going from zero-dollar premium to a non-zero-dollar premium, what you typically see is people who need the coverage, they’re going to find that extra 20, 30 bucks. People who don’t need the coverage, they’re going to drop. And so then the average health of the remaining population is significantly worse, needing a much larger rate increase,” he explained.