Mary Mayhew, president and CEO of the Florida Hospital Association, is urging lawmakers to address changes to the Affordable Care Act, warning that more Floridians could lose coverage.
The ACA, enacted in 2010, provides subsidies — or premium tax credits — to help households earning between 100% and 400% of the federal poverty level afford insurance.
During the COVID-19 pandemic, Congress temporarily expanded these subsidies, boosting income limits and nearly doubling enrollment in Florida over two years.
But those expanded subsidies are set to run out at the end of the year as Congress has not extended the enhanced tax credits.
A July analysis by the nonpartisan KFF health policy research group projects that many ACA marketplace enrollees could see average premium increases of around 75% next year. For example, someone paying $60 a month this year could see that rise to about $105 a month. In some cases, particularly for higher-cost plans, premium increases could exceed 90%.
What choice will people have if priced out of ACA?
On "The Florida Roundup," Mayhew said her No. 1 priority is working to extend the extra subsidy for the premiums. She's been to Capitol Hill to speak about the topic with the question, "If not this, then what?"
Mayhew, whose organization represents more than 300 hospitals in the state, said that with premiums increasing, it's "simply unrealistic" to expect people to be able to afford and purchase coverage. Some estimates have premiums going up 93% or more and an increase of $1,000 a month or more, she said.
These folks likely don't have employer-sponsored coverage or earn too much to qualify for Medicaid, the federal-state insurance program for low-income people. So, she asks, what choice will they have?
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Mayhew worries they will become uninsured and have to rely on hospital emergency departments for care, which tend to be the most expensive point of entry to the health care system.
"The estimate is that well over a million Floridians will lose coverage through the marketplace," Mayhew said. "The harsh reality is that there isn't an alternative coverage, and that's what I've been communicating with our congressional delegation. Let's not have false expectations that these individuals have some other choice to get their health insurance elsewhere. They will become uninsured."
How do small businesses benefit from individual care?
Mayhew told program host Tom Hudson that Florida leads the country with over 4.7 million people purchasing coverage through the federal marketplace.
She also said there are also hundreds of thousands of small businesses benefiting: "Either a small entrepreneur, the mom with the day care center, the couple that's opened the pizza shop, the guy that wants to do automotive repair," she said.
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Mayhew said that long before the ACA, small businesses were priced out of the small-group market. It's been a challenge across the country to provide affordable insurance options for small businesses to purchase — for owners or employees.
"The vast majority of these individuals that are getting coverage through the marketplace are working are employed," Mayhew said.
She said 3.8 million of those getting coverage earn less than 200% of the federal poverty level (about $51,000 a year for a family of three).
Mayhew added that the vast majority of Floridians who have insurance through the ACA are between 100% and 150% of the federal poverty level (about $39,000 for a family of three).
Why isn't there a unified political voice on insurance?
For context, Trump previously appointed Mayhew to lead Medicaid years ago, before she served in Gov. Ron DeSantis' administration as the head of Florida's Agency for Health Care Administration, which oversees the state's Medicaid program.
This year, at an event with other conservative business leaders in Florida, Mayhew said, "There should be a unified political voice in support of the federal marketplace and the premium assistance in Florida."
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She told Hudson she believes there isn't a unified voice due to misinformation and "polarizing politics" of the ACA, largely pertaining to Medicaid expansion, a provision of the law that allows states to extend Medicaid eligibility to more low-income adults.
Florida is one of 10 states that have refused to expand Medicaid, sending many low-income earners to the marketplace for coverage. Gov. Ron DeSantis and members of the Republican-led Legislature argue expansion could saddle the state with long-term costs, even though the federal government covers 90%.
Mayhew added that there hasn't been a focused analysis of what the marketplace has done — particularly in states like Florida. Mayhew said there hasn't been a full appreciation or understanding of what the marketplace has long represented.
"This is still a commercial health and insurance product. It is still a public-private partnership," Mayhew said. "But ... it's making the difference between individuals having an insurance card in their wallet or not. And we know that without a health insurance card, individuals are not able to access, in particular, primary care, to be able to have access to the prevention, the primary care, the early intervention, the chronic disease management."
This article was compiled from interviews conducted by Tom Hudson for "The Florida Roundup."
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