ST. CLOUD, Fla. (AP) 鈥� Florida chef Elijah Button was chopping onions in June when his knife slipped and sliced his middle finger to the bone.
It was his worst kitchen accident to date. But having given up his health insurance plan in January because of a $100 monthly premium hike he couldn鈥檛 afford, the 21-year-old in St. Cloud didn鈥檛 have the money for emergency care.
鈥淕oing to the hospital for it wasn鈥檛 even an option,鈥� he said, gesturing toward his finger before preparing a pot roast for his aunt and uncle in their suburban home. 鈥淢y first thought was, 鈥榟ow am I going to fix this?鈥欌��
After Republicans in Congress let for Affordable Care Act health plans expire in January, millions of Americans including Button had to decide whether to keep insurance that often doubled or tripled in cost 鈥� or risk going without it.
Months later, with no action from lawmakers to replace the lost funds, they鈥檙e facing the consequences. Some are dealing with strained budgets and exorbitant medical bills, while others avoid the doctor in fear of the cost.
Florida, whose large population of gig workers, entrepreneurs and small business owners relies heavily on the federal health insurance marketplace, has become one of the nation鈥檚 most visible epicenters of that impact.
Figures first reported by The Associated Press showed that about 440,000 Floridians dropped their Affordable Care Act plans this year 鈥� . Thousands more who kept coverage are struggling to get by, as prices of necessities like groceries and gasoline remain steep, and health insurers project another year of .
While Florida had the most affected residents, its struggles are reflective of broader nationwide concerns over rising healthcare costs and a lack of meaningful policy to address them.
In the deep-red state where congressional districts were recently redrawn to strongly favor Republicans, the cost of healthcare is a major campaign issue. Republican midterm candidates have been promoting fraud crackdowns to protect federal health programs, while Democrats have been urging voters to help Congress change hands so they can restore subsidies.
Button, who is estranged from his parents, asked his uncle for help with his bloodied finger. With a butterfly bandage, splint and daily cleanings and dressings, it healed. But the scar still gnaws at Button as a symbol of what else could go wrong.
鈥淚t just feels like I鈥檓 living in a house of cards,鈥� he said.
Florida鈥檚 population and politics make it ground zero for ACA fallout
Last fall, debate over the expiring subsidies consumed Congress, resulting in a record 43-day as Democrats insisted on extending the COVID-era assistance and most Republicans refused.
Fast forward almost a year and lawmakers rarely reference the topic anymore. The administration says it is addressing affordability with fraud-busting efforts and deals with drug companies, but Congress hasn’t passed any significant legislation to lower health costs.
In part due to its large number of construction, hospitality and small business workers 鈥� and also because its Republican-led legislature never expanded the Medicaid safety-net health program 鈥� Florida has the largest Affordable Care Act enrollment in the country. At just over 3.8 million enrollees, it represents about a fifth of the nation鈥檚 total enrolled population.
Of the roughly 443,000 Floridians who left the marketplace, most are likely going without insurance, according to Cynthia Cox, a vice president at the healthcare research nonprofit KFF. She said that鈥檚 because it is typically a 鈥減lace of last resort鈥� to get coverage.
The data doesn鈥檛 tell the stories of those who kept insurance. Tracy Rand, a licensed mental health counselor in Leesburg, Florida, is one of them.
Ever since getting her ovaries removed last year due to benign but painful tumors, she has had severe menopause symptoms that require medication, including an overactive bladder and hot flashes that cause piercing headaches.
She uses clear plastic containers to organize the more than 30 medicines and supplements she takes daily, their bottles crammed into a living-room drawer and a tray on her kitchen counter.
The 51-year-old鈥檚 Affordable Care Act plan was going to surge in price this year from $55 a month to $1,100 a month, so she downgraded. Her new plan, with higher deductibles and copays, costs $160 a month.
To make that work in her budget, Rand quit a doctoral program she was working toward, started buying groceries at cheaper stores, gave up once-monthly dinners out with her husband and stopped meeting friends regularly at a paint-your-own pottery studio.
It鈥檚 been a difficult adjustment, but a necessary one for her health.
Rand said the prospect of insurers raising rates again fills her with dread.
鈥淚 don鈥檛 know what else we can get rid of,鈥� she said, covering her face with her hands. 鈥淚 don鈥檛 know if we鈥檙e going to have to file bankruptcy.鈥�
Clinics for the uninsured are a saving grace 鈥� but they can鈥檛 take everyone
In Orlando’s leafy, brick-paved neighborhood of Colonialtown South, Tarsha Watson found her lifeline. A clinic there called Grace Medical Home provides low-income, uninsured Floridians with comprehensive care for a $5 per-visit fee.
Watson, 54, has a master鈥檚 degree in business administration, but she hasn鈥檛 been able to find work since losing her job two years ago. That means she doesn’t have health insurance. When she explored Affordable Care Act coverage, she was quoted $600 per month, far out of her reach.
At Grace, Watson learned her blood sugar is high and that she needed to lose weight. Now, she walks laps around her backyard pool and does Tai Chi YouTube tutorials to focus on fitness. She said she wishes everyone could have her experience.
鈥淚t’s very hard out here,鈥� she said. 鈥淚t’s not enough.鈥�
At the clinic, patients cycle in and out of a wide hallway lined with appointment rooms as doctors scan supply shelves for complimentary over-the-counter medications. The expansive building has separate areas for dental, mental health, vision and pediatric care.
CEO Stephanie Garris said it鈥檚 one of 110 free or charitable clinics in Florida, but that鈥檚 not enough to handle demand. To treat more people in response to the Affordable Care Act changes, it recently started hosting a mobile acute care clinic for walk-in patients.
Garris said Grace Medical Home treated about 1,350 people last year. Every year, they take about 350 new patients.
鈥淲ould I love to double that, triple that? Of course,鈥� Garris said. 鈥淚 just think in the reality, with the huge number of uninsured that we have, it鈥檚 just not possible.鈥�
Health costs become an issue in midterm campaigns
For U.S. Rep. Darren Soto, a Democrat defending his seat in a sprawling 鈥� and now much redder 鈥� redrawn district south of Orlando, health costs are a campaign focal point.
He said his district, which is near various theme parks, had the second-largest Affordable Care Act enrollment in the nation, in part because many small tourism businesses can鈥檛 offer employees health insurance.
鈥淚 just hear it everywhere I go,鈥� he said. His Republican opponent, Navy veteran and former Trump administration official Dan Green, did not answer emailed questions about the subsidies but has emphasized affordability of groceries and property insurance as campaign priorities.
Soto voted with Democrats and some Republicans 鈥� including a few from Florida 鈥� to save the subsidies last year. The Republican majority declined and suggested other ideas, including funding Americans’ health savings accounts. No law along those lines has passed yet.
Button, a Democrat in Soto鈥檚 district, said he is open to different reforms for health costs, but said politicians aren’t acting fast enough.
鈥淭hey keep trying to make excuse after excuse,鈥� he said. 鈥淚 don鈥檛 have six months to a year to wait for you guys to pass this through the hoops that you need to.鈥�
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