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WELLINGTON, Fla. – The insurance agent called Bianca in January. Bianca's health insurance premium had at least doubled from its previous rate, the agent said, wondering if the registered nurse who works a 40-hour week could still afford access to health care.
"I talked to my husband about the new rate," said Bianca, 32, who asked NPR to withhold her last name, as political activists in her community have faced harassment. "It was not something we were able to afford."
She cancelled a lineup of asthma and mental health related doctors' visits. Since then, she's had to take loans to pay out of pocket for a visit to the emergency room and for prescriptions to treat pneumonia.
The rise in Bianca's insurance premium is not isolated to her, or even to Collier County in South Florida. In December 2025, the Trump administration let enhanced subsidies that the Biden administration had announced for Affordable Care Act coverage during the Covid-19 pandemic expire. In the Senate, most Democrats had voted to extend the subsidies; most Republicans opposed them.
The expiration caused a spike in premiums for millions of people across the country, but it hit Floridians especially hard because of its large number of ACA enrollments and expansive gig economy. In 2025, 4.3 million people in Florida were enrolled in ACA plans. Nearly 443,000 fewer people had healthcare in Florida in 2026 according to federal enrollment data. Florida is also one of the states that opted out of expanding coverage to Medicaid.
This November, as open enrollment begins, premiums are expected to rise again, at the same time voters head to the polls. In some of Florida's newly drawn, competitive districts, such as the area encompassing Tampa and parts of South Florida, access to healthcare appears to be on the ballot for this election.
Bianca said she will be voting for the Democratic nominee in her district, Pia Dandiya.
"Pia is trying to expand the Affordable Care Act," said Bianca. "Which I think is really important, especially for families like mine."
Dandiya, running in Florida's 22nd Congressional District, is campaigning on bringing back the subsidies, reversing the cuts the Trump administration has made to Medicaid and lowering drug prices.
"We know that we need to all work together to introduce [health insurance] legislation at the House level, and get some bipartisan support," she said in her campaign office in Wellington. "Health care is not a blue issue or a red issue. It's a red, white and blue issue. It's something that is impacting all of us."
Dandiya's Republican opponent, Casey Askar, wants to eliminate the ACA altogether and crack down on fraud to preserve Medicare and Medicaid. His campaign did not reply to interview requests.
The district Dandiya and Askar are running in consists of the Everglades, stretching from the Gulf coast on one end, to suburbs of Palm Beach County on the other. But lack of access to health insurance spans even wider. More than 10 percent of Floridians are uninsured according to United Health data from 2024. The passing of the One Big Beautiful Bill tax cut and spending bill —which affected ACA subsidies and reduced federal Medicaid funding — exacerbated the situation.
Prices are expected to rise even further this November, said Katie Roders Turner, the Executive Director of the Family Healthcare Foundation, a Tampa-based nonprofit that connects families in West Central Florida with health insurance.
"We've already seen the projection of higher maximum out of pockets and higher deductibles," she said. "Changes to the availability of subsidies based on people's immigration status is creating more of a burden for people."
Mixed feelings about healthcare
Back in the 22nd District, many retirees and others on Medicare and private insurance said their vote is not related to health insurance.
Fred Gleim recently retired after working with the city's water department for more than 30 years. He's conservative and will be voting Republican.
"I'm 76, I've got Medicare," he said while walking his dogs in Naples. "It's been working great."
For those struggling to find affordable health care, Jerson Dulis, the Executive Director of the Florida Health Justice Project, a non profit which focuses on health equity and access to care, says a big problem is the confusion that comes with changing laws and policies.
"A lot of people don't know if they even belong in the system or not, or if they deserve access to health care," he said. "Often when people receive a notice saying there's been a change in their ACA or Medicaid policy, they miss their appointments or just abandon their care."
Deyanah Johnson, 24, used to have insurance but she fell off and for a while, she didn't even realize when, why or how that happened, she said.
Johnson used to live in West Palm Beach with her family. As rent got too expensive, they moved inland and are still struggling to pay for housing.
She's working as a receptionist at Palm Beach State College, while also studying to be a dental hygienist, and isn't sure if she qualifies for Medicaid. At the same time, she can't afford any of the plans she's been looking at on the healthcare Marketplace.
"It's like we basically can't afford to live," she said. "I hope we get free health care. In other countries, they get free health care."
Johnson has previously voted for Republicans, but this time she's considering voting for Democrats, "to get our country back in order," she said.
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