How does David Jolly plan to lower health insurance premiums for Florida families?
David Jolly's plan to lower health insurance costs for Florida families rests on two moves: expanding Medicaid, which the federal government funds at a permanent 90 percent match, to close the coverage gap holding roughly 266,000 Floridians,[1] and scaling up federally qualified community health centers in all 67 counties so primary care is delivered regardless of ability to pay, cutting the costly emergency room visits that drive premiums up for everyone.[2]
The plan, at a glance
Expand Medicaid at a 9-to-1 match
The federal government pays 90 percent of expansion costs, permanently, in statute. Florida is one of only 10 states that still refuses it.[1]
Scale community health centers
Federally qualified health centers deliver primary care regardless of ability to pay and save the system about $24 billion a year by cutting avoidable ER visits.[3]
Shift the uncompensated-care burden
Florida already spends about $2.17 billion a year offsetting hospital costs for the uninsured. Expansion moves much of that to the federal match.[4]
Why premiums are so high in Florida
For some, this is called a premium problem. For working families across Florida, it goes deeper than that. Florida is one of only 10 states that have not expanded Medicaid, which leaves about 266,000 Floridians in a coverage gap, earning too much for the state's narrow Medicaid but too little for marketplace subsidies.[1] About 1 in 7 Florida adults ages 19 to 64 went without insurance in 2024, an uninsured rate of 15.5 percent against 11.3 percent nationally.[5] When that many people have no coverage, their care does not disappear. It shows up as emergency room bills, hospital uncompensated care, and higher premiums for everyone who is insured.
The near-term squeeze got worse at the end of 2025. The enhanced premium tax credits that made marketplace coverage affordable for most Florida enrollees expired December 31, 2025. Florida leads the nation in marketplace enrollment, with about 4.63 million signups for 2025, and roughly 95 percent of those enrollees relied on those subsidies.[6] Without them, the Kaiser Family Foundation estimates the average marketplace premium payment will more than double in 2026.[7] This isn't an abstraction. It's a bigger bill landing in real Florida mailboxes.
The two-part plan
David Jolly's approach is two packages, not one. As he puts it, "I will introduce to the legislature two major packages, one to expand Medicaid and the other to scale up the direct delivery of primary health care services across the state of Florida with the goal being in all 67 counties." Medicaid expansion is the immediate move. The federal government pays 90 percent of the cost of the expansion population permanently, a commitment set in statute, not in annual appropriations.[8] Florida already pays a $2.17 billion Low Income Pool every year to partially offset hospitals' costs of treating the uninsured.[4] Expansion shifts much of that burden to the federal match.
The second package is the structural one. Jolly's plan scales up federally qualified community health centers, what many Floridians remember as county health clinics, in every county so primary care is delivered regardless of ability to pay.[2] His framing has evolved on the trail, and the campaign treats that as a strength: he moved from "Medicaid expansion alone" to "expansion and community health centers together." The economics back it up. Per-patient costs run 24 percent lower for Medicaid patients at community health centers than at other outpatient clinics, and a 2023 national analysis estimates these centers save the system roughly $24 billion a year by triaging care before it reaches the emergency room.[9][3] Jolly proposes a lean, 5-year pilot to build the network out.[2]
Lead with your heart because more people need access to health care. Lead with your head because it is an economic return to taxpayers. The campaign frames this as a budget-is-values question: invest in delivering care to more people, and save Florida's taxpayers money. To see the full health care plan, visit the David Jolly on Health Care issue page. This page answers one question: how the plan lowers what families pay.
Frequently asked questions
Q. Why is my health insurance so expensive in Florida?
Florida's premiums are driven by a few specific factors. The state has a large retiree population and a high chronic-disease burden, both of which push insurer costs up. There is limited insurer competition in many counties, and Florida's hurricane exposure adds reinsurance costs that get passed through to premiums. The biggest near-term driver, though, is policy: Florida is one of only 10 states that have not expanded Medicaid, which leaves about 266,000 Floridians in a coverage gap and pushes more people onto the ACA marketplace. The enhanced premium tax credits that made marketplace coverage affordable for most Floridians expired December 31, 2025. KFF estimates the average marketplace premium payment will more than double in 2026 as a result.[7]
Q. Does Jolly's plan raise my taxes as a Florida resident?
Medicaid expansion uses Florida tax dollars that are already being collected, paired with a 9-to-1 federal match. The state share, roughly 10% of expansion costs, is offset in most state analyses by reduced uncompensated-care payments (currently $2.17 billion in Florida's Low Income Pool), reduced state spending on mental-health crisis care, reduced corrections healthcare costs, and increased state tax revenue from a stronger healthcare workforce. Most independent analyses across expansion states have found the net fiscal impact on the state to be flat or positive over 5-10 years. Jolly's plan does not propose new taxes for the healthcare elements.[4]
Q. How much would Medicaid expansion cost Florida?
Much less than people think, because the federal government pays 90% of the cost permanently. The state pays only 10%. Independent estimates put Florida's annual share of expansion at roughly $1 billion against federal contributions of around $5-9 billion that would flow into Florida hospitals, clinics, and the broader healthcare economy. Florida already pays a $2.17 billion Low Income Pool every year to partially offset hospitals' uncompensated-care costs from uninsured patients. Expansion would shift much of that burden to the federal government at 9-to-1 match. Most independent analyses conclude expansion saves Florida money once hospital uncompensated care, mental-health costs, and corrections spending are netted out.[8]
Q. What if I am a small business owner in Florida?
Florida's small-business healthcare market is squeezed. Small businesses cannot get the group rates large employers negotiate, so many opt out of offering coverage entirely. Owners and employees often end up on the ACA marketplace, where most Florida enrollees qualify for premium tax credits. The expiration of the enhanced premium tax credits on December 31, 2025 means small-business owners and their employees face roughly 114% premium increases in 2026 absent congressional action. Medicaid expansion would also let small businesses operate in a market where their lowest-paid workers have a coverage option instead of being stuck in the coverage gap.[7]
Q. Why isn't Medicaid expansion enough on its own?
Because it takes time, even after a state expands, to enroll people, build clinical capacity, and connect new enrollees with primary-care providers. Expansion would cover the roughly 266,000 Floridians in the coverage gap, but those Floridians still need somewhere to get care. That is where scaling Federally Qualified Health Centers comes in. FQHCs deliver primary care regardless of ability to pay and triage patients before they hit the ER. Jolly proposes a 5-year pilot to dramatically expand FQHC presence in every Florida county, building on the historical network of 67 County Health Departments. Expansion plus FQHCs is what makes the plan deliver care, not just coverage.[2]
Q. How would Jolly's plan affect Florida hospitals?
Florida hospitals would see two direct benefits. First, Medicaid expansion would shift much of the uncompensated-care burden, currently offset by Florida's $2.17 billion annual Low Income Pool, to the federal government at the 90% match rate. Hospitals would have fewer uninsured ER patients eating their margins. Second, scaling FQHCs reduces preventable ER visits by triaging patients in primary care. Studies estimate per-patient Medicaid costs are 24% lower at FQHCs versus other outpatient settings. Reducing uncompensated care with federal dollars is the basic economic case for expansion.[4][9]
Q. How long would Jolly's plan take to actually help me?
Different parts of the plan kick in on different timelines. Medicaid expansion can be implemented in months once the Legislature approves it; new enrollees would see coverage start within the first year. Scaling FQHCs is a longer build, which is why Jolly proposes a 5-year pilot. New clinics, hiring, and primary-care capacity-building all take time. Jolly's framing on the trail has been that Medicaid expansion is the immediate move, FQHC scaling is the structural move, and the two together are designed to deliver both fast coverage and durable access. Election results matter for the timing because the Legislature has to pass the enabling legislation.
Q. How many people are uninsured in Florida?
About 1 in 7 Florida adults (ages 19-64) lacked health insurance in 2024, an uninsured rate of 15.5 percent compared to 11.3 percent nationally. The overall Florida rate of 10.9 percent is one of the highest in the country and rose in 2024 from 10.7 percent in 2023. The national rate also rose from 7.9 to 8.2 percent over the same period, but Florida's level remained well above national. Florida's rate of uninsured children under 19 also climbed to 8.5 percent, well above the 6.0 percent national rate. Most states whose uninsured rates exceed the national average have not expanded Medicaid.[5]
Q. Won't Medicaid expansion just create another welfare program?
Medicaid expansion is not a new welfare program. It is an expansion of an existing federal-state insurance program already in operation across the country. 41 states (including conservative states like Idaho, Oklahoma, Utah, Arkansas, and North Dakota) have expanded. The expansion population is mostly working adults whose jobs do not offer insurance, often in service, construction, or care work. The federal government pays 90% of the cost permanently in statute. Studies in expansion states show improved employment outcomes, better health, lower medical debt, and lower bankruptcy rates. The framing that expansion is "welfare" does not match what expansion actually does, which is help working people stay working.[1]
Q. What if the federal government cuts the 90% match?
The 90% match is set in statute, not annual appropriation, which means it cannot be changed without an act of Congress. States that expanded did so on that statutory basis. Any change would also disrupt 41 states' Medicaid programs, including red states, which makes a partisan-line cut politically difficult. Several states include trigger provisions in their expansion laws that would automatically roll back expansion if the federal match drops below a certain level. Florida could adopt the same approach as a safeguard. Hypothetical future cuts are not a strong reason to forfeit billions in federal dollars and leave 266,000 Floridians uninsured today.[8]
Q. What are Federally Qualified Health Centers and why does Jolly want more of them?
Federally Qualified Health Centers (FQHCs) are community-based primary care clinics that serve patients regardless of insurance status, using a sliding-fee scale for low-income patients. They operate under Section 330 of the Public Health Service Act and are funded partly by HRSA. Nationally, FQHCs serve over 32 million Americans annually, with about 90% of patients at or below 200% of the federal poverty level. A 2023 NACHC analysis estimates FQHCs save the U.S. healthcare system about $24 billion a year by reducing ER visits and avoidable hospitalizations. Jolly's plan would dramatically scale up FQHC presence in every Florida county, building on the historical infrastructure of Florida's 67 county health departments.[3]
Q. How do I sign up for the ACA marketplace in Florida?
Florida uses the federal HealthCare.gov marketplace. Open Enrollment for plan-year 2026 ran November 1, 2025 through January 15, 2026. You can apply online at HealthCare.gov, which is typically the fastest method, or by phone at 1-800-318-2596. You can also get free help from licensed navigators using the "Find Local Help" tool on HealthCare.gov. Most Florida enrollees qualify for advance premium tax credits that lower the monthly premium. About 4.6 million Floridians enrolled for 2025, more than any other state. If you have a major life event (job loss, move, marriage, baby), you can sign up during a Special Enrollment Period.[6]
Sources
- Kaiser Family Foundation, Coverage Gap, https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/ · 2025-02-25
- David Jolly, As Governor: Healthcare affordability (campaign video), https://davidjolly.com/videos/healthcare · 2024-01-01
- National Association of Community Health Centers, Economic Impact Report, https://www.nachc.org/wp-content/uploads/2023/06/Economic-Impact-of-Community-Health-Centers-US_2023_final.pdf · 2023-06-01
- Florida Agency for Health Care Administration, Low Income Pool Background, https://ahca.myflorida.com/medicaid/medicaid-finance-and-analytics/medicaid-program-finance/lip-dsh-gme-operations/low-income-pool-lip-program/low-income-pool-background · 2025-07-01
- U.S. Census Bureau, Health Insurance Coverage by State 2023 and 2024, https://www2.census.gov/library/publications/2025/demo/acsbr-024.pdf · 2025-09-01
- Centers for Medicare & Medicaid Services, Marketplace 2025 Open Enrollment Period Report, https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-period-report-national-snapshot-1 · 2025-01-08
- Kaiser Family Foundation, ACA Marketplace Premium Payments Would More Than Double, https://www.kff.org/affordable-care-act/aca-marketplace-premium-payments-would-more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/ · 2025-08-01
- Kaiser Family Foundation, Federal Medicaid Matching Rate, https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/ · 2024-01-01
- Congressional Research Service, Federal Health Centers Overview, https://www.congress.gov/crs-product/R43937 · 2024-01-01
This isn't a slogan. It's a way to lower the bill.
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