Nearly half a million Floridians could lose their health insurance if Republicans in Congress do not extend subsidies that lower insurance premiums through the Affordable Care Act, two new reports warn.

An analysis by the Urban Institute estimates that 453,000 Floridians — including 32,000 children — would become uninsured if tax credits put in place during the pandemic are not extended beyond next year, when they are scheduled to sunset.

The tax credits were put in place as the federal government sought to lower the number of uninsured during the COVID-19 outbreak in 2020. They save more than 14 million Americans an average of $527 on monthly health insurance premiums. But the tax credits are widely expected to be reduced, if not eliminated, under a Congress Republican lawmakers will soon control.

Without the tax credits, premiums will skyrocket for more than 1.1 million Florida residents, according to a report from The Center on Budget and Policy Priorities.

A 45-year-old Floridian earning $62,000 per year would see their annual premium soar to an average of $6,983 a year, an increase of $1,713, the study shows. Premiums for a family of four with a household income of $126,000 would rise to $19,700 per year, a hike of more than $9,000.

That will leave hundreds of Florida families struggling to keep health care, health advocacy groups warn.

“The number of people that are taking advantage of the tax credits speaks to the need for care that has existed in this state for a long time,” said Scott Darius, executive director of Florida Voice for Health, a nonprofit that advocates for policies that increase access to health care.

The two reports provide a first in-depth look at how the end of the subsidies would affect Florida in the wake of a Congressional Budget Office report that estimates 4 million Americans would lose health insurance nationwide if the subsidies are not extended.

More than 21 million Americans are now insured through the Affordable Care Act, including 4.2 million Floridians. The program — often called “Obamacare” — made health insurance affordable to more Americans by creating health insurance marketplaces and subsidizing the cost of premiums. The legislation also provided protections for preexisting health conditions and let parents keep children on their health plans until they turn 26.

Widely regarded as the signature policy of President Barack Obama, the program has been attacked by Republicans who label it as bureaucratic, expensive and lacking in choice. An attempt by GOP lawmakers to scrap the program in 2017 failed by just two votes in the U.S. Senate.

It’s unclear if the Donald Trump’s incoming administration would try again, but the president-elect’s Cabinet could include one Florida political figure with a long track record of opposing the Affordable Care Act.

While serving as Florida Attorney General, Pam Bondi became the face of a legal campaign waged by several GOP attorney generals to have the Affordable Care Act declared unconstitutional because of a mandate requiring Americans obtain insurance. The U.S. Supreme Court upheld the majority of the law.

She and then-Governor Rick Scott, now a U.S. Senator, also sued the federal government in 2015 alleging it was trying to coerce Florida into expanding Medicaid.

The Tampa-based attorney is now Trump’s pick to serve as U.S. Attorney General after his first choice, Matt Gaetz, removed himself from contention.

The repeal of the Affordable Care Act or the end of subsidies would likely hit many Floridians hard, Darius said.

The insurance plans protect the state’s residents from medical debt and the program’s infrastructure, with federal money paying for navigators who help residents find the best plan, tries to steer people away from enrolling in overly expensive plans that won’t cover their needs.

“The argument we’ve been hearing is how expensive everything is,” he said. “The last thing we want to do is pour gasoline on that particular fire.”

An increase in the state’s uninsured level would further strain the resources of hospitals in Florida’s rural areas and put their viability at risk, Darius said. Those hospitals already operate on virtually no profit, in part because Florida remains one of 10 states not to expand access to Medicaid to more low-income residents.

Three rural hospitals — Shands Regional Medical Center Live Oak, Shands Regional Medical Center Starke and Shands Lake Shore Regional Medical Center in Lake City — have closed since 2020.

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