September 25th Disclaimer: The Florida Decides Healthcare Ballot Initiative has postponed their efforts until the 2028 General Election, citing petition roadblocks imposed by the passage of 2025 HB 1205. Our endorsement remains and is preserved in full below.

Most of us know that Trump’s Big B.S Bill will cut Medicaid and other healthcare spending for millions of Americans, especially for the elderly, children, and women. Unfortunately, based on current state programs and years of inaction by the Florida Legislature, our state and our people will be more negatively impacted than the rest of the country. Florida has long had some of the worst numbers in the nation for the number of children and the elderly who do not have full access to healthcare. Now, the situation is going to get worse.

Millions of Floridians are Losing Healthcare

Today, nearly 1.4 million Floridians are stuck in the Medicaid coverage gap — earning too much to qualify for Medicaid but too little to afford insurance. The federal reconciliation law that passed this year in Washington still preserves the 90% federal match for to cover the costs for states that expand Medicaid, but it failed to extend enhancements to ACA tax subsidies for people accessing healthcare through the Affordable Care Act (Obamacare). This will dramatically drive-up ACA out of pocket premium costs, pushing millions more into this coverage gap.

Starting in January of 2026, when these tax credit enhancements expire, another 2.3 Floridians will lose their ACA coverage, meaning 3.7 million will fall into the Medicaid coverage gap. Florida will be hit harder than any other state by these changes. Tragically, experts predict 1 in 5 Floridians will be uninsured.

An Economic Crisis

Florida is already leaving over $4 billion in federal funds on the table every year. These are dollars Florida taxpayers have paid and should be coming to the state. Soon, that number will balloon to $10.5 billion annually because of the more than doubling of Floridians falling into the coverage gap. These tax dollars, collected from Floridians, will continue to help residents in New York and California— unless we take action. The loss of these funds threatens over 40,000 jobs.

Combine the threats to ACA premiums, the straight loss of Medicaid funds, over a decade of inaction of providing healthcare for children through state programs and we are looking at an upcoming healthcare disaster of epic proportions.

Everyone will be impacted

With millions losing health care coverage, more and more will get healthcare in the emergency rooms. This is the most expensive type of healthcare, and this drives up costs for every single Floridian. Experts are warning that the changes on the horizon will drive up healthcare premiums for everyone, including union members who have fought for employer sponsored group coverage at the bargaining table.

The Solution: Medicaid Expansion on the Ballot

One silver lining of Trump’s Big B.S Bill is that it maintained the federal Medicaid Expansion match (which brings fully twice as much into the state as the state spends.) This means that Medicaid Expansion is still the very best option to mitigate some of the damage on the horizon. There’s just one problem…the Florida legislature has repeatedly refused to do expand medicaid. Florida is just 1 of 10 states that has not updated its Medicaid eligibility requirements since 2013 because, since the days of Rick Scott—who plead the 5th over 75 times in the single biggest Medicare fraud cases in history—the Republican line has been “Medicaid expansion is Obamacare –> Obama is bad –> no to Medicaid expansion. For 15 years bills have been filed in Florida on Medicaid expansion, and there has never been a single hearing. Now, with these new threats on the move, it is time for the people to do it ourselves.

Medicaid Expansion Will:

• Provide Medicaid and healthcare services to 3.7 million Floridians, including parents of young children, women of childbearing age, part-time workers, seniors, caregivers, and people with chronic illnesses
• Save an estimated 7,000 lives a year, reduce maternal and infant mortality, improves breast cancer outcomes, and reduce opioid deaths
• Keep our $10.5 billion in federal taxes here at home
• Provide a huge boost to our economy by helping to attract and retain doctors and nurses
• Lowering costs for healthcare for all by promoting preventive care and reducing strain on emergency rooms
• Keep hospitals open, especially in rural communities where access to care is already limited

The Florida AFL-CIO Joins the Fight for Medicaid Expansion

Florida Decides Healthcare is a citizen’s initiative campaign to put Medicaid Expansion on the ballot as a Constitutional Amendment, and they are battling serious headwinds. For years, the Legislature has chipped away at the ability for Floridians to use the citizen’s initiative to make changes to the state constitution. They have made the process more and more difficult, stripping us of our constitutional right to direct democracy by a thousand paper cuts. In 2025, the Legislature passed the coup de grâce in the form of HB 1205. Wanting to finally make the initiative process impossible, the legislature imposed new onerous regulations, seemingly insurmountable processes and confusing procedures. But Florida Decides Healthcare is fighting on, and we are joining them.

With a long history of endorsing and fighting to pass bills during each session, we are now turning our attention to the ballot box. The Florida AFL-CIO unanimously adopted a resolution and is proud to fully endorse the Florida Decides Healthcare campaign. Working with a massive coalition of organizations, we are going to do everything we can to secure a victory. Let’s get ready to rumble!

In Solidarity