Key West, Florida

A few weeks ago, Heather Slivko-Bathurst sat down with her husband for a “what if” assessment. Suppose the Trump administration and congressional Republicans went ahead with plans to sunset the extra federal subsidies that, in their case, had made the Affordable Care Act (ACA) actually affordable? Where would their family have to cut back on its spending?

Groceries? Daycare? “Unfortunately, some of our non-negotiables are going to have to become negotiable in order for us to be able to afford anything,” Slivko-Bathurst told The New York Times.

A 37-year-old mother of a toddler, Slivko-Bathurst works for a boating company in Key West; her employer offers only a bare-bones form of health insurance, while her husband’s job offers none at all. Their ACA plan currently costs about $800 a month. Without the subsidies, Slivko-Bathurst reckoned, that number would rise to nearly $2,000.

Those subsidies, introduced during the pandemic, helped millions of Americans keep their coverage. They are set to expire on December 31st, the latest casualty of a budget impasse in Washington. If Congress fails to extend them, an estimated third of Florida’s 4.7 million ACA enrollees could lose their plans next year.

For Slivko-Bathurst’s family, that likely means switching to the cheaper plan available through her job — coverage that provides “about half as much” protection for the same price. “You’re paying a ton of money for very, very little,” she said.

Florida has one of the nation’s highest enrollment rates in ACA plans and remains one of ten states that have not expanded Medicaid. In Key West, where the cost of living has surged, families like Heather’s are bracing for higher bills and harder choices.

Posted on November 19, 2025