When President Lyndon B. Johnson signed the Medicare and Medicaid Act of 1965, he said: “No longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.”
Within a year, 19 million Americans were enrolled Medicaid. In 2025, 71.1 million Americans were enrolled, about 21% of the country. Medicaid is still the largest source of health care funding for people with lower incomes in America.
So, when one takes a sunset drive past the mansions on Bird Key or notices the exorbitant rental prices at the apartment buildings that seem to sprout up every day, Sarasota County wouldn’t seem to be a place where residents have to worry about cuts to the program.
But local health care providers and policy experts say that the $4 billion in Medicaid cuts Florida is expected to sustain if the GOP’s One Big Beautiful Bill passes would have wide-ranging effects for everyone. Various estimates project that tens of thousands of residents in the Sarasota-Manatee County area would lose health care coverage as a result of the legislation in coming years, with the impact reverberating through the hospital and health care economy as well.
The bill narrowly passed the U.S. House of Representatives – by a single vote, with support from Sarasota-Bradenton area Republican Congressmen Greg Steube and Vern Buchanan. The Senate approved the legislation with changes July 2, sending it back to the House, with the goal of sending it to President Donald Trump by July 4.
Steube declined to comment to the Herald-Tribune.
Buchanan reaffirmed his support for the bill this week, with a letter to Floridians that cited the bill’s tax cuts and elimination of taxes on tips, as Congress pushed hard toward President Donald Trump’s goal of passage by July 4.
“We are also protecting and strengthening Medicaid for American citizens who need it by rooting out waste, fraud and abuse, and implementing common sense work requirements,” the letter said.
It was co-signed by Rep. Byron Donalds, R-Naples, the GOP front runner for governor, Rep. Jimmy Patronis, R-Walton Beach, the former Florida Chief Financial Officer, and Rep. Randy Fine, R–Melbourne Beach.
The landmark legislation would allow the Republican-controlled Congress to follow the Trump Administration’s lead on cutting government spending with steep cuts to Medicaid, the Supplemental Nutrition Assistance Program (SNAP, also known as food stamps), clean energy, and environmental programs.
The U.S. Senate’s version would impose even more cuts to Medicaid than were proposed by the House. Two Republican senators voted against the bill, though both of Florida’s senators, Republicans Rick Scott and Ashley Moody, voted in favor. The 50-50 tiebreaker vote was cast by Vice President J.D. Vance.
Bill would affect tens of thousands in Sarasota, Manatee area
Despite statements by the White House that the bill “significantly improves our nation’s fiscal trajectory,” economic policy centers such as the Yale Budget Lab have concluded that the tax and spending cuts would substantially raise the national debt and deficit.
The Tax Policy Center found that while 84% of U.S. households would see some sort of tax cut, most of the relief would go toward the county’s wealthiest – households making between about $460,000 and $1.1 million.
Steep cuts to Medicaid meant to offset the tax cuts would rescind promises made by Trump on the campaign trail. As recently as March, the White House said, “the Trump Administration will not cut Social Security, Medicare, or Medicaid benefits,” as congressional Republicans named the bill after his full-throated support for it.
The Congressional Budget Office (CBO), a nonpartisan federal agency, reported that the bill would cause nearly 11 million Americans to lose insurance coverage through 2034; it also reported that the tax cuts would lead to a $2.4 trillion increase in the federal deficit over the next 10 years.
Republicans have said the cuts to social programs address fraud and improper payments, but groups like the Florida Health Justice Project (FHJP) have taken issue with that framing.
“Although some claim the proposed cuts will only address fraud, the amount of fraud and abuse in Medicaid is insignificant in comparison to the $880 billion cut currently under consideration by Congress,” an FHJP report said.
Florida has more people enrolled in the Affordable Care Act (ACA, also known as “Obamacare”) than any other state, at about 4.7 million. For those Floridians, cuts from the bill would increase the annual average cost of health insurance by about 90%, according to the Florida Policy Institute.
The FHJP found that Florida could lose $4 billion in annual Medicaid funding from the federal government. State legislators would have to decide whether to make up for that gap by defunding other state programs, or to simply let Medicaid languish.
Sarasota is one of the wealthiest counties in the state, more known and marketed for its beachside views, tourist attractions, and cultural scene; it has among the lowest Medicaid enrollment rates in Florida at about 10.5% in 2024, according to Florida Health.
An analysis by the Center for American Progress (CAP), a liberal-leaning policy institute, found that about 2 million Floridians were estimated to lose their health coverage by 2034; 60,000 of them reside in Steube’s district, which includes all of Sarasota and Charlotte counties and 62,000 in Buchanan’s, which includes Manatee County.
In addition, an estimated 14,000 to 15,000 people in the two congressional districts would lose SNAP benefits, the institute said.
Although county-level estimates were not available, thousands of people in Southwest Florida − nearly half a million statewide − would likely lose coverage because of dramatic premium increases, shorter enrollment periods, income verification requirements and out of pocket requirements, according to outside analysts.
“Nationally, the bill − along with additional Trump administration health changes − would strip nearly 14 million Americans of health insurance coverage by 2034,” the CAP study said.
The KFF, a health care research organization, found that between Medicaid cuts and changes to the ACA, Florida’s uninsured population is projected to increase by about 9 percentage points – the worst rate of any state in the country.
Former Trump, DeSantis official critical of legislation’s impact
Before she became CEO of the Florida Hospital Association (FHA), Mary Mayhew was well-involved in all things Medicaid policy. For years she ran the Maine Department of Health and Human Services.
The Bangor Daily News described her as a “polarizing figure” whose “arch-conservative six-year tenure” running Maine’s health department was a roadmap for conservative Medicaid policy. She was tapped by Trump to run Medicaid nationwide in 2018, but left the post after a few months; in 2019 Gov. Ron DeSantis appointed her to run the Florida Agency for Health Care Administration.
Now, as the head of a lobbying organization that represents more than 200 hospitals and health systems, and despite her background in conservative politics, Mayhew has deep reservations about the GOP bill, which she described as a tax bill being funded through cuts to Medicaid.
“We are extremely concerned about the impact it will have on access to critical health care services,” Mayhew said.
Florida would be uniquely hurt by the bill, Mayhew said, precisely because of its historic fiscal conservatism with Medicaid; it was one of only 10 states that declined to expand Medicaid under the ACA.
The bill would freeze Florida’s relatively low provider taxes – the fees assessed on healthcare revenue. In Mayhew’s view, Florida would be punished by a conservative-controlled D.C. for its conservative approach to Medicaid. With the new changes, the state would be less able to improve reimbursement rates – payments to health care providers to serve those on Medicaid; the trickle-down effect would harm pediatric practices, primary care physicians, and mental health agencies across the state.
Although Mayhew said her experience with Florida representatives was positive, she also said Congress had taken “an easy button approach,” rather than a holistic view to make Medicaid more efficient.
“The package is protecting those states that have aggressively maximized Medicaid spending and seems to be far more punitive to conservative states, because it has frozen us where we are,” Mayhew said.
She wrote in an op-ed for the Palm Beach Post that the cuts were “draconian” and “an extreme blow to a system of care that is already underfunded and is relied on by about 1 in 5 Florida residents.”
“Make no mistake about the nature of the cuts. They are not an accounting tactic. They are not a tax cut. Nor are they a means of making Medicaid more efficient or cost-effective,” Mayhew wrote.
Steven Ullmann, the director of the University of Miami’s Center for Health Management and Policy, said the only silver lining of the cuts is that since Florida has never expanded Medicaid, so there are fewer people who would be thrown off when federal funds dry up.
“There are people who won’t be cut off from Medicaid because they were never on Medicaid,” Ullmann said.
Besides that, there was little proposed that excited Ullmann. He worried that if the country moved into a recession, a drop in tax revenues would disincentivize elected officials in Tallahassee from making up the funding gap in the state budget – not to mention if DeSantis gets his wish and eliminates property taxes.
He also worried that nursing homes, which already keep their doors open on slim financial margins, would experience more hardship as reimbursements decrease. This could cause staffing shortages, reductions in available space, and some more rural and low-income facilities to shut down.
Sarasota County has nearly twice as many nursing homes as the state average, according to Florida Health. The cuts to services for the elderly could come as about half of them in Sarasota County are either living in poverty or teetering on the brink of it. Medicaid pays for 58% of all nursing home residencies in the state.
Sarasota health care providers worried by an already weakened system
As the Chief Advancement and Engagement Officer for CenterPlace Health, Christine Coviello has seen first-hand what’s been called the “unwinding” of Medicaid. During the COVID-19 pandemic, states were barred from disenrolling recipients of the program. Since that rule ended in 2023, Florida kicked about 1.3 million residents off Medicaid − nearly half of them children, according to the Florida Policy Institute.
“We’ve already seen over the past five years a pretty steep decline in Medicaid, and we’re concerned that if that continues – our safety net is getting weak – it would target the most frail: older adults, senior citizens, lower income senior citizens, as well as our moms and babies,” Coviello said.
The clinic’s rate of uninsured patients rose by about 15 percentage points from 2019 to 2024.
CenterPlace doesn’t turn anyone away based on their insurance status and serves much of the area’s lower-income communities. By accepting Medicaid, they are able to help a lot more patients.
For a clinic system the size of CenterPlace, those Medicaid dollars are vital. Removing $4 billion in health care funding from the state could cause providers across Florida to shut their doors, especially those that serve more vulnerable communities.
“I think you’re literally going to see some drastic issues happening in our community,” Coviello said. “Sarasota is such a wealthy community, and we have so much philanthropic support, but sometimes it’s just there’s not enough for everybody.”
Local advocates like Coviello worry that more economic turmoil for the local working class and working poor, who are already burdened by inflation and Florida’s affordable housing crisis, would mangle the lifeblood of Sarasota’s economy: tourism. Much of the industry is held up on the overworked shoulders of line cooks, restaurant servers, bartenders, retail associates, and construction workers, who all earn relatively low wages and likely don’t earn health care coverage from their employer.
Washington Hill is one of the most respected doctors in Sarasota. An obstetrician and gynecologist with CenterPlace, he was brought in by Sarasota Memorial Hospital 32 years ago to help found its at-risk pregnancy program.
Hill called Medicaid a lifesaver for women and their babies and said the scale of the Medicaid cuts as a disaster for maternal health in Florida.
“We see patients at the hospital who are pregnant, and probably 50% of them are on Medicaid,” Hill said.
While women who are in labor will be treated by federally licensed health care centers, such as the emergency room at Sarasota Memorial Hospital, cuts to state health care may inhibit their ability to receive care during their pregnancy. Some who suffer from high blood pressure, gestational diabetes, risk of miscarriage, or a litany of other issues associated with carrying an entire human child to term, could have to go without medical care.
“If Medicaid is cut, if the funds to the state are cut, then the number of patients who are on Medicaid would decrease,” Hill said. “And those patients will go through their pregnancy or a part of their pregnancy with no coverage.”
All this in a state that instituted a six-week abortion ban in 2024, which has likely led to an increase of children born into poor households, experts say, although it is still too early for direct, definitive data to be available.
Families USA, a health care advocacy organization, has come out strongly against the cuts. In an analysis of the bill, it found that during a four-year stretch to 2023, maternal mortality rates in states that did not expand Medicaid, such as Florida, had a 35% higher maternal mortality rate than expansion states.
“If Congress makes harmful cuts to Medicaid, 38% of reproductive age women who rely on Medicaid could lose health care coverage,” the report said.
The Commonwealth Fund found that pregnant Medicaid beneficiaries are less at risk of cesarean-section births and mental health issues associated with pregnancy. Its State Scorecard on Women’s Health and Reproductive Care classified Florida as a “bottom-performing state,” ranked 39th in the country.
“Medicaid beneficiaries use prenatal care during pregnancy more than their uninsured counterparts do and have better health outcomes,” the Fund’s report said.
The University of Pennsylvania’s Budget Model found that the top 10% of earners in the country would receive 70% of the bill’s value.
“On a dynamic lifetime basis, lower-income households and some in the middle class are worse off, despite positive economic effects. All future generations are worse off,” the study concluded.
Christian Casale covers local government for the Sarasota Herald-Tribune. Email him at ccasale@gannett.com or christiancasale@protonmail.com
This article originally appeared on Sarasota Herald-Tribune: Fate of health coverage for thousands in Sarasota, Manatee, hinges on ‘Big Beautiful Bill’
Reporting by Christian Casale, Sarasota Herald-Tribune / Sarasota Herald-Tribune
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