“I’m terrified”: Florida woman who spent years voting Republican now faces losing the health coverage keeping her alive

Catalina Jaramillo, a lifelong Republican voter in South Florida, is beginning to imagine a future she never thought possible: one where she can no longer afford the care keeping her kidneys from failing.

Jaramillo, diagnosed with acute kidney disease in 2022, relies on Affordable Care Act insurance—made affordable only through the expanded subsidies created under the American Rescue Plan. When those subsidies expire at the end of the year, her monthly premium will more than double, and the treatments protecting her kidneys will become out of reach.

“I’m terrified,” she said. “I’m like a deer in the headlights.”

She’s not alone. More than 22 million Americans—disproportionately from deep-red states—are about to face the same nightmare. For months, Congress has been paralyzed by infighting over whether to extend the subsidies. Republicans have spent that time recycling long-standing attacks on the ACA, while Democrats have pushed for a three-year extension to avoid skyrocketing premiums.

The impasse comes after a record-long government shutdown, which ended without any agreement to protect the subsidies. Despite Republican Senator Josh Hawley warning of a “massive crisis” for 24 million Americans, his party remains split—and largely unmoved.

Costs Will Explode — Especially in Trump Country

If Congress does nothing, ACA premiums will rise 114 percent on average, according to KFF. This would increase the uninsured population by millions. And the states with the most to lose? Florida, Texas, Louisiana, Mississippi, West Virginia—almost all deep-red Trump strongholds.

Florida, which Trump carried by double digits, now has a staggering 4.7 million ACA enrollees, more than any other state. Many earn modest wages in the tourism industry and depend on subsidies to access coverage. When premium notices landed last month with January rate hikes, fear spread quickly.

“It’s disbelief,” said Scott Darius of Florida Voices for Health. “People are saying, ‘On top of everything else, now I have to worry about this too?’”

Trump Signals He’s Fine Letting Subsidies Die

Trump initially appeared open to a short-term extension but reversed after Republican backlash. This week, his White House made its position clear: Democrats’ push to extend subsidies is a “con job,” and the administration is prepared to let them expire.

“The current system is not working,” spokesperson Kush Desai said, accusing Democrats of bailing out insurance companies—even though nonpartisan analyses show that the expiration will devastate millions of middle- and working-class Americans.

Democrats, meanwhile, are preparing to campaign heavily on the issue. “The public will see exactly who is standing up for them,” Senator Tim Kaine said.

‘Now My Support Is Wavering’

For Jaramillo, the political rhetoric has stopped being theoretical. A lifelong Republican voter, she now admits that her party’s stance on health care—and the financial pain she’s about to face—has shaken her loyalty.

“It’s wavering,” she said.

According to a new KFF poll, almost two-thirds of ACA enrollees say they will blame Trump and Republicans if premiums spike, and more than a quarter say they will likely drop insurance entirely if costs double.

The irony is brutal: the ACA’s enhanced subsidies overwhelmingly benefit communities that fueled Trump’s rise—and many of those same supporters are now poised to lose access to lifesaving care.

As the year-end deadline approaches with no deal in sight, millions of Americans are about to learn the consequences of the policies they voted for.

And for Jaramillo, the stakes could not be higher. Without coverage, the treatment protecting her kidneys becomes unaffordable.

Her support for Trump may be wavering—but without insurance, her health may not survive the fallout.