Commissioner Oliver Gilbert Introduces Urgent Healthcare Legislation to Expand Medicaid and Extend ACA Subsidies

On December 15, Miami-Dade County Commissioner Oliver G. Gilbert III introduced a critical resolution (252451) aimed at addressing the healthcare crisis in South Florida. The legislation formally urges the State of Florida to expand Medicaid and calls on the U.S. Congress to extend enhanced Affordable Care Act (ACA) subsidies before they expire.

The Commissioner’s push comes as tens of thousands of Miami-Dade residents—and millions more nationwide—continue to delay essential medical treatment due to the skyrocketing cost of insurance.

According to a May 2025 KFF health tracking poll, 1 in 3 Americans (36%) report they have skipped or postponed getting needed healthcare in the past 12 months due to cost. Additionally, the poll reports that about 18% of adults report that their health condition actively worsened specifically because they delayed or skipped care due to the price tag.

Specifically, Florida is currently facing a “healthcare tidal wave,” as it leads the nation with 4.7 million residents enrolled in Affordable Care Act (ACA) plans as of late 2025—the highest enrollment of any state, according to PolitiFact.

As reported by WUSF, this crisis is most acute in Miami-Dade County, which holds the highest number of ACA Marketplace enrollees in the country; without legislative action to extend enhanced subsidies, local experts warn that over 1 million residents in the county alone could face “catastrophic” premium hikes—potentially doubling in 2026—or the total loss of coverage.

In a moving call to action in an Instagram video, Commissioner Gilbert emphasized that the current system forces residents to choose between their financial stability and their physical health.

“Healthcare should not come too late. It should be there early, consistently, and without fear,” said Commissioner Gilbert. “I did not know my father had congestive heart failure until he was hospitalized….No family should learn the truth about a loved one’s illness in an emergency room.”

By expanding access, the legislation seeks to move the community toward a system where preventive care reduces the strain on public hospitals and prevents families from being “blindsided” by late-stage diagnoses.

Gilbert noted that the consequences of Congress’s inaction are felt daily at Jackson Memorial Hospital, where emergency rooms often become the “entry point” for manageable conditions that have turned into life-threatening crises.

“I see this community. I understand [this community], and right now, people are struggling,” added Gilbert. “They’re working. They’re contributing, but still afraid to go to the doctor….When we delay preventive care, we pay for it in emergencies. We pay for it in heartbreak, and we pay for it in higher costs for everyone.” 

The legislation has officially begun its path through the county’s regulatory process, having been assigned to the County Attorney’s office and the Office of the Chairperson on December 15, 2025, for review and placement on an upcoming agenda.

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