The past year saw a number of critically importent actions at the state and federal levels that could transform how health care is delivered and financed in 2026 and the years to come.

The consequences of these choices have yet to be fully felt by Floridians.But they definitely are on the near horizon.

In considering the most crucial Florida health care stories of the year, the Florida Phoenix reached out to associations that represent consumers, providers, insurers, beneficiaries, and think tanks.

#### Vaccines

Three months after Florida Surgeon General Joseph Ladapo and his boss, Gov. Ron DeSantis, announced their goal to eliminate all vaccine mandates from Florida regulations and statutes, the state held a public meeting in Panama City Beach in December to take input from interested parties.

For three hours, Florida Department of Health officials heard public testimony on proposed rules changes to remove requirements for children attending public and private schools to receive the hepatitis B, varicella (chicken pox), and haemophilus influenza B or Hib vaccines. The proposal also would eliminate from rule the pneumococcal conjugate vaccine for admission to a licensed day care facility.

The proposed rule also would broaden the religious exemption parents can use to refuse vaccines to include personal or philosophical opposition. 

Additionally, the proposed rule would allow parents, guardians, and college and university applicants aged 18-23 to opt out of disclosing their vaccination status to the Florida SHOTS program. SHOTS is how the state collects vaccination data. The new language tracks a 2019 law change.

The changes, some argue, conflict with the DOH’s statutory mission to operate a communicable disease prevention and control program that includes school immunization. The agency is charged by statute to ensure that “all children in this state” are immunized against vaccine-preventable diseases.

Health care lobbyist and Jacksonville attorney Christopher Nuland told the Phoenix, “People absolutely are in tither over both sides of the argument.” He predicted litigation over the proposed rule changes “will bleed over into the [2026] legislative session.”

Ladapo and DeSantis announced during a September press conference that they’d like to see all vaccine mandates eliminated. While the DOH has control over its rules, it## DeSantis Vetoes Medical Malpractice Bill, Setting Up 2026 Showdown

TALLAHASSEE – Gov. Ron DeSantis vetoed legislation that would have considerably altered Florida’s medical malpractice laws, a move that drew immediate criticism from patient safety advocates and praise from the medical community. The bill, dubbed the “free kill” bill by opponents, would have made it harder for patients to sue doctors for negligence.

DeSantis announced his veto during a press conference in Jacksonville, appearing alongside Ladapo, lee Health President Dr. Lawrence Antonucci, and others who supported the veto.

“If this legislation would be enacted,it would lead to higher costs for Floridians,it would lead to less care for Floridians,and it would make it harder for us to keep,recruit,and maintain physicians in the state of Florida,” the governor said.A trio of flashing billboards less than two miles from the Florida Capitol is slamming Gov. Ron DeSantis for vetoing the “free kill” bill on medical malpractice. (Photo by Christine Sexton/florida Phoenix)

DeSantis said he could be swayed to support ending the ban, though, if the Legislature placed limits on non-economic damages in all medical malpractice lawsuits, as well as limits on attorney fees. The caps that DeSantis covets are being pushed by organized medical,insurance,and business interests,but they were rejected during the 2025 session by a one-vote margin in the Senate. The caps, to date, have been a non-starter in the Florida House.

like vaccines, this 2025 issue will spill over into the 2026 session, the last for DeSantis as governor. The House already has fast-tracked the issue. HB 6003 has cleared all its committees of reference and is ready for a House floor vote.The bill has attracted 73 lobbyist registrations. To date, no Senate companion has been filed.

#### Soaring health insurance rates

Since the inception of the Affordable Care Act (often referred to as Obamacare) exchange, Florida has led the nation in the number of people enrolling to purchase subsidized health insurance plans. Florida enrollment topped 4.7 million people for 2025.

Despite the millions who rely on the coverage, Florida insurance officials decided not to warn Florida residents enrolled in the exchange that their health premiums would go up.

Florida is not alone in these rate hikes – insurers nationwide are filing double-digit increases. A review by KFF,the health care analysis institution,of marketplace plans submitted by 312 insurers in 50 states and the District of Columbia shows that the me

Florida’s Expanding Direct Payment Programs for Rural Healthcare

Florida is significantly increasing its investment in direct payment programs aimed at bolstering healthcare access in its rural counties. These programs, designed to address unique challenges faced by rural providers, are projected to total nearly $3.6 billion by fiscal year 2034-35. This initiative represents a substantial commitment to improving healthcare outcomes in underserved areas of the state.

Understanding Direct Payment programs

Direct payment programs, also known as value-based payment models, differ from traditional fee-for-service healthcare. In a fee-for-service system, providers are paid for each individual service they deliver. Direct payment programs, however, focus on rewarding providers for the *quality* of care and patient outcomes, rather than the *quantity* of services. This shift is especially critically important in rural areas where access to care is limited and providers frequently enough serve a disproportionately high number of patients with complex health needs.

Why Rural Healthcare Needs Direct Payment

Rural healthcare systems face several unique hurdles:

• Workforce shortages: Recruiting and retaining healthcare professionals in rural areas is notoriously challenging.
• Financial Sustainability: Lower patient volumes and a higher percentage of uninsured or underinsured patients can strain rural hospitals and clinics.
• limited Infrastructure: Rural areas often lack the advanced medical technology and specialized services available in urban centers.
• transportation Barriers: Patients may have to travel long distances to receive care.

Direct payment programs can help mitigate these challenges by providing a more stable and predictable revenue stream for rural providers, incentivizing them to focus on preventative care and chronic disease management, and supporting investments in infrastructure and technology.

Florida’s Four Key Direct Payment Programs

florida’s investment encompasses four primary direct payment programs:

1. Rural Hospital Stabilization Program

This program provides financial assistance to rural hospitals facing financial distress. It aims to ensure these hospitals can continue to provide essential services to their communities. Details on eligibility and funding allocations can be found at the Agency for Health Care Management (AHCA) website.

2. Graduate Medical Education (GME) Expansion

Expanding GME programs in rural areas is crucial for increasing the number of physicians practicing in these communities. This program supports the creation of new residency positions in rural hospitals and clinics, encouraging doctors to establish long-term careers in underserved areas. More details is available from the Florida Department of Health.

3. Critical Care Transportation Program

Given the distances involved in rural healthcare, reliable transportation is vital. This program supports air ambulance and ground transportation services, ensuring patients can quickly access specialized care when needed. The Florida Division of Emergency Management oversees this program.

4. Enhanced Physician Loan Repayment Program

This program offers loan repayment assistance to physicians who commit to practicing in designated rural and underserved areas of florida. It’s a powerful incentive to attract and retain medical professionals where they are most needed. Details can be found on the Florida Department of Health loan Repayment Programs page.

projected Impact and future Outlook

The projected $3.6 billion investment represents a significant step towards addressing healthcare disparities in Florida’s rural communities. By focusing on quality of care,financial stability,and workforce development,these direct payment programs have the potential to transform healthcare access and improve health outcomes for millions of Floridians.Continued monitoring and evaluation will be essential to ensure these programs are achieving their intended goals and adapting to the evolving needs of rural healthcare systems.

Key Takeaways

• Florida is investing heavily in direct payment programs for rural healthcare.
• These programs prioritize quality of care and patient outcomes over volume of services.
• The four key programs address hospital stabilization, physician training, transportation, and loan repayment.
• The initiative aims to mitigate unique challenges faced by rural healthcare systems, such as workforce shortages and financial instability.

Publication Date: 2025/12/30 07:38:52