And the consequences will ripple through both health and politics
C in Midtown Miami exudes the city's vibe. The nonprofit clinic is bright and adorned with street art. Staff discuss the difference between Cuban and Colombian Spanish; a Bentley is parked on the street outside. But for all its glamour, it is a safety-net doctors' office. Keeping it open requires "put[ting] together a quilt" of grants, insurance and pharmacy income, says Karin Sabey, the clinic's boss. In 2024 over half of patients did not have health insurance. That is set to grow. Last year about a third of nearby Miamians bought insurance through the Affordable Care Act () marketplace. With the end of pandemic-era subsidies, many will be priced out. "Any change in the system could be catastrophic", Ms Sabey says. "It's a house of cards."
