About 440,000 Floridians dropped Affordable Care Act health plans this year after enhanced federal subsidies expired in January, more than in any other state, while many who kept coverage accepted higher deductibles, copays or reduced household spending. Insurers project another year of double-digit premium increases. Florida has the largest ACA enrollment in the country, with just over 3.8 million people—about a fifth of the national total—partly because many construction, hospitality, gig and small-business workers lack employer coverage and the state has not expanded Medicaid, the federal-state health program for low-income people. The fallout is visible in patients such as 21-year-old chef Elijah Button, who treated a finger severed to the bone at home after abandoning a plan whose premium rose by $100 a month, and Tracy Rand, whose monthly premium jumped from $55 to $1,100 before she switched to a $160 plan. Free clinics such as Orlando’s Grace Medical Home offer uninsured patients comprehensive care for $5 per visit, but CEO Stephanie Garris says Florida’s 110 free or charitable clinics cannot meet demand. Healthcare affordability is emerging as a major midterm issue, with Democrats calling for subsidy restoration and Republicans emphasizing fraud enforcement and other proposals that have not become law.