A battle over the future of healthcare in Florida is heading toward the 2028 ballot box. Two of the nation’s most prominent health advocacy groups, the American Cancer Society Cancer Action Network (ACS CAN) and the American Heart Association (AHA), have officially thrown their weight behind a statewide petition drive to expand Medicaid.
The effort, organized by the coalition Florida Decides Healthcare, aims to bypass a hesitant state legislature and put the decision directly into the hands of voters.
The goal is massive: organizers must collect roughly one million valid signatures to qualify for the ballot. If successful, the initiative would ask Floridians to approve a constitutional amendment expanding Medicaid eligibility to single adults earning up to $22,024 and a family of four earning up to $45,540.
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Currently, Florida is one of only 10 states that have declined to expand the program under the Affordable Care Act, leaving an estimated 1.4 million residents in a “coverage gap”—earning too much to qualify for traditional Medicaid but too little to afford private insurance.
For the organizations involved, the push is about more than just numbers; it’s about medical outcomes. Susan Harbin, a senior director for ACS CAN, noted that insurance status is often the single biggest factor in whether a patient survives a cancer diagnosis, as those without coverage frequently skip the early screenings that catch the disease when it is most treatable.
“Too many Floridians with heart disease delay care or skip medications because they simply can’t afford them,” said Tiffany McCaskill Henderson, American Heart Association Florida government relations director. “Expanding Medicaid would help close that gap, ensuring people can get the care they need before their condition becomes life-threatening, and to support recovery following a heart attack or stroke. From both a medical and public health perspective, expanding Medicaid is a proven, cost-effective way to strengthen our healthcare system and improve heart health across the state.”
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The timing of the campaign is strategic.
Following federal shifts in H.R. 1 and the potential expiration of marketplace tax credits, advocates argue the state’s healthcare safety net is under increasing pressure.
While Florida lawmakers have historically resisted expansion, citing concerns over long-term costs and federal dependency, proponents point to a track record of success in other conservative-leaning states. Since 2017, voters in Idaho, Missouri, Nebraska, and Oklahoma have all bypassed their statehouses to pass Medicaid expansion via similar ballot measures.
Beyond individual health, the coalition is highlighting the economic impact on Florida’s infrastructure. Data from the Florida Policy Institute suggests that expansion could be a lifeline for the state’s struggling rural medical centers, potentially reducing the risk of rural hospital closures by as much as 62%.
As the 2028 cycle begins to take shape, the signature-gathering effort will serve as a litmus test for whether Florida’s electorate is ready to follow the lead of other states in transforming its healthcare landscape.
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