Florida Hospital Districts Face $323 Million Loss if Amendment 3 Passes

Frank Isele, executive director of the Indian River County Hospital District, predicts the agency will serve about 10,000 fewer residents if voters approve Amendment 3 on November 3. The district currently supports roughly 27,000 people, or one in six county residents, through medical visits, counseling, and prenatal checkups. Isele estimates the district will lose about one-third of its property tax revenue under the proposed measure.

The Indian River district funds nearly all its operations through property taxes. These funds pay for Meals on Wheels for seniors, dental and mental health care for children, and hospice services. They also cover the county's share of Medicaid costs. Isele stated that many patients will forgo care if the revenue drop occurs as expected.

The Florida Policy Institute estimates that public hospital districts and health systems across the state will lose approximately $323 million in the amendment's first few years. Scott Darius, executive director of Florida Voices for Health, said the cuts will create chaos because each county must decide independently how to prioritize spending. He noted that no one can yet predict exactly which clinics will add waitlists or which programs will close.

Florida lacks a single, unified safety net for the uninsured. The state relies on a patchwork of 28 hospital districts, each with different powers and funding sources. Eleven of these districts collect property taxes that make up the bulk of their budgets. These 11 districts serve eight counties with a combined population of about 5.3 million. Seven other counties use a local sales tax for indigent care, a revenue source Amendment 3 does not affect.

State economists estimate the amendment will cut local property tax revenue by $4.9 billion in its first year. That figure is projected to grow to $11.8 billion by 2031. The measure would raise the homestead exemption for non-school property taxes from $50,000 to $150,000 in 2027. It would also lower the annual cap on assessment increases for non-primary residences from 10 percent to 5 percent and make new residents wait five years for the full exemption.

The financial impact varies by district. Four hospital districts in Indian River, Baker, Lake, and Volusia counties rely on property taxes for 95 percent or more of their revenue. None of these four operate hospitals directly; they pay other facilities to treat low-income residents. The Florida Policy Institute estimates the Indian River district will lose about $8.9 million over the next three years. In contrast, North Broward's district, which runs large hospital systems, would lose about $100 million over the same period, but property taxes represent only 12 percent of its total revenue.

Sarasota Memorial Health Care System collected about $103 million in property taxes during fiscal year 2025. This amount represents about 4 percent of its $2.3 billion in total revenue. Kevin Cooper, a board member for the system, said the district projects losing about $36 million over two years. That loss is almost exactly the cost of a cancer center expansion recently approved in Venice. Cooper said expansions of geographic reach and service capacity may be delayed or scaled back.

In West Volusia, property taxes provide nearly all funding for the hospital authority. Board chair Rakeem Ford said the board will look at major line items first, including $4.5 million annually for specialty care such as dialysis and cancer treatment. Ford stated that balancing the budget requires either increasing taxes or removing services. Heather Miranda, CEO of Treasure Coast Community Health, said her health center receives about 14 percent of its funding from the Indian River district. She warned that without care, patients' health worsens and they end up in emergency rooms.