The outcome of the 2020 election could have an enormous influence on Florida’s economy, and more specifically, on a handful of healthcare companies that are impacted by major shifts in federal and state policy. While the decisions of state lawmakers hold enormous sway over Florida’s business climate, Republican control over the state legislature isn’t expected to change after next Tuesday. The real impact, this cycle at least, will come from the outcome of the Presidential contest between Joe Biden and Donald Trump.

Since the contentious nomination and subsequent confirmation of Justice Amy Coney Barrett, media outlets have highlighted the possibility that “Obamacare” could be in jeopardy with a pending court case, Texas v. California, currently set for oral argument on November 10th, just a week after the election. If the case succeeds, Obamacare might indeed be left entirely gutted. Yet despite the alarmed rhetoric from progressives, many conservative legal scholars believe the case will fail on its merits, preserving Obamacare as it currently exists. However, that, too, means it will remain a shell of its original vision, languishing and likely doomed to eventually be replaced with something more fiscally solvent.

Regardless of the Supreme Court’s ultimate ruling, the health care industry likely faces some major changes in the event of a Joe Biden victory next week. To be sure, any sweeping changes will also require Democrat control of the United States Senate. Assuming that happens, we can look to Biden’s stated vision to better understand the impact of his proposals in Florida. In the last Presidential debate, we heard more about “Bidencare,” which Biden said will include a push to offer a “public option” health care policy.

For those unfamiliar, the “public option” was the major sticking point during the contentious national debate in 2009 over Obamacare. Even Democrats, who controlled the White House and Congress, didn’t have the votes to pass it then. The public option is essentially a government-backed health insurance policy competing directly with private health care plans.

A decade after the national fight over Obamacare, Democrats and Republicans alike all know that a public option is the key to unlocking universal healthcare – or in Republican terms, “socialized medicine.”

All rhetoric aside, suffice it to say that if Biden wins, and if Democrats hold the House and take the Senate, Bidencare and the public option could easily become a reality before the end of 2021. Here’s a list of top companies operating in Florida that have the most at stake:

Florida Blue – one of the most dominant insurance companies in the nation, Jacksonville-based Florida Blue is currently ranked fourth on a list of companies with the highest insured market shares in the largest number of metropolitan areas. And according to the American Medical Association, the competition is drying up. If Biden wins and pushes for a public option, that’s a direct threat to Florida Blue. Expect them to spend big trying to influence the shape of health care policy in a Biden Administration.

Other notable insurers with operations in Florida: Humana, UnitedHealthcare, and Wellcare. Combined, these insurers control around 65 percent of the health insurance market, and that figure is up signficiantly since 2016.

Like insurance companies, Florida’s hospitals and hospital systems also have a lot at stake, especially since all of them, non-profit and for-profit alike, provide services to indigent patients – that is, people who have no insurance and / or very limited financial resources to cover the cost of their care. Here’s a list of just a handful of the larger hospital systems in the state, each with tens of thousands of employees, serving millions of patients.

HCA Healthcare – though based in Nashville, Tennessee, HCA Florida is one of the largest private health systems in Florida, featuring 50 hospitals across the state and 31 surgery centers. The company provides care for millions of patients, including more than 2.5 million hospital emergency room visits each year. Suffice it to say that if there is a push for “Bidencare” or a public option, HCA could see big changes to its bottom line, but it all depends on the fine print.

AdventHealth – another national hospital company, Advent has operations in Central Florida ranging as far north as Ocala and as far south as Okeechobee, just north of the lake. That includes more than 20 hospitals and ERs in the seven counties in and surrounding metro Orlando. Their hospitals, combined with a comprehensive outpatient care network, sees more than 3.4 million patients each year. According to 2019 data, Advent had a net income of $539.3 million and a profit margin of over 13 percent.

Other notable hospitals and hospital systems in Florida: UF Health / Shands, Baptist Hospitals, Mayo Clinic, Memorial Health System.

On the flip side, a Trump win on Tuesday won’t bring about any sort of immediate upheaval in the nation’s healthcare system. Barring a red wave, a Trump Administration will largely be at the mercy of a Democrat-controlled House, making it highly unlikely that the second-term president will be able to push for anything as dramatic as his rival is promising. Once the dust settles at some point after Tuesday at 8pm, when most swing state polling locations are finally closed – we’ll have a better picture of where Florida’s health care industry is headed over the next two years.