Health & Science
4:13 pm
Fri May 9, 2014

Florida Lawmakers Reject Medicaid Expansion A Second Time

Nearly 1 million Floridians have gained insurance though federal exchanges as part of the Affordable Care Act. Many of those people are seeing big savings on their insurance costs, courtesy of subsidies they’ve received from the federal government, but hundreds of thousands more have been left with nothing.

Stories From Those In The Medicaid Gap

“I was told I didn’t qualify for any subsidies because I’m Medicaid eligible under the federal guidelines, but not under the state guidelines," says Reed Mahoney, a 55-year-old uninsured part time radio technician from Gadsden County. He, along with Victoria Stout and David Stafford, protested in the final days of session against the Legislature's refusal to take up bills that would have expanded the state's Medicaid program to more low-income Floridians.

"Everything shouldn’t be subjected to an ideological litmus test, and healthcare is one of those things," said Stout, who spoke with WFSU months prior when she found out she wasn't eligible for insurance subsidies on the federal government's exchanges.

"The reason I’m here today is that it turns out the state has turned down $51 billion to expand Medicaid," said David Stafford, who is also uninsured.

Mahoney, Stout and Stafford all fall into what’s called the “Medicaid gap.” They’re part of the healthcare advocacy group Florida CHAIN and came to Tallahassee in waning days of the legislative session to try and stir some movement on expanding the health insurance program for low-income people.

It didn't work.

Medicaid Expansion A Non-Starter

This is the second year the Florida Legislature has refused to expand Medicaid, leaving an estimated 750,000 Floridians in a gray area—making too much money for Medicaid, but too few dollars to pull down federal insurance subsidies. Florida lawmakers could have opted to pull down $51 billion in federal money to offset a majority of the cost for those extra people, but did not. The Medicaid expansion was a non-starter from the beginning, as evidenced by this exchange between House Democratic Leader Perry Thurston and Rep. Matt Hudson (R-Naples) over the Medicaid budget.

“Rep. [Mark] Pafford [(D-West Palm Beach)] indicated he believed there was no desire to expand or accept any money for healthcare expansion in this budget. Is there any desire to accept the healthcare expansion for this budget?” Thurston said to Hudson during a House budget committee hearing in late March.

“If you’re asking me if there is a desire to expand Medicaid and if that’s reflected in this budget, the answer is no," Hudson responded.

Aside from small flare-ups like this one and occasional mentions of Medicaid along with other grievances, Democrats were largely absent from the Medicaid issue this year. That’s a reversal from last year when they howled over the Republican majority’s refusal to accept the dollars and brought the Legislature to a crawl during the session’s final days as a protest. Democrats’ silence on the issue this year has not gone unnoticed.

“The silence on this, an issue for Democrats, if they continue to remain silent, is that they’re going to be unable to rally their voters come election day," says University of Miami Political Scientist George Gonzales.

Will Third Time Be The Charm For Medicaid In Florida?

But the Legislature’s resounding “no” to Medicaid could soon change into a "yes"—depending on the outcome of the November gubernatorial election. Gov. Rick Scott has said he supports expanding Medicaid—though he did little in the past two years to encourage his fellow Republicans to do it. He’s up for reelection this year. Running against him is former Republican-governor-turned Democrat Charlie Crist—who has also backed an expansion. Both men are probably factoring in their political futures when it comes to decisions about where to put themselves on the Medicaid issue.

“For Crist to get elected and not accept the expansion of Medicaid, he’ll have to explain to the wider audience why he chose not to do that. In that case, it would be a liability for him," Gonzales says. "Same with Rick Scott. If he goes forward, he’ll have to explain why he accepted the Medicaid expansion amongst Republicans. Similarly, he may have to explain why he did not.”  

Throughout the course of the legislative session Medicaid did pop up a time or two. Sen. Bill Nelson (D-Florida) even came up with a plan for the state.  Under the senator’s proposal the 32 counties that contribute local dollars to shore up their hospitals would steer a portion of that to offset the state’s cost of the expansion.

Nelson's Compromise Pitch Goes Nowhere

“I don’t know a county in my 14 counties that’s not already strapped with the obligations of providing their government services now. I don’t have a lot of surplus in the 14 counties I have," says Congressman Steve Southerland (R-FL2), who says the idea does not fly in his Panhandle district, which, with the exception of Tallahassee, trends conservative.  

“To now hand them a tax or a bill to expand Medicaid—at first hearing that, that doesn’t sound like something I’d be interested in doing," he says.

Florida’s counties, which would have been called upon to put up even larger shares of Medicaid money, were lukewarm to Nelson’s proposal.

But the federal government hasn't exactly forced the issue with states that haven't expanded their Medicaid rolls, and political scientist Gonzales has a theory about why.

“There’s an irony that the less states that sign up for this,  the more likely the federal government is to finance this as promised for those states that do sign up," he says.

In short, not expanding Medicaid saves the federal government money.

Florida Republicans continue to point to cost as a major roadblock—the state’s share of the expansion is $3.5 billion over a decade, and Medicaid already consumes the largest share of the budget.  Florida is now in a minority of states that continue to turn down the Medicaid expansion.

And when--or if-- the Legislature decides to pull down the federal dollars, it could very well be too late for people like Denise Wade, who is uninsured, has uterine cancer, needs a hysterectomy and can’t find a doctor to perform the surgery.

“Don’t let us die an untimely death, when it could be prevented," she says.