House Approves Medicaid Alternative But Issue Could Be Dead This Session

Apr 26, 2013

The chances of insuring more low-income Floridians is fading. Florida lawmakers could adjourn the 2013 legislative session next Friday without an agreement on accepting $50 billion dollars from the federal government to insure a million more poor Floridians.

Governor Rick Scott, once a staunch opponent of the federal health law, stunned his supporters, and his opponents, when he endorsed the law’s expansion of the Medicaid program, and the $50 billion of federal Medicaid money that would flow to the state over the next decade to support a million more poor Floridians on the state’s Medicaid rolls:

“I cannot, in good conscience, deny the uninsured access to care," Scott said during his State of the State Address that kicked off the 2013 legislative session.

That reversal angered Republicans and in the opening weeks of the 2013 legislative session both the House and Senate rejected the Medicaid expansion. Prospects for the fate of those additional one million eligible Floridians looked dim...until the Senate came up with a plan: use the federal money to give those one million Medicaid eligible Floridians private health plans. The house crafted its own proposal to give only 115,000 of those people state-funded vouchers to purchase private coverage and reject the federal money. And that’s where the two sides have been ever since. In a stalemate.

Meanwhile, healthcare advocacy groups like the Florida Hospital Association and its lobbying campaign, Florida Remedy—amped up the pressure: running ads like this one statewide to urge lawmakers to accept the federal money and insure more people.

                              

For the hospitals it’s a matter of dollars and cents: Treating uninsured patients costs Florida hospitals $3 billion a year. To make up for that loss, people with insurance are often charged more. Florida Hospital Association President Bruce Reuben calls it a “hidden tax”.  

"That is why it’s so important for these people to get insurance coverage. Because the hidden tax would be taken out of the cost of care for everybody else," he said.   

The Senate’s plan is the favorite among the hospitals, and business groups like the Florida Chamber of Commerce and Associated Industries of Florida. If more people sign up for Medicaid the businesses could stave off having to pay some of the penalties outlined under the federal health law they would have otherwise incurred for not insuring employees.

The groups pushing to take the Medicaid money are strange bedfellows. Senate Republicans and Democrats, a conservative Governor once against-and-now for the Medicaid expansion, business groups that are normally suspicious of Washington, and regulation. On any other issue, it would sound like a winning deal. But there is another force equally as strong. And equally as stubborn: the Florida House.

“I had the privilege of leading the house. And I know the rich history of the house and the conservativism they espouse.  And I understand where they’re coming from. But I hope they’ll be listening to us,”  said Senator John Thrasher, who is also a former House Speaker.

Republicans in the House chamber have been adamantly opposed to pulling down federal money. They say Washington can’t be trusted. That Medicaid is broken. The main issue is how much, if any federal dollars Florida should accept to insure more poor people, and how many of those people, and who, should be covered.

The House recently voted to adopt its own plan, which spends almost $3 billion in state money over the next decade to help low-income Floridians purchase private insurance.  But in the run-up to that vote, some moderate Republicans, in swing districts, have been targeted by health advocacy groups hoping to sway some votes in their favor:.

The SEIU, a public employee union, has run ads like this one, targeting Representatives Manny Diaz and Eric Fresen of Miami—a place where large swaths of people are uninsured and could be covered by expanding Medicaid. Both lawmakers though ultimately voted no.

So far fourteen states have voted against the Medicaid expansion while 20 have said yes. And legislative leaders are well aware of Florida’s role as a pivotal swing state. When asked about the consequences of saying no, House Speaker Will Weatherford said, “If enough states reject the all-or-nothing approach...I think you could see the federal government go back and look at the way they’re implementing PPACA. That’s our hope as well.

PPACA is the federal health law. A potential compromise between the House and Senate plans seems to be going nowhere.Weatherford seemed to hint the legislature could finish its business next Friday—and leave the Medicaid issue unresolved. If that happens, a million more poor Floridians will remain uninsured.