House Leader Says "No" To Medicaid Expansion But Advocates Undeterred

Jan 29, 2015

House Speaker Steve Crisafulli
Credit Florida Channel

Florida House Speaker Steve Crisafulli says his chamber is not interested in using federal dollars to add up to a million low-income people on the state’s Medicaid rolls. But some organizations aren’t taking “no” for an answer.

House Speaker Steve Crisafulli calls Medicaid a broken system, and says he’d rather pursue other aspects of healthcare—like expanding access through services like telemedicine, or letting nurses and other healthcare practitioners do more. What he’s not interested in: a Medicaid Expansion.

“Ultimately, right now, we stand in a position where we aren’t going to be doing anything on the issue, but as I said. We have a long way to go and a lot of conversation to be had," Crisafulli said.

Senate President Andy Gardiner is on the other side of the issue. But that’s no surprise. The Senate has repeatedly supported pulling down federal dollars to offer Medicaid to people who make too much money to qualify for traditional Medicaid, but too little for federal help to purchase private plans.

Groups that previously opposed or were silent on the Medicaid expansion question are now coming out in support of the plan.  Hospitals have mostly led the way—because they have a lot to lose. About $2 billion dollars in federal support for hospitals to treat low-income patients is going away this summer and the federal government has no plans to renew it.

“I think the Obama administration is taking a stand and saying that Florida needs to come to the table and negotiate when it comes to Medicaid expansion," said Florida Legal Service-Miami's Charlotte Cassell.

Her organization examined several counties to see what they’d lose under the expiration of what’s called the Low Income Pool, versus what they’d gain through a Medicaid Expansion. Take Hillsboro County for example:

"In Hillsboro County [hospitals], the $150 million that would be lost would be offset by about a conservative estimate of $373 million. So more than double what is lost would be drawn down. 

That holds true for most of the counties the group examined. But Crisafulli says there’s a difference between taking federal funding through the Low-Income pool, versus taking federal funding for Medicaid.

“It’s not about the money. It’s about the product. Ultimately, there are some concerns about the money apart of it because you have to backfill it when that money disappears. There’s concern with that. But with regard to the issue with Medicaid expansion, currently the posture of the house is not to do anything further," he said.

That may sound like an absolute, “no” on the Medicaid question, but League of Women Voters of Florida President Deirdre Macnab sees nuance in the Speaker Crisafulli’s statements.

"We think the Speaker is a smart man. We think he’s concerned about the economic competitiveness of the state. He did say he’s a man that never says he won’t listen to things," Macnab said. The organization supports expanding Medicaid in the state. " The bottom line is, we see a glimmer of light at the end of the tunnel for the house taking And we see a glimmer of light at the end of the tunnel for the house taking this consideration up of this proposal.”

And for now, that’s enough to keep hope alive for the growing number of proponents of a Medicaid expansion in Florida.