Medicaid Expansion: Picking Up Where We Left Off

Feb 28, 2014

Florida has stood on the sidelines for more than a year as other states have taken the federal government up on its offer to provide more funding if more people are added to Medicaid rolls. Last year, the House and Senate flirted with the idea but failed to reach an agreement. But the conversation continued even after lawmakers went home.

When Tampa Bay Resident Victoria Stout first heard about the Affordable Care Act, she was excited. She’s 57, self-employed, healthy, and uninsured. Her odd jobs earn her an income, but it’s not enough to afford private insurance. So the federal health law and the promise of subsidies to purchase insurance sounded great -- Until she realized her income was too low to qualify for financial assistance.

“Actually, I just found my 1040 from 2012, and my adjusted gross income was between $10,000 and $11,000. By the time I got my standard deduction and exemption, my taxable income was about $600.”    

That puts Stout right at the federal poverty level. Technically, she qualifies for Medicaid under the federal health law—except for another problem: states aren’t required to expand their Medicaid rolls.  And Florida is among a minority of states that have refused the federal government’s offer to fund an expansion of the program. So, according to Florida’s current Medicaid rules, Stout makes too much money to qualify for the health insurance program.

“If something catastrophic were to happen to me, I’d be screwed. You know? Every day is a gamble" she said. 

Nearly a million Floridians such as Stout fall in the Medicaid expansion gap:  they make too much to qualify for the Florida’s Medicaid program for low-income people, and they make too little to qualify for insurance subsidies through the federal insurance exchange. Last year, Florida lawmakers turned down more than 50-billion federal dollars that could have been used to insure more people like Stout.

The Florida Senate wanted to use the money to help subsidize private insurance plans for the people who otherwise would have been Medicaid eligible. The House did not—and offered a far smaller proposal. The two sides couldn’t agree. Since then, most legislative leaders asked about the status of negotiations said the same thing: Medicaid is dead for 2014.

But other lawmakers like Hialeah Republican Senator Rene Garcia didn’t get the memo:

“The next step is to sit down and have a conversation with Speaker Weatherford and his team and see if we can come up with a compromise. It doesn’t have to be this bill, but I think we should have a conversation.”

Garcia has re-filed the Senate’s Medicaid expansion proposal for the upcoming session and he’s got a House Sponsor in New Port Richey Democrat­­­­­­­­­­­­ Amanda Murphy. More recently, House Speaker Will Weatherford refused to declare Medicaid Expansion a dead issue:

“Look, nothing is ever dead for a session. I think the House has a very clear position on Medicaid expansion. We talked about it for quite some time. I know where the editorial boards are, they know where I am philosophically. And I think the Senate has offered a proposal and the House has as well, but we have not been able to negotiate a place where everyone is happy. I believe the ball is in Secretary Sebelius’ court.”  

That’s U.S. Secretary of Health and Human Services Kathleen Sebelius, whose agency oversees Medicaid and Medicare. Weatherford’s refusal to give an out-and-out “no” to the Medicaid question is giving some groups, such as the healthcare advocacy agency Florida CHAIN, hope that lawmakers can work out a deal this year.

“We’re very pleased to hear there are sponsors of legislation to expand healthcare, and very pleased to her leadership talking about this opportunity still being on the table during session," said CHAIN's Executive Director, Leah Barber-Heinz.

Despite signs to the contrary, Florida’s leaders never stopped trying to find a way to break the impasse between the House and Senate, even though a compromise has been elusive.  Back in July, Senate President Don Gaetz wrote a letter to the federal government asking if the state could get approval for a partial expansion of Medicaid: in other words, a plan that would cover more people than the House proposed, but fewer than what the Senate wanted. Gaetz says the feds weren’t interested:

“I can’t speak for Secretary Sebelius. I don’t know why she chose not to positively respond to our request...I don’t know which part of our approach she found the most troublesome, but we were not able to work anything out with the federal government, and therefore, we really had no basis to go back and negotiate with the Governor and the House of Representatives.”  

In short, the federal government has said “yes” to the Senate plan, “no” to the House plan, and “yes-but”, to a compromise:  If the two chambers met in the middle of their plans, the state wouldn’t be able to tap the $51 billion in federal money, but it would still be eligible for the regular Medicaid match. In the final weeks of the 2013 legislative session a compromise plan between the two chambers was discussed, but no bill ever emerged. Still, lawmakers like Garcia say they’re still working to find a way forward. The Florida legislature is now in a place where it could pick up where it left off last year.