Medicaid Expansion Unlikely In 2014 Legislative Session

Dec 19, 2013

Tampa Bay resident Victoria Stout is 57. She’s self-employed, healthy, works odd jobs, and is uninsured. She’s been without health insurance most of her adult life. She’s healthy, and takes measures to ensure she stays that way. And while she doesn’t have health insurance, she does get healthcare: paying for it out-of-pocket.

“I try to make what few dollars I have stretch the maximum. I am proactive about my health so I don’t need a lot from the healthcare system, but as I get older, I know I will need more. I try to take as much personal responsibility as I can and find providers that will work with me.” 

So she was excited about the Affordable Care Act – at first. But there was one big hurdle Stout couldn’t overcome—her income:

“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.”  

To put it plainly, Stout is living right at the federal poverty level. But according to Florida’s Medicaid eligibility rules—she makes too much money to qualify for the health insurance program for low-income people.

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

Stout is one of the more than three-quarters of a million Floridians being left behind in the rush to sign up for health insurance through the federal government’s website. These 764,000 people make too much money to qualify for the state’s Medicaid program for low-income people, and they make too little money to qualify for insurance subsidies through the federal insurance exchange.

Florida is now in the minority of states that have refused to expand their Medicaid program to include more low-income people, turning aside more than $51 billion in federal money in the process. Earlier in the year, state lawmakers tried and failed to come up with a plan that would have allowed the expansion— a move backed by health insurance companies, advocates, and even Governor Rick Scott. But Scott has been relatively silent on the issue since.

During a September Congressional hearing, Naples Republican Matt Hudson, who chairs the Florida House Healthcare Committee, reiterated his party’s opposition to the expansion, including concerns that more physicians will refuse to accept Medicaid patients. Opponents like Hudson are also concerned about the cost of the expansion to the state:

“It has been difficult to estimate true cost of expansion. In Florida, officials estimates range from less $30 billion over a decade, to $55 billion. Then as we learned more about expansion, cost estimates for Florida went from $1.4 billion to $3.5 billion.” 

State economists put Florida’s share of expansion costs at $3.8 billion dollars over a decade, in exchange for the federal government kicking in $51 billion to cover the additional people. In a November op-ed published in the Jacksonville Times Union, House Speaker Will Weatherford repeated his opposition to the expansion, despite his family having relied on the program to cover medical expenses in the past. And more recently Stuart Republican Senator Joe Negron, who attempted to broker a compromise with the House last session, told the Florida Current such a deal probably won’t happen during the 2014 legislative session. Still, incoming House minority leader Mark Pafford says Democrats will raise the issue nonetheless:

 “The Florida Senate and the governor were showing some signs of leadership on this issue, but we come back to the Florida house where opposition has been strong. But that’s why they make a 2014 legislative session, so we can revisit it and hopefully change enough minds.”

Few people expect the Legislature to move on a Medicaid expansion in the upcoming legislative session, despite continued calls from hospitals and others to do so.