Senate Approves Medicaid Alternative Plans, Talks About Potential Compromise With House

Apr 17, 2013

Florida lawmakers continue to grapple with how best to serve the state’s uninsured population.  The group is estimated to be nearly four million, and the federal health law would have sent down enough money to cover a million of them by expanding Medicaid. But Florida lawmakers rejected that in favor of a state-based plan. 

Three proposals are on the table which would cover between 60,000 to a million uninsured Floridians, but with time running out, no clear path in sight, some say it’s time for a compromise.

At the center of the debate on how best to give more people access to insurance, are people. Low-income, uninsured or underinsured people, who work. People like Vera Nelson who was recently turned away from an eye doctor, because she doesn’t have medical insurance.

“I have visual insurance. I went to an eye doctor. The peripheral vision on the right side had deteriorated. They sent me to a specialist. The specialist outright said ‘if you don’t have medical coverage, we can’t see you’ and hung up the phone," she told a Senate Health Committee Wednesday.

There some 3.7 million uninsured Floridians. Roughly a third of them would have gotten access to Medicaid had Florida gone along with the federal health law, and used federal Medicaid money to get them into the program. Instead, Republican Senator Joe Negron came up with a plan to use the federal dollars to get those people into private health plans using the state’s Healthy Kids program a vehicle.

Groups like the SEIU sat in on the Senate’s healthcare committee hearing and have been making the rounds to legislative leaders urging them to support the proposal.  Negon’s Plan or NegronCare, as its’ been called, requires recipients to pay $10 to $20 dollar premiums and co-pays. It has the backing of the Florida Hospital Association, Florida Chamber, business lobby Associated Industries of Florida and even the Florida Association of Health Plans have. Wednesday, it won unanimous approval from the Senate committee.  But Republican Senator John Thrasher says, it’s going to take work to convince the more  conservative 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 also hope they’ll be listening to us. This is a game changer for the state of Florida. But this is about can we be, find a way to be pragmatic, solve a problem, and to be compassionate for our fellow citizens?”

The House has proposed a plan using state money to give adults with children and those with disabilities under the federal poverty level a $2,000 stipend to purchase private health plans. It’s funded through state dollars, and is estimated to cost nearly $240 million a year. Those people would also have to pay $25 dollar a month premiums. The plan is estimated to cover an additional 116,000 people—far fewer than the one million that could be served under Negron’s plan. The House has modeled its proposal after one by Republican Senator Aaron Bean. The BeanCare alternative, uses a combination of premium assistance and health savings accounts to allow people to purchase bare-bones insurance plans offered under the state's untested Florida Health Choices marketplace for small businesses. Bean says, while much smaller in scope, his proposal is an attempt to get both chambers to a common goal:

“There’s another body across the way that has a say in what we do. They haven’t shown an interest in taking Florida funds. So enter “plan C”. 

Bean’s plan also cleared the Senate committee. But in the end, only one plan will survive. And Negron is proposing a hybrid plan where people would be able to choose whether to sign up under his Florida Healthy Kids option, or, take a state-issued voucher and shop for insurance on their own using Florida Health Choices.

“They could arrange for preventative care. They could have a very high deductible. But they would be given a choice," he said.

But Democratic Senator Bill Montford says endorsing different plans sends mixed messages to the House.

“It’s like trying to take two dates to the prom,” Montford said. “You don’t do that where I’m from.”  

Montford also worries the dual vote could give the House the impression that the Senate is willing to settle for less. There are only two weeks left in the regular legislative session for lawmakers to reach a deal.  A compromise as envisioned by Negron would still rely on federal dollars, which the House has adamantly opposed.