Supporters Hope Third Time Is The Charm For Medicaid Expansion In Florida

Dec 12, 2014

A coalition of businesses groups, local officials and healthcare industry representatives has rolled out a plan to insure nearly one million low-income Floridians. But they’re not calling it a Medicaid Expansion. 

More than 800,ooo Floridians are in health insurance limbo. They fall into what’s called the Medicaid coverage gap. Reed Mahoney of Tallahassee, is among them.

“I was told I didn’t qualify for any subsidies because I was Medicaid eligible under the federal guidelines, but not the state guidelines," Mahoney said of his attempt to get insurance through the federal government's healthcare.gov website earlier this year.

Mahoney tried to get health insurance through the Affordable Care Act but couldn’t because his income is too low. He doesn’t qualify for Medicaid from the state, because his income is too high.

“The least expensive plan for me with a 5,000 deductable was $499/month. Now, if I made about $400 more, that same plan would have been $60," Mahoney said.

For the past two years a plan to insure nearly a million people like Mahoney has failed in the Florida legislature. But a coalition of groups is pushing for change again. This time, they’re not calling it a Medicaid Expansion, because that’s a dirty word in the Florida legislature. Instead, the proposal is called, “A Healthy Florida Works”. And it goes like this:

An outside vendor would be hired to run an exchange-like system.  Florida would pull down 50-billion dollars in federal dollars to fund insurance and pay for the program. Unlike traditional Medicaid, there are premiums, which would be based on income. People would be required to work, or look for work, and education could be substituted for that.  The issue of the cost-sharing and work rules are important because it could make the plan more appealing to Florida’s Republican legislative leaders, who have pushed for such requirements in the state’s current Medicaid program.

“We think shared responsibility is an important piece of this, and when people are engaged in their own health, it leads to healthier behaviors, and that’s important."

Jennifer Fennell is the spokeswoman for “A Healthy Florida Works”. This year’s effort to cover people in the Medicaid Coverage gap is also well-timed. The mandate that large employers—defined as those with 100 or more employees—provide insurance plans to their workers is going into effect. In 2016 the mandate kicks in for firms with more than 50 workers. Fennell says companies are doing the math.

“You’re going to have a lot of Florida businesses that are facing financial penalties of $2,000-$3,000 per employee if they can’t provide those employees health insurance. Not just those employees, but their dependents. So we really need to do something to help those businesses now," she says.

Hospitals and other providers are also feeling the pinch, because they still have to pay to treat patients who are uninsured. The federal government has provided funding for hospitals that treat large numbers of uninsured patients—but that funding is steadily decreasing.

And then, there’s the politics. Which means getting it through the Florida legislature and to Governor Rick Scott. The Governor has said he supports expanding Medicaid, but has done little to actually push it, and when asked about “A Healthy Florida Works” Scott says he, "hasn't seen it yet."

Meanwhile the biggest obstacle is getting the plan through the Florida House, which has been adamant in its opposition to mostly everything related to the Affordable Care Act. Its new leaders say they’re willing to take a look at the proposal.  But some healthcare advocates are worried about parts of the plan-- like the idea that the state’s Medically Needy Program could go away. Medically needy is a cost-share system for people who, aside from income—would otherwise be eligible for Medicaid. Under the Healthy Florida Works plan, that program would disappear, and its funding would be used to cover Florida’s share of the cost for the Medicaid Expansion population. Supporters say those people would still be covered, but it worries  Leah Barber Heinz, who heads the healthcare advocacy group, Florida Chain.

“That’s a really good example of what I was saying—we really don’t have enough information," she says. "We definitely would have to learn more about what that means for the medically needy program because there would still be a need for that program in our state, as far as we can tell.”

Others, like Damien Filer, with the group Progress Florida, say getting something in place, even if it’s not ideal—is far better than the status quo.

“I just don't see any way we can let another year go by and let these people continue to wait. And for some of them, they won't even--they won't have that luxury."

If the plan does get through the legislature it will have to pass the smell test with the federal government. The same work requirements and premium payments that could give it a win in the Florida legislature, could also prove problematic with the federal government, which has refused Florida’s work requirements and premium payments for low-income people in the past.

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