When the U.S. Supreme Court upheld the federal health reform law, it gave states the option of expanding Medicaid for more low-income people. Last month Florida lawmakers rejected expanding Medicaid to a million more Floridians who would have qualified for it under federal law. At the time, Senator Joe Negron (R-Stuart) also said the state couldn’t just leave those people out in the cold:
“The problem is we have millions of people who go to work every day but can’t afford health insurance for themselves or their families. So we want to find a creative way to help people, empower people, to have their own private health insurance but not put them into the Medicaid program.
So Negron came up with an alternative. It uses the state’s existing Healthy Kids insurance program and expands it to include adults. Florida would also use the same federal Medicaid funding it would have otherwise gotten to help those adults purchase private plans. But for other Republicans, Medicaid is a four-letter word, and they don’t like the idea of pulling down some $51 billion in federal funds. So another Senator, Aaron Bean (R-Jacksonville), came up with another option that’s more modest.
This one relies on the untested, state-run Florida Health Choices small business exchange. Bean’s plan would use state funds to give $20 a month to people under the federal poverty level to offset the cost of what are called “wraparound service” plans. That includes things like discount medical services and pharmacy benefits. Initial estimates said the plan could serve 600,000 Floridians, but now the number is closer to 10 percent of that.
“I think that this plan is very small. It’s a little better than the itty-bitty teeny bitty Bean plan, but it still doesn’t get to where it should," said Minority Leader Perry Thurston (D- Fort Lauderdale) when asked about how Bean's plan versus one in the House.
House Republican leaders have finally unveiled their own proposal, which Democrats had been pushing them to do. The House plan is based on Bean’s plan.
Where BeanCare, as its sometimes called, would serve an estimated 60,000 low-income Floridians, the House plan, by Republican Representative Richard Corcoran (R- Land o' Lakes) would assist about twice that—and won’t use any federal money:
“The focus for us is why are we even in this discussion? What’s the whole point behind this? And that is, to try and take a population, and provide them with quality healthcare. The payment part is secondary. So what we’ve outlined is a plan that provides people with quality care," Corcoran said.
But some have questioned the House proposal, mainly because its $230 million a year price tag is funded partly by skimming money from planned state employee pay raises, and that’s angered some lawmakers.
“There were many members, including Republicans, that came up to me and thanked me for bringing it to their attention. This was unfortunately a move that was a little bit non-transparent to reduce the increase of the pay raise for our state workers, an then of course we later found out why," said Representative Mike Fasano (R-New Port Ritchey).
The healthcare Advocacy Group Florida Chain, call the House plan a non-starter, as far as they’re concerned:
“We think the alternative House plan is an outright attempt to undermine the federal Affordable Care Act. And frankly, we think it does so on the backs of a million uninsured, hard-working Floridians," said the group's spokeswoman Leah Barber Heinz.
The price tag of the House’s proposal has also raised eyebrows among other groups like the Florida Hospital Association. The Association’s President Bruce Reuben says he doesn’t understand how lawmakers can spend two-billion dollars over the next decade to cover only 130,000 people. Especially, when the original Medicaid expansion would have resulted in a net gain of $48 billion over the same amount of time—and covered one million people:
“We’re already paying for this. And we’re paying billions for it in various forms. And it makes sense that we would get coverage for the full number of people that we can get coverage for.”
House leaders say the Senate alternative that relies on federal Medicaid money is a no-go for them, but Senator Joe Negron, who crafted that plan, which is favored in the Senate, says not to count his proposal out yet.
“The real issue is how are we going to pay for it. What money we’re going to use to pay for it. But we have three weeks left to work that out, and I’m optimistic. We all agree on the goal. It’s just how to get there.”
The House has scheduled a meeting Monday to formally introduce its proposal. At stake: How many more low-income Floridians will gain access to insurance? And how much will it cost the state of Florida to insure them.