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Medicaid expansion a big part of Florida's healthcare challenge


By Lynn Hatter


Tallahassee, FL – Florida along with a coalition of 25 other states and the National Federation of Independent Businesses want the Supreme Court to declare the healthcare overhaul law unconstitutional. Lynn Hatter reports, the group is focusing on two key arguments: 1) that the federal government cannot require everyone to purchase health insurance and 2) that an expansion of the Medicaid program for low-income people is unfairly coercive to state government.

Florida leaders say the fight against the federal Affordable Care act is a battle for personal rights and financial freedom. Governor Rick Scott says if the law is allowed to stand, it could bankrupt the nation's healthcare system.

"If you look around the world, as governments have gotten more involved in healthcare they over-promises, and they run out of money. And as they run out of money what it does is, reduce reimbursement, and then there are no providers to take care of people, so by doing that, it actually rations care."

The federal health overhaul says by 2014 states will expand their Medicaid roles or lose out on federal funding. In Florida alone, three million people are uninsured and another three million relying on the joint, state-federal Medicaid program, state Attorney General Pam Bondi says the Medicaid expansion poses a big problem.

"We believe, if you can threaten our funding of Medicaid, by not participating in this, then that is truly coercion, and if that's not coercion, then I don't know what is."

State estimates show an expansion of the Medicaid program could mean another 1.5-to- two million more eligible people. Right now Florida economists are projecting a billion dollar hole in the state's Medicaid program. And opponents to the federal Affordable Care Act say that deficit could balloon to nearly four-billion dollars in the upcoming years if the state is forced to add more people into the program. But not everyone agrees with that projection.

"In fact, there could be potential savings to the state based on the assumption they make."

Dr. Jack Hoadley of Georgetown University says Florida's estimates on the cost of the Medicaid expansion are exaggerated, and he puts the actual cost of the expansion at a billion dollars.

"There are some direct costs to the state for expanding their enrollment. But the state made the assumption that every single person eligible will enroll. And that's just not realistic. It's not something that's ever happened. There are always some people who fail to enroll in Medicaid even when they're eligible, so we assumed a less-optimistic rate of 75-percent, and even that might be relatively optimistic given past experience in the state."

Despite the push-back from state leaders the federal overhaul law does have its supporters. Laura Goodhue is the Executive Director for the consumer healthcare group Florida CHAIN. She argues for keeping the Medicaid expansion in place.

"If funding for Medicaid is taken away, which the Affordable Care Act provides, that really will increase premiums and lead to higher costs, because you'll have uncompensated care, low income people won't have Medicaid, they'll go to the ER and the costs will be shifted to insurance companies and policy holders."

The health overhaul law calls for the federal government to provide the money for the first few years that the expansion is in place. States would then be required to pick up the costs in the out years. The Supreme Court is expected to rule on the healthcare overhaul by June right in the middle of the 2012 Presidential campaign.

*This story is part of a reporting partnership that includes WFSU-FM, NPR and Kaiser Health News.*