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Dream Of A Medicaid Expansion Deferred In Florida

The question of whether Florida would expand its Medicaid program to cover more low-income people has been answered, and it’s a “no” -- at least for now. The state legislature closed its regular session Friday failing to reach an agreement on expanding access to the program under the Affordable Care Act.

To be revived in the near term, Gov. Rick Scott would have to call a special session of the legislature. There’s been no indication that he is willing to do that – or close to a deal with state House Republicans that would warrant such a session.

Scott, a Republican, stunned supporters and critics alike when he flipped from being a staunch opponent of the federal health law to endorsing its Medicaid expansion earlier this year.

The healthcare overhaul gives states the option to expand their existing Medicaid programs with the federal government footing the full cost of the expansion the first three years and paying 90 percent thereafter. In Florida, the raw numbers were persuasive to Scott, a former executive with hospital giant, HCA: Medicaid expansion would bring in $50 billion in federal money over the next ten years and cost Florida $3.5 billion in the same time frame.

State Sen. Joe Negron, a Republican, was the architect of a bill that passed the Senate. He laid out the differences between members of the two chambers within his own party.

“I have a view that when it comes to providing health care to people who get up and go to work every day, there is a role for government to provide assistance for their premiums,” Negron said. “And in the House, there’s a concern that we’re becoming too reliant on federal funds, and we could be setting up a program that’s too expensive for us to afford.”

Negron’s proposal, which is similar to a plan that has passed in Arkansas, would use the federal money to help eligible Floridians purchase private plans. That was a non-starter for House Republicans. Instead House lawmakers pitched a separate plan to insure far fewer people using state funds. The back and forth between the two sides for a and against expansion got heated, culminating in a protest by House Democrats that required every single bill to be read aloud before the chamber, line-by-line, and in full. That prompted Republicans to employ “Mary” the House’s auto reader who stalled all House business for two days as she read.

At one point, there were talks of a compromise between the two chambers. But Senate President Don Gaetz said, “It appears the shot-clock has run out on the healthcare issue for this session. But that doesn’t mean we’re going to stop working.”   

Nearly 4 million people, or about one-in-five people in the state, are uninsured. An expansion of the Medicaid program, or some kind of alternative, could cover up to a million of the uninsured. Florida Hospital Association President Bruce Rueben says accepting the federal money would reduce the costs of treating the rest of the uninsured.

“Even if we did nothing, we’d still be paying for the cost of care for these people,” Rueben said. “We’d simply be paying for it through a hidden tax, a cost shift onto people’s private health insurance premiums.”

Fort Lauderdale Rep. Debbie Wasserman Schultz, who is Chairwoman of the Democratic National Committee, criticized Scott for his inaction.

“It seems to me he’s sitting on the sidelines trying to have his cake and eat it too,” said Wasserman Shultz. “You can’t have it both ways. You’re either for it or you’re against it, and in Tallahassee you have to take a stand.”

For states that have taken action, the Medicaid expansion goes into effect in January. If Florida waits until next year to expand the program, it would lose some of the federal money it would otherwise have received. States do not have a deadline when they have to accept or permanently reject the expansion.

There is precedent for states jumping in late to government health programs. Florida adopted the main Medicaid program in 1970, four years after states began it.