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The Problem With Florida’s Medicaid Program Isn’t Cost. It’s Too Many Working Poor.

| January 31, 2013

Life's benefits are passing them by. (Joe Green)

Life’s benefits are passing them by. (Joe Green)

By Rick Outzen

The James Madison Institute, a conservative think-tank based in Tallahassee, recently released a policy brief on Medicaid expansion in Florida under the federal Affordable Care Act.

The James Madison Institute is agin’ it, which should be no surprise.

The brief, “Florida’s Best Medicaid Option under the PPACA: Expand the Reforms, Not the Rolls,” argues that the Medicaid expansion to 138 percent of the federal poverty level will result in nearly doubling the number of enrollees at substantial cost to the state and federal governments.

“Florida can barely afford its current $21 billion Medicaid program now so it would not be wise policy to expand it,” wrote the brief’s author, Jason Fodeman, M.D., a James Madison Institute adjunct scholar. “From a policy standpoint, it is frustrating that the government spends so much on a program with so little return, but it is far more frustrating and stressful for those patients who desperately depend on Medicaid for care and cannot find it.”

Dr. Fodeman is focusing on the wrong number.

florida voices columnists flaglerlive

The real issue isn’t the cost of expanding Medicaid to provide health insurance for all Floridians. No, the issue is that we have so many people living so near the federal poverty level.

In 2012, for an individual to be eligible at no more than 138 percent of the federal poverty level meant an annual income of $15,415. For a family of three, that annual income was $26,344. The Kaiser Commission on Medicaid and the Uninsured estimates that Florida has 29 percent of its population living below the 138 percent threshold.

Simply stated, Florida has too many working poor whose employers don’t provide health insurance. Rather than complaining about the costs of coverage, we should try to increase the earnings of our people.


The working poor tend to be in service, retail, or manual labor jobs that pay low wages. Their jobs are unstable and often seasonal. They can’t afford to pay for health insurance themselves because they are living paycheck to paycheck and juggling bills each month. They forgo doctor visits as they narrow down their expenses to just essentials.

As a result, high blood pressure, diabetes, asthma, high cholesterol and other ailments go untreated. Their health deteriorates to such a low level that they are finally forced to visit the “family doctor” — who is the hospital emergency room, the most expensive entry point into the healthcare system.

The Medicaid expansion can be a game changer that may actually reduce the cost of Medicaid as Floridians become healthier. The expansion could also reduce all of our medical bills since those bills have always been padded to pay for the uninsured.

Rick Outzen is the publisher/editor of Pensacola’s Independent News. He can be reached by email here.

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3 Responses for “The Problem With Florida’s Medicaid Program Isn’t Cost. It’s Too Many Working Poor.”

  1. Bruno Tars says:

    “The real issue isn’t the cost of expanding Medicaid to provide health insurance for all Floridians. No, the issue is that we have so many people living so near the federal poverty level.”

  2. Magnolia says:

    There is not much difference here. Under the ACA, those uninsureds are placed in state Medicaid plans, which the federal government was to supplement for 3-4 years in agreement for the states setting up insurance exchanges. The federal subsidies are only for a limited time.

    Poverty, uninsured, it’s all the same. And unfortunately many of the local businesses we have here just cannot afford to pay much more than they are paying now.

    I hope the attached article is wrong. Otherwise, the news is not good. Lots of promises, no real solutions. I don’t know many who can afford this:

    http://cnsnews.com/news/article/irs-cheapest-obamacare-plan-will-be-20000-family

  3. Devrie says:

    I know it’s a touchy subject, but being a right-to-work state also has its disadvantages. I know of national companies who employ folks across the nation, and for people working in Florida, the average starting wage is $8.00/hr vs. the $13.00 in places with comparable living costs.

    When I was in the Navy, there a girl and I were looking at our finances to determine the cost of leaving the military. Before entering the Navy, he worked at a Dairy Queen and was paid $10.00. Two story houses where she lived cost about $100,000, and rent for a two bedroom place was about $600 a month for a reasonable place in a decent neighborhood.

    I had to leave the Navy for personal family issues, though staying would have been my dream. I was nearly depressed at the job opportunities and pay I was faced with coming home. It was like a slap in the face. Small office jobs that demand at least some college, if not two years of college only paid $8.50/hr??

    It was nearly impossible to find even a one bedroom apartment, pay for health insurance, gas for my vehicle, groceries and a basic phone line, let alone extended-day child care on that kind of income.

    I finished my B.A and that lead to even more $9.00/hr job opportunities…now I’m slowly creeping up on a second one in management.

    The problem as I see it, is that many families are struggling to stay here, because they have aging parents. Florida has a sort of development problem. It encouraged retiring seniors to come here, and they, in order to stay somewhat self-sufficient, encouraged their kids, many of whom are now baby-boomers who worked int he service industry with little to no retirement benefits–and here we are: capable, educated, willing to work adult kids who struggle to get by on $8.00 to $10.00/hr jobs.

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