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.
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.