Although Florida lawmakers have made it known they have no intention of going along with an expansion of Medicaid under the federal health care law, legislative leaders say they’re open to crafting an alternative that would find some way to expand health care coverage to many more uninsured as the law envisions. Advocates for those lacking health coverage want them to hurry up and move on that.
“If they have proposals, let’s get ’em on the table,” Jack McRay, a lobbyist for AARP, said at a Thursday rally for expanded coverage. “They say making legislation is like making sausage. Well, I think the people of Florida want to see what it’s being made with and how it’s being made. Let’s make it transparent.”
It was the second rally for expanded health care coverage this week, with Sen. Eleanor Sobel, D-Hollywood, and Rep. Mike Fasano, R-New Port Richey, leading a coalition of advocates.
Fasano said lawmakers shouldn’t wait to act, given that four million Floridians lack access to primary care. He called for the Legislature to extend Medicaid coverage to as many Floridians as possible – while crafting an alternative plan.
“A million Floridians would have the ability to have access to Medicaid if we would simply accept the dollars that are owed to us,” he said. “If (lawmakers) want to come up with an alternative, they have three years to do it.”
Under the federal law, the federal government has promised to pay for covering additional uninsured people in Medicaid, the joint state-federal health program for the poor. Gov. Rick Scott has suggested Florida should take the money for at least the three years Washington says it will pick up the full cost. Republicans in both the Senate and House, however, are against going along with President Obama’s signature initiative, which most of them have spent years criticizing.
On Monday, when the Senate Select Committee on the Patient Protection and Affordable Care Act voted not to extend Medicaid eligibility to an additional 1.2 million Floridians, Senate Budget Chairman Joe Negron said the state could find a better solution.
“I think there is an interest in rejecting the Washington plan but saying, ‘What’s a Florida plan?” said Negron, R-Stuart. “What can we do to provide health insurance in the private market to people who go to work every day?'”
Negron’s alternative would target the same Floridians who would have been newly eligible under the Medicaid expansion. It would create a voucher-like program to buy private health insurance, relying on federal money to help subsidize the coverage. Instead of enrolling people in Medicaid, it would expand the Florida Healthy Kids Corporation, which provides subsidized private health insurance to roughly 240,000 children of low- and moderate-income families.
The proposal hasn’t yet been filed.
Sobel, Negron’s vice chair on the Senate select committee, said Florida ranks 48th of the 50 states for coverage of children’s health and 50th for coverage of adults. In 2011, she said, an average of 29.5 percent of Florida adults were uninsured, compared to the national average of 21 percent.
Medicaid expansion under the federal health care law would allow enrollment of people whose incomes are up to 138 percent of the federal poverty level, including childless adults.
“We have a moral and economic responsibility to seize this moment,” Sobel said.
If the state opted for expanded Medicaid eligibility, the federal government’s 100 percent share of the cost would gradually drop to 90 percent in 2020, with the state paying the remaining 10 percent. Analysts last week estimated the expansion would cost the state about $3.5 billion over a decade, with the federal government paying about $51 billion.
However, the main argument lawmakers have used to reject Medicaid expansion is that the program is broken and they don’t believe the federal government will be able to follow through and pay its share.
Fasano called that analysis hypocritical.
“We accept all kinds of other money from the federal government,” he said. “What concerns me as well is the Senate is saying, ‘Let’s come up with an alternative plan, but let’s use those federal dollars to come up with that alternative plan. So to say in one breath, ‘We don’t want the federal money, but we’ll take it if we can use it for something else’ is a bit hypocritical.”
He said he’s concerned that lawmakers who oppose Medicaid expansion will drag the process out until it’s too late, but that rallies like Thursday’s would help prevent that.
“I think (lawmakers have) put themselves in a position where they better either come up with an alternative or accept the money and expand Medicaid,” he said.
Meanwhile, a new survey out this week shows most small business owners in the state opposed to expanding Medicaid. The poll of 500 Florida members of the National Federation of Independent Business found that 76 percent say the Legislature shouldn’t pass any expansion of the federal-state program. NFIB was one of the plaintiffs, along with the state of Florida, in a lawsuit challenging the federal health care law. The government eventually won the right to proceed with the plan with the U.S. Supreme Court deciding against the plaintiffs.
–Margie Menzel, News Service of Florida