After emerging from a meeting with U.S. Health and Human Services Secretary Kathleen Sebelius, Florida Gov. Rick Scott said Monday he asked for the federal government to "expedite" approval of the state's controversial proposals to shift most Medicaid beneficiaries into managed-care plans.
But Scott offered few details about their discussion on another major issue --- how, or if, the state will carry out key parts of the federal Affordable Care Act.
Speaking to reporters in Washington, Scott reiterated his oft-repeated concern about the costs of the 2010 law, commonly known as Obamacare. In the coming months, state lawmakers are expected to consider whether Florida should take part in running a health-insurance exchange and expand eligibility for Medicaid, two pieces of the law aimed at helping more people get health coverage.
"Growing government, it's never free,'' Scott said. "It always costs money."
A Health and Human Services official, speaking on background, said Sebelius noted during the meeting that Florida has the third-highest rate of uninsured residents in the country. Sebelius encouraged Scott to work in partnership with the federal government on an insurance exchange and also said the law would lead to the federal government paying 100 percent of the costs of a Medicaid eligibility expansion during the first three years and 90 percent of the costs later.
Scott, who made his fortune as a hospital-company executive, helped hatch his political career by being a vocal opponent of President Obama's efforts to overhaul the health-care system. Scott and other Florida Republican leaders fought the Affordable Care Act in the courts as well as politically. But in recent months --- following a landmark U.S. Supreme Court decision and Obama's re-election --- they have grappled with how to move forward with the law.
At the same time, Florida has been seeking federal approval of proposals that would ultimately lead to Medicaid beneficiaries statewide signing up with HMOs and other types of managed-care plans. Scott and Republican lawmakers approved the proposals in 2011 but have waited more than a year for decisions by the federal Centers for Medicare & Medicaid Services, which is under Sebelius.
Florida Medicaid director Justin Senior said last month he expects a February decision about one of the proposals, which would lead to managed care for seniors who need long-term care services. It is unclear, however, when the federal government will make a decision about another proposal that would affect the broader Medicaid population.
"I've asked the secretary if she would expedite those and get those finished,'' Scott said after the meeting with Sebelius, a former Kansas governor and insurance commissioner.
But state Rep. Mark Pafford, a West Palm Beach Democrat who is critical of shifting beneficiaries into HMOs, issued a statement Monday that warned Scott against trying to link the managed-care proposals and the Affordable Care Act in discussions with Sebelius. Pafford said he hopes Scott "isn't demanding that expansion of the Medicaid program (under the Affordable Care Act) be contingent upon federal approval of a controversial Medicaid HMO-managed experiment."
After more than two years of largely refusing to carry out the Affordable Care Act, the state House and Senate have formed committees that will study the law during the upcoming legislative session. While the law has various implications for the state, much of the discussion centers on a health insurance exchange and the potential expansion of Medicaid eligibility.
Under the Affordable Care Act, each state will have an online exchange aimed at helping individuals and small groups shop for insurance coverage. Depending on their income levels, many people will qualify for federal subsidies to help afford coverage. The federal government is expected in January 2014 to begin running an exchange for Florida, though the state could enter into a partnership or eventually run an exchange itself.
Florida does not have to carry out the Medicaid expansion, which would increase income thresholds and also open the program to many childless adults who currently do not qualify. Supporters, such as Pafford, say the expansion would reduce the amount of uncompensated care provided by hospitals and health professionals and would prevent thousands of deaths each year.
While the federal government says it would cover virtually all of the expansion costs in the initial years, Scott has repeatedly warned that the increased eligibility and other changes in the Affordable Care Act would lead to hefty costs for Florida's Medicaid program.
Scott on Monday pointed to an estimate by his Agency for Health Care Administration of $26 billion over 10 years, though that is substantially higher than other estimates. The governor said he was trying to look out for Florida families.
"We want good access to health care, quality health care but (at) a price that they can afford,'' Scott said.