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 without reaching an agreement to expand 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 has been no indication that he is willing to do that – or that he is close to a deal with state House Republicans that would warrant such a session.
Scott, a Republican, stunned supporters and critics alike in February when he flipped from being a staunch opponent of the federal health law to endorsing its Medicaid expansion.
The health care overhaul gives states the option to expand their existing Medicaid programs with the federal government footing the full cost of the expansion in the first three years and paying 90-percent thereafter. In Florida, the raw numbers were persuasive to Scott, who is a former executive with hospital giant, HCA. Medicaid expansion would bring $50 billion in federal money to the state 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 [that] 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 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, stalling 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 health care issue for this session. But that doesn’t mean we’re going to stop working.”
Nearly 4 million people, or about one in five Floridians, 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 Reuben 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,” Reuben said. “We’d simply be paying for it through a hidden tax, a cost shift onto people’s private health insurance premiums.”
U.S. Rep. Debbie Wasserman Schultz, who is Chairwoman of the Democratic National Committee and who represents the Fort Lauderdale area, 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 Schultz. “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 it began.
This story is part of a reporting partnership that includes WFSU, NPR and Kaiser Health News.