TALLAHASSEE — The debate that dominated last year's legislative session hasn't gone away.
Hospitals, powerful business alliances and grassroots advocacy groups still believe Florida should access the billions of federal dollars available for Medicaid expansion.
The difference between this year and last: Nobody wants to talk about it.
House Republicans, who blocked a similar move in 2013, say there is no point in having the contentious conversation again.
"The federal government has parameters that are too constrictive," said Rep. Richard Corcoran, R-Land O'Lakes, of the guidelines for accepting the money. "Until the feds say they will give us flexibility, there is no reason to move forward."
But critics say election-year politics are at play.
Polls show that some registered Republicans in Florida oppose Medicaid expansion. And in an election year, Republicans lawmakers are particularly wary of supporting policies associated with Obamacare.
"Ideology is the only thing stopping House Republicans from moving forward on this issue," House Democratic Leader Perry Thurston said. "Not expanding health care is the wrong thing for Florida."
The expansion is aimed at helping some 800,000 Floridians too poor to qualify for subsidized private insurance under the Affordable Care Act.
Last year, the Senate unanimously approved a bill that would allow the use of federal Medicaid expansion dollars to buy private insurance policies for poor Floridians.
But the bill went nowhere in the House, which instead voted to reject $51 billion in federal Medicaid funding.
This year, Republican Sen. Rene Garcia, of Hialeah, has introduced a plan for Medicaid expansion in the upper chamber (SB 710). Freshman Rep. Amanda Murphy, D-New Port Richey, is carrying an identical bill in the House (HB 869).
Neither has been scheduled for a hearing.
It's not for lack of support from influential groups. The Florida Chamber of Commerce continues to support Medicaid expansion, so long as there are certain prerequisites meant to control costs and improve outcomes.
"We have not backed off our position," Vice President of Governmental Affairs David Christian said. "But since there is no discussion — nothing has been teed up — you won't see me in front of a podium saying, 'This is our position on Medicaid expansion.' "
Instead, the Chamber is focusing on proposals that would expand access to telemedicine and address the shortage of primary-care physicians.
The Safety Net Hospital Alliance of Florida has also shifted its attention to something more pressing: a federal waiver that would prevent Florida from losing existing "low income pool" money for health services to the poor and uninsured.
"We are subject to losing $1 billion in federal money in the next 45 days," President Tony Carvalho said. "That's money that's being used to support the system."
Carvalho said his organization still strongly supports Medicaid expansion. "Obviously, it's an uphill battle right now," he said.
Groups like the Florida League of Women Voters and Planned Parenthood are making noise in support of Medicaid expansion.
Leah Barber-Heinz, of the patient advocacy group Florida CHAIN, hasn't given up hope either. Her group recently ramped up its campaign to organize supporters on the local level.
"We know it is an election year, and Republicans think supporting [Medicaid expansion] will hurt them," Barber-Heinz said. "But if they listened to their constituents, they would find out that this is something the people really want. More people are accessing the marketplace and realizing they won't get a subsidy."
But a recent Tarrance Group poll of registered voters in Republican-held state Senate districts found that 57 percent of Republicans disapprove of Medicaid expansion. And conservative groups like Koch-brothers funded Americans for Prosperity have continued to rail against the proposal.
Corcoran dismissed claims that he and other Republicans were motivated by politics.
"All we've ever cared about is creating quality healthcare outcomes for Floridians," he said.
Garcia hasn't given up on his bill in the Senate.
"I haven't spoken with one member of the Senate who doesn't support our plan," Garcia said. "If we could get it on the floor, we could pass it."
Health Policy Chairman Aaron Bean, R-Fernandina Beach, said he hadn't ruled out giving the bill a hearing, but that it isn't likely.
"The problem is that time is precious," Bean said. "It wouldn't make a lot of sense for us to spend time discussing something that isn't going anywhere in the House."
Senate Budget Chairman Joe Negron, who sponsored last year's Medicaid expansion proposal, believes the issue is a nonstarter.
"Sometimes in life there are intractable differences that can't be resolved," he said. "We have to continued to discuss possibilities with our friend in the House, but we have two very different ideas about how to proceed."
Contact Kathleen McGrory at kmcgrory@MiamiHerald.com.