Health policy wonks call it the "woodwork" effect: Millions of poor Americans who were eligible for Medicaid but didn't know it sign up for the program as a result of publicity around the Affordable Care Act.
A new federal report shows the phenomenon is real in most states — though not yet in Florida, which has one of the nation's stingiest Medicaid programs. In October, opening month for the Obamacare marketplace, Florida saw a small decline in the number of adults applying for Medicaid coverage.
That news comes as Florida's top House Republican signaled state legislators will again decline federal dollars — $51 billion over a decade — that would pay for a more generous Medicaid program. Currently, an estimated 800,000 Floridians are too poor to buy even subsidized insurance, yet can't qualify for Medicaid.
In the initial years of expansion, the federal government foots 100 percent of the bill. In future years, the state would have to put up a minority of the funds, and that has been attacked by Republican leaders.
But a report issued Thursday by the Commonwealth Fund, a national policy foundation, puts Florida's potential share of the costs into another context. In 2022, the state would have to spend $1.2 billion of its own money on the expansion — less than a fourth of what it's projected to spend on tax incentives to attract private businesses to Florida.
Nationwide, applications to Medicaid and the Children's Health Insurance Program grew by 2.5 million in October, according to the Centers for Medicare & Medicaid Services, which runs the programs.
Among Republican-led states that refused to accept federal expansion dollars, applications increased by an average of 4.1 percent, compared with 15.5 percent in states that did take the dollars.
Yet in South Carolina, a non-expansion state, applications increased by 20 percent as it made access easier online and teamed up with churches and nonprofits to find people who didn't know they were eligible for the existing program.
In Florida, around 311,120 adults applied for Medicaid in October — down about 2 percent from an average of the three previous months.
Florida's numbers did not include children, because the vendor that processes those applications was changed, and the figures were skewed, said Florida Healthy Kids spokeswoman Erika Villanueva.
In Florida, it's nearly impossible to get Medicaid if you are a nondisabled adult under age 65 who isn't pregnant or doesn't have minor children.
Under the Affordable Care Act, Medicaid should have been available to anyone who makes up to 138 percent of the poverty level — about $32,000 for a family of four or $15,800 for a single person. But the U.S. Supreme Court struck down that portion of the law, giving states the option.
The Florida application figures seem to contradict an earlier enrollment report from the federal government, which showed that 12,800 more people who logged into healthcare.gov, the federally run insurance marketplace, were currently eligible for Medicaid and the Children's Health Insurance Program.
But because of technological problems with the federal website, Florida has not received a single Medicaid application through healthcare.gov, said Michelle Glady, a spokeswoman for the Florida Department of Children and Families.
State House Speaker Will Weatherford wrote last week in the Florida Times-Union that he won't expand Medicaid.
"We didn't fall for the Washington promise that, 'If you like your Medicaid funding, you can keep your Medicaid funding,' " Weatherford wrote.
Even so, hospitals and business groups such as the Greater Tampa Chamber of Commerce are pushing for reconsideration.
Steve Mason, president and chief executive officer of BayCare Health System, said Wednesday that he has never heard a practical case against taking the federal funds.
"There's an ideological stake driven into the ground here," Mason said in a meeting with the editorial board of the Tampa Bay Times. "It's the same rhetoric over and over."
He said getting more uninsured people on the Medicaid rolls would offset cuts that hospitals face. BayCare lobbyist Keri Eisenbeis noted that expansion remains its biggest advocacy issue — even if House Republicans won't budge.
"On a humane level, there's too much at stake for us to give up," she said.
Jodie Tillman can be reached at firstname.lastname@example.org or (813) 226-3374.