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Sides entrenched, health care deal likely dead

TALLAHASSEE — Lawmakers are likely to return home this week without an agreement on meaningful health care reform, despite the early endorsement of Gov. Rick Scott and the pleas of businesses and hospitals.

With two days remaining in the legislative session, Republicans in the House are no closer to caving on accepting $51 billion in federal health insurance aid.

Democrats are no closer to being recognized as a legitimate partner in talks.

And Scott, who bucked many in his party to support a major health care expansion, is no closer to being seen as an effective advocate.

"We're no closer than we were the first day," Senate Democratic Minority Leader Chris Smith said.

Senate leaders on Wednesday continued to seek flexibility from federal health officials to craft a plan that House Republicans might stomach. But House Republicans seem more entrenched than ever against accepting federal money, and a proposed compromise reported by the Associated Press was quickly downplayed by leaders in both chambers.

The decision by House Democrats to protest a lack of a health care compromise has only emboldened Republicans to hold their ground.

The most likely result — nothing gets done.

"I think nothing should probably happen this session, and we take a deep breath and come back and work on it," said Sen. John Thrasher, R-St. Augustine.

While Scott early on endorsed a plan to expand Medicaid, and subsequently the federally funded alternative offered by the Senate, House leaders always were an impediment. House Speaker Will Weatherford, R-Wesley Chapel, made it clear on Day 1 of the 60-day lawmaking session when he called Medicaid expansion a "social experiment" that is doomed to fail.

"I believe it crossed the line of the proper role of government," Weatherford said in his opening day speech to lawmakers. "Florida should not buy it."

Rep. Mike Fasano, R-New Port Richey, said the speech painted Weatherford into a corner. Worse yet, he brought the Republican caucus with him. Fasano was the lone GOP House member to vote to accept federal money.

Now no one wants to cave, even though taking the money should be a no-brainer, Fasano said, noting that the health expansion would be 100 percent federally funded for the first three years.

As a result, the Capitol resembles a dysfunctional family. Depending on who you ask, the older brother Senate is either wiser or unreasonable. The younger brother House is either innovative or unrealistic.

Scott is the absent father.

The governor has made broad statements supporting health care expansion (after originally opposing the plan), but he has done little to force or broker an end to the stalemate.

Democrats say it's ineffective leadership. Republicans call it a flip-flop.

"Either he's for accepting those funds and is willing to use his clout and his weight and put the full weight of his office behind that position or he's not. And if he's not, it's meaningless," Democratic National Committee chairwoman and U.S. Rep. Debbie Wasserman Schultz said Wednesday.

There never was much urgency from the Legislature, either.

While both the Senate and House quickly rejected expanding Medicaid itself, both sides dawdled on crafting alternatives. The House plan, which uses state money to provide basic care to far fewer people, wasn't released until Week 6 of the nine-week session.

The Senate, meanwhile, didn't threaten to hold up House bills or delay budget talks in order to reach a health care deal, Sen. Jack Latvala, R-Clearwater, said.

"I just don't think there's a lot of enthusiasm in the whole building for doing it," Latvala said.

Lawmakers are likely to return to their districts, where constituents may feel differently. According to several polls, a majority of voters support accepting the federal Medicaid expansion dollars. The Florida Hospital Association released a poll that said 62 percent of voters approved of taking the money, with nearly half of respondents saying they felt strongly. Another survey by Associated Industries of Florida, a business group, also showed a majority of voters favored Medicaid expansion.

Inaction could lead to a special session late in the summer or early fall, or maybe a plan could be hatched and approved when committee work begins for the 2014 session.

But there is also a precedent for taking even longer. When Medicaid was created in 1965, many states were reluctant to join the voluntary program although all eventually did.

Florida was one of the last, joining in 1970.

Contact Tia Mitchell at tmitchell@tampabay.com.

What happens to Floridians who would have qualified for Medicaid expansion?

The Legislature's inaction on a plan to expand health insurance coverage to poor Floridians means many people will remain without health care. But it does not mean they face fines under the individual mandate as part of President Barack Obama's health care law. Here's what happens:

• Uninsured people earning less than $10,000 as an individual or $20,000 as a family in 2013 are exempt from paying a fine.

• Uninsured people who would have to pay more than 8 percent of their income to purchase health insurance also are exempt from a fine.

• A group of uninsured Floridians — close to 300,000 — are eligible for Medicaid under its current terms but not yet enrolled in the program. They can enroll. If they chose not to, they likely would not be subject to fines because of their income level.

• Another group of about 175,000 Floridians currently pay for their own health care but would have been eligible for the expanded Medicaid system, or an alternative. They could continue to purchase their own health care.

• Beginning in 2014, people who earn more than 100 percent but less than 400 percent of the federal poverty level will be able to use tax credits to purchase coverage in new health insurance exchanges.

Source: Henry J. Kaiser Family Foundation

Sides entrenched, health care deal likely dead 05/01/13 [Last modified: Thursday, May 2, 2013 11:01am]
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