TALLAHASSEE — A Florida Senate committee voted Monday against Medicaid expansion, joining the House in rejecting Gov. Rick Scott's proposal for a three-year trial covered entirely by federal funding.
Sen. Jeff Brandes, R-St. Petersburg, said Florida should pursue a program that is stronger than Medicaid, which he described as flawed and costly.
"Why in the world would we take the federal government's position when they promise that they'll pay for Medicaid expansion when we know that they will be unable to keep that promise in the long run?" Brandes said.
The conversation now turns to what Florida can do for roughly 1 million uninsured people that will still draw down billions of federal dollars.
Cost will be the focus, because even if the federal government pays for everything in the first three years, the state's share will eventually rise to 10 percent.
"I oppose the Washington plan, and I want a Florida plan," said Sen. Joe Negron, the Stuart Republican who chairs the committee, which talked about creating a program to use the federal money to purchase private insurance policies for those who qualify.
The Senate select committee on the Affordable Care Act voted along party lines, 7-4. Democrats said they were willing to explore alternatives but unsuccessfully pleaded with colleagues to embrace expansion as a backup.
"There is coverage at least that we know about in a Medicaid expanded world," said Sen. Audrey Gibson, D-Jacksonville.
Scott released a statement after the vote saying he looked forward to seeing what lawmakers come up with.
"I am confident that the Legislature will do the right thing," Scott said, "and find a way to protect taxpayers and the uninsured in our state while the new health care law provides 100 percent federal funding."
Negron outlined five "guiding principles" he believes should be contained in the Senate's plan:
• Cost-sharing that required plan participants to pay something for emergency room visits and other services they used, based on income.
• Administering the program through Florida Healthy Kids Corporation, a public-private organization that offers low-cost insurance to children ages 5-18.
• Creating "health reimbursement accounts" that reward participants for healthy behaviors by adding money to accounts that can be used for co-pays.
• Allowing participants to purchase private health insurance plans.
• Using available state and federal funds to help subsidize the premium costs of the insurance plans.
Negron said he believes the plan can be created using existing federal laws, such as a provision that allows Medicaid dollars to be used to subsidize the cost of private insurance. Florida used "premium assistance" sparingly during a five-county managed care pilot program, but other states have used it much more.
Any plan would have to be approved by President Barack Obama's administration and be in place by the fall and up and running in January in order for Florida to remain on the Patient Protection and Affordable Care Act's schedule and ensure it receives all the federal funds that have been earmarked.
State analysts have estimated that Florida could get up to $55 billion in federal funds for the first 10 years while paying out about $3 billion for Medicaid expansion.
"We're ahead of schedule," Negron said. "We're ahead of most other states in exploring an alternative."
Compared to the Florida House, the Senate has expressed more of a willingness to find an alternative that still would allow Florida to draw down the additional federal funding. The House is pursuing alternatives, too, but said the loss of Medicaid expansion dollars won't be a deciding factor.
Rep. Richard Corcoran, R-Trinity, said he believes the two sides can come to agreement now that both are pursuing alternatives.
"It sounds like we're moving in the same direction," Corcoran said. "It's just going to come down to what vessel you use, and the big question is how you fund it."
A recent actuarial study conducted on behalf of the state's Agency for Health Care Administration shows a so-called "benchmark plan" offered to new enrollees instead of the standard Medicaid package could reduce costs more than $100 million a year, or about 4 percent.
Negron said that justifies his decision to put the expansion population onto private insurance plans instead of Medicaid.
Contact Tia Mitchell at [email protected] or (850) 224-7263.