Sunday, August 19, 2018

Medicaid expansion plans face long odds in final weeks of session

TALLAHASSEE — Gail Jones has the same thought whenever she gets into a car: "Please, Lord, don't let me crash. I don't have health insurance."

Jones, a 51-year-old Opa-locka resident who works at a drug and alcohol rehabilitation center, doesn't qualify for Medicaid. But the Obamacare marketplace for health insurance is also out of reach. The reason: Her salary is too low to receive tax credits that would make coverage affordable.

Whether she — and roughly 800,000 other Floridans in the so-called coverage gap — will have access to coverage hinges on decisions that will be made in Tallahassee over the next three weeks.

The state Senate is advancing a plan that would let Florida use federal Medicaid expansion money to subsidize a new state-run marketplace for private insurance. It would be available to low-income Floridians who work and pay small monthly premiums.

The proposal has the support of influential business organizations, hospitals and grass roots consumer advocacy groups. But for both political and logistical reasons, it is a long shot in the final weeks of Florida's legislative session.

Among the strong forces working against it:

• Powerful House Appropriations Chairman Richard Corcoran, a Land O'Lakes Republican who controls a large bloc of lawmakers, has repeatedly refused to consider the plan. The conservative House considers it an endorsement of the politically charged Affordable Care Act, also known as Obamacare.

• Republican Gov. Rick Scott last week said he no longer thinks Florida should accept the federal money because he doesn't trust the government to keep its promise.

• Even if the plan were to win support from the legislative and executive branches, it would still need approval from the U.S. Centers for Medicare and Medicaid Services because it is not Medicaid expansion as envisioned under the Affordable Care Act. The agency has rejected plans from other states that included a work requirement.

"The House holds all the cards right now," Barry University political science professor Sean Foreman said. "There really is no incentive for them to change their minds."

Still, Jones and other Medicaid expansion advocates plan to keep the pressure on House Republicans as the 60-day session builds to a crescendo. It officially ends May 1.

"Even though they have a supermajority, they need to be held accountable to the people," Jones said from the steps of the Capitol last week.

The federal money — initially $51 billion over 10 years — was first offered to Florida in 2013 as part of the Affordable Care Act. It was intended to help expand Medicaid coverage to people earning up to 138 percent of the federal poverty level.

In 2013, the Senate advanced a plan to take the money. But the House refused to go along, saying the Medicaid program was too broken to expand.

In 2014, the legislative conversation was a nonstarter. It revved up again this year, however, because the federal government said it would not extend a $2.2 billion hospital funding program known as the Low Income Pool past its June 30 expiration date.

Advocates of Medicaid expansion were quick to note that the end of the LIP program — which helps hospitals in covering the cost of treating uninsured, under-insured and Medicaid patients — would be disastrous to safety-net hospitals like Jackson Health System in Miami and Tampa General Hospital.

They pitched expanded coverage as a way to help those hospitals on the front end if the state and federal government could not negotiate a LIP successor.

The business community rallied around the idea, providing the political muscle needed to drive the conversation in Tallahassee.

Enter the Senate. It is billing its 2015 plan as a free-market approach to Medicaid expansion that rewards individuals who work and have "skin in the game," according to Health Policy Committee Chairman Aaron Bean, R-Fernandina Beach. It has won unanimous support among senators.

Hoping to build support for the plan, Senate President Andy Gardiner, R-Orlando, dispatched two senators to Washington this month to meet with federal health officials.

But House Republicans have dug in their legislative heels.

"They want us to come dance?" Corcoran said this month. "We're not dancing. We're not dancing this session, we're not dancing next session, we're not dancing next summer. We're not dancing."

And they now have Scott on their side.

"It's very difficult to trust the same government because of their action on the (LIP) program," Scott said last week.

In a move best described as political posturing, the Senate is trying to force the governor's hand — and that of the House — by threatening to hold up the budget process. Gardiner has also said he may have to exclude $690 million in tax cuts that Scott considers a priority.

The gridlock over expansion and the uncertainty over the LIP funding have brought all other legislative proceedings to a virtual halt.

Some leaders are already predicting the need for a special or extended session.

Foreman, the Barry University professor, said it would be virtually impossible for the House to reverse course and save face politically.

"They've painted themselves into a corner," Foreman said, pointing out that Corcoran is scheduled to become the powerful House speaker in 2016. "Corcoran can't go back on his word now, because he'll lose credibility for his future leadership."

Still, the fight is far from over.

A coalition of business groups and individuals known as A Healthy Florida Works has released an online video praising Gardiner and the Senate for "bold leadership," and has continued pushing the idea that expansion will lower business costs.

Grass roots groups are also ratcheting up their efforts.

Catalyst Miami, a nonprofit advocacy organization, sent 40 members to Tallahassee last week to build support for the Senate plan. The volunteers held a demonstration outside of the Capitol on Thursday morning and then tried to get meetings with House Republicans.

Jones, who traveled to Tallahassee with the group, said it was important to tell lawmakers her story.

She sometimes has severe allergic reactions, but is afraid to go to a doctor. Instead, she treats the condition with home remedies that rarely help.

"I don't want to be left behind," she said. "I want them to know that there are 800,000 people out here who need health care."

Contact Kathleen McGrory at [email protected] Follow @kmcgrory.

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