Tuesday, December 12, 2017

Obamacare fight is anything but over in Florida

Florida isn't just a battleground state for presidential elections; it's ground zero in the nation's Obamacare wars.

It's all about demographics. And geographics.

Retiree-heavy Florida has a surplus of voting seniors nervous about Obamacare's changes. But Hispanics — the state's least-insured but fastest-growing population — tend to support the Affordable Care Act.

Fourth-most populous in the nation, Florida is the most-diverse political swing state and has the nation's second-highest rate of uninsured, nearly 25 percent.

Active Democratic voters, who outnumber Republicans by more than 500,000, learned last year from President Barack Obama's campaign that the law can be a political plus — especially among Hispanics — after it was a millstone in 2010.

Republicans control the state power structure, and have fought Obamacare in court, with new laws, at the ballot box and on TV.

Two of the most-recognizable Republican figures in the fight: Florida Sen. Marco Rubio and Gov. Rick Scott, who's up for re-election next year and launched his political career four years ago by founding a group opposed to Obamacare.

So 2014 could become a political tiebreaker over the Affordable Care Act, which has remained unpopular overall in Florida since its passage.

"Florida is ground zero for Obamacare," said John Anzalone, President Obama's Florida pollster. "If you take a look at all of Florida's natural constituencies, you have seniors. … You have minority communities, including Hispanics."

"And you have areas of the state, like Fort Myers, that were heavily impacted by the recession," he said. "Also, Miami-Dade is a heckuva lot different than the Tampa area. And then you have North Florida, which is really Southern."

The travel schedule of the Obama Administration's top health official, Kathleen Sebelius, attests to Florida's importance.

Sebelius has been to Florida five times since June — more than any other large state, in large part because the state refuses to help set up health-insurance marketplaces. So the federal government has to do it. Sebelius has also repeatedly visited GOP-led Texas, which has the nation's highest uninsured rate at 25 percent, also has refused to go along with Obamacare.

Called insurance "exchanges," the online marketplaces — including Spanish-language ones Sebelius touted last week in Miami — are designed to help provide policies to individuals who are now mandated to buy coverage or pay a penalty tax.

The exchanges go online Oct. 1.

The day before, Sept. 30, is another deadline: the end of the federal government's budget year. Gridlocked Congress hasn't passed a new budget, requiring a temporary one, called a continuing resolution, to be passed.

But Rubio, joining Texas Sen. Ted Cruz and Utah Sen. Mike Lee, has helped pressure House Republicans to refuse to support a resolution that doesn't temporarily defund Obamacare. On Friday, the House voted largely along party lines to defund it — the 42nd anti-Obamacare vote in the chamber.

Democrats and White House officials say they won't budge, increasing the likelihood of a government shutdown and possible credit downgrade.

Top Republicans have indicated they have no appetite for a shutdown and would be willing to the pass the bill without the health care provision. But it is unclear how much clout the leadership has over tea party-backed lawmakers still insisting the shutdown is worth the risk.

"The real disaster is Obamacare itself," Rubio said in a Senate floor speech in July when he doubted whether some of the state exchanges would be up and running.

Rubio pointed out that Obama postponed a mandate that employers offer health insurance: "It is such a disaster that the people who supported it are now delaying implementing portions of it."

During the August recess, Rubio toured parts of North and Central Florida to highlight what he said were the failures of Obamacare as seen through the eyes of regular Florida citizens and businesses, like the iconic Gatorland and SeaWorld theme parks in the Orlando area.

There, Rubio said, park owners are like other businesses big and small that are struggling over how to balance higher insurance costs, with the need to keep people employed and customer prices low.

Sebelius rebutted some of the criticism in singling out reports about SeaWorld scaling back part-time employees. She said SeaWorld is adding more full-time employees and said that "they will have affordable health coverage for the first time ever in the new markets."

Sebelius bashed the Florida Legislature for passing a law last year that, for two years, removes the state's insurance office from reviewing the cost of health insurance plans offered through the exchanges.

The law could allow insurers to raise rates with little oversight, which could put "Florida consumers at great risk," Sebelius said. Republicans say the statute is designed to remove conflicts between state and federal health insurance law.

The law, which Sebelius said was unique to Florida, was just one example of efforts in Tallahassee to slow, disrupt or question Obamacare by:

• Suing to block Obamacare as unconstitutional. Joined by peers in other conservative-run states, Florida Attorney General Pam Bondi lost that battle in the U.S. Supreme Court.

• Rejecting $9 billion in extra federal Obamacare money over three years to expand Medicaid, the federal-state health insurance program for the poor. Scott called for the expansion of Medicaid last year, but he spent no political capital to try to persuade a recalcitrant Florida House to back him.

• Proposing a state constitutional amendment in 2012 designed to block Obamacare-like government requirements that people buy health insurance. It failed, with 48.5 percent supporting it and 51.5 percent opposing.

• Refusing to set up the state exchanges, even returning federal incentive grant money designed to do it.

• Heavily regulating Obamacare "navigators," health coordinators who would help people figure out the complicated law. The Department of Health, a Scott agency, earlier this month ordered 60 county health departments to deny navigators the ability to tout the new health-insurance law on premises.

"My biggest concern is about privacy. They're getting a lot of our citizens' information and haven't told us how they're going to use it, how they're going to share it," Scott told reporters last week.

Scott mentioned a data breach that happened in Minnesota and said, "We know identity theft is a big problem."

But the federal government routinely manages health data through Medicare and Medicaid, Sebelius said, pointing out the Minnesota case was a failure at the state and not the federal level.

Also, had Florida participated more in setting up Obamacare exchanges, it could more tightly regulate outreach coordinators than it does now.

So far, conservatives have won the public-relations battle race overall.

About $500 million in Obamacare-related advertising has been spent since 2009, with opponents outspending supporters by a 5:1 ratio, according to Kantar Media's Campaign Media Analysis Group, which projects ad spending to double to $1 billion overall by the end of the 2014 elections.

Obamacare hasn't been polled in Florida for months, but generally state surveys mirror national polls, which show significant opposition.

A Pew Research Center national poll last week showed 53 percent disapproved and 42 percent approved, "among the most negative assessments of the law," which 47 percent disapproved of and 43 percent approved of in July last year.

The poll showed few have "a solid understanding" of the law, 63 percent have "yet to see much of an impact," but a plurality thinks it has and will have negative consequences.

But the poll shows a racial, ethnic and age divide in which African-Americans back the law by 91 percent, Hispanics by 61 percent and non-Hispanic whites by only 33 percent.

As the Hispanic vote grows nationwide and in Florida, its political support is key to the political parties.

In Florida, Hispanics are about 23 percent of the overall population and about 14 percent of the voter rolls, but they account for about 35 percent of the state's Medicaid-eligible population.

A March poll from Associated Industries of Florida, a conservative business lobby, showed Hispanics favored expanding Medicaid under Obamacare 60-28 percent, while Florida voters overall supported it by a lesser amount, 54-31 percent.

The Obama campaign spent between one-quarter and one-third of its Spanish-language ad money in the nation and Florida on touting Obamacare, and it helped the president best Republican Mitt Romney by significant margins.

"Health care was one of our top persuasion messages in the Hispanic community," said Ashley Walker, Obama's Florida campaign manager.

But with two eloquent Hispanic Republicans leading the charge against Obamacare, Rubio and Cruz, long-term Latino support is no guarantee.

Also, minorities are generally less reliable voters than older whites, who form the base of the Republican Party, in midterm elections.

What's more, Hispanics are still largely uninformed about the law, making outreach and campaigning more crucial than ever for both sides.

Ultimately, Obamacare will either fail or succeed on its own merits.

But until then, polling and demographic data show that Florida is the ultimate proving ground for the law's effects in an election. In the meantime, Democrats intend to conflate Republican opposition to Obamacare with GOP resistance over immigration reform, a potent one-two-punch — unless Hispanic voters pull a repeat of 2010 and stay away from the polls.

"Five years from now, the Republican position could be right and Obamacare could be a disaster," said Matt Barreto, pollster with the nonpartisan Latino Decisions polling firm. "In the short term, it makes sense for the Democrats to keep doing what they're doing."

So get ready for more campaigning, more ads and more legislative fights from Washington to Tallahassee.

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