By refusing to expand Medicaid under the Affordable Care Act, Florida's Republican-controlled Legislature left a million poor residents without health care coverage and turned away billions in federal money. Senate President Don Gaetz sent a list of questions to the Obama administration this summer that ask for more flexibility and has not received a response. The administration should answer with a resounding "no," because states should not be given a loophole that allows them to deprive some needy residents of coverage.
The reason the state rejected an estimated $51 billion in federal money from Medicaid expansion over 10 years was because House Speaker Will Weatherford, R-Wesley Chapel, does not want to cover working poor adults. So Gaetz wants Kathleen Sebelius, secretary of the Department of Health and Human Services, to let states only partially expand Medicaid, so several hundred thousand uninsured Florida adults could be left out. Gaetz also asks that states be allowed to impose new cost-sharing and premium payments on poor Medicaid recipients, which is now strictly limited under federal law.
Gaetz sent the letter in late June and has yet to receive a reply, which gives Republicans the chance to huff about foot-dragging by the Obama administration. It's true that "no" should not take long to type.
There isn't any reason to trust that Republican legislators who have put ideology before providing their poorest citizens with health care coverage will do right by this vulnerable population when given more discretion. Weatherford's House-passed plan covered about 120,000 poor adults — nowhere near the 1 million Floridians eligible for expanded Medicaid — with a state subsidy of $2,000 per year, far less than the average cost of annual premiums in 2012 of $5,600 for single coverage. Weatherford stood by this plan even after the business lobbying groups urged that he approve expanded Medicaid for the jobs and economic activity it would bring.
If states are allowed to shift costs and premiums to Medicaid recipients, it may put coverage and health care out of reach for the poor. And a partial expansion would leave some people out, undermining the ACA's goal of nearly universal coverage.
The Obama administration already is being flexible in its interpretation of the federal law, letting states fashion their own approach to Medicaid expansion and the online health insurance exchanges as long as the program's overall purposes are met. A plan passed by the state Senate to use the federal money to expand coverage using private insurers instead of the Medicaid program probably would have passed muster in Washington. But what Gaetz is asking for would give state's too much discretion to deny poor people health coverage.