The single most important act the Legislature can take this spring to brighten Florida's future is to accept the expansion of Medicaid. Gov. Rick Scott has endorsed the expansion, which would bring billions of federal dollars to the state and provide nearly 1 million uninsured Floridians with health coverage. Republican legislators who share the governor's disdain for the Affordable Care Act should follow his lead, set aside their distaste for the federal law and the Obama administration, and act in the best interest of this state.
It is understandably difficult for Republicans to look beyond their long-held objections to the landmark health care law. But the U.S. Supreme Court upheld the guts of the law, President Barack Obama won re-election and the law is being implemented. If Scott can look beyond his unwavering opposition and conclude accepting the Medicaid expansion is best for Florida, surely Republican state lawmakers can be just as pragmatic.
There is a powerful human argument for accepting the Medicaid expansion. Roughly 4 million Floridians lack health insurance, and the Affordable Care Act offers paths to health coverage for nearly all of them and opportunities for more productive lives. If that is not convincing enough, lawmakers should look at the map and the math for compelling evidence that the Medicaid expansion makes sense:
• The federal government would send billions to Florida to cover the entire cost of the Medicaid expansion for three years, then gradually decrease its portion to 90 percent. Floridians are federal taxpayers, and our federal tax dollars will help pay for the Medicaid expansion in other states. Florida already sends more money to Washington for roads and many other services than it gets in return. Why should Florida taxpayers get shortchanged again?
• While the Affordable Care Act offers states money to expand Medicaid, it reduces the rate of growth in spending on Medicare. Florida accounts for more than 8 percent of all Medicare spending, so it faces a $58 billion reduction in the future growth of Medicare over the next decade. Rejecting the Medicaid expansion would amount to a double whammy: Billions less than expected for Medicare, but no additional billions for Medicaid.
• The Affordable Care Act will significantly reduce the $200 million in federal money that Florida hospitals now receive to help cover the cost of treating the uninsured or under-insured. That money will decline even if the state rejects the Medicaid expansion. It would be foolish to lose so-called disproportionate share money and not lessen the impact with the Medicaid expansion.
• Smaller Southern states with Republican governors who are rejecting the Medicaid expansion cannot be compared to Florida. They have fewer uninsured residents, the federal money at stake isn't as much and they don't have as much to lose. In fact, some states already get much more federal money to help cover charity care than Florida does even though they have fewer uninsured.
Scott persuaded the Obama administration to grant permission to privatize Medicaid into a managed care system, studied the financial numbers and endorsed the Medicaid expansion. Senate President Don Gaetz, House Speaker Will Weatherford and their leadership teams have an obligation to make the same honest assessment. If they do the math, it adds up to accepting billions for Medicaid expansion as the only rational course for Florida's economy and the health of its residents.