The Florida Senate has fallen prey to the same faulty thinking as the House on Medicaid expansion, and now 1 million poor and uninsured Floridians can only hope for the best from a Legislature that has ignored their plight for years but now claims it can find a solution in 50 days.
Like a House committee before it, a Senate committee's party-line 7-4 vote Monday to reject billions in federal dollars to expand Medicaid was based far more on partisan demagoguery than on reason. Republican committee members, including Sen. Jeff Brandes of St. Petersburg, wrung their hands and contended the federal government couldn't be trusted to pay for Medicaid expansion. Yet many of them then turned around and said they might support taking those same federal dollars for a half-baked alternative to subsidize insurance offered by Sen. Joe Negron of Stuart. So much for ideological purity. There's a reason that more rational minds, from Gov. Rick Scott to Florida's business community, support expansion as Florida's best choice.
State analysts estimate that Florida would receive up to $55 billion in federal money over the first 10 years of Medicaid expansion while expending only about $3 billion in state funds. That's because, for the first three years, the federal government picks up the full cost of expanding Medicaid to people who earn up to 138 percent of the federal poverty line. After that, the federal share reduces slowly to 90 percent in 2020 and beyond. Other studies point to the multiplier effect of this huge injection of federal funds in fueling the state's economy and supporting tens of thousands of jobs in a range of fields, including construction. These are just the kind of good jobs Republicans say Floridians need.
The focus of Republican criticism seems to be that Medicaid is too costly even if the state is only shouldering a 10 percent share in later years. Negron lays out a series of "guiding principles" as the basis for an alternative. They include using the federal Medicaid expansion money to subsidize private insurance for the poor and requiring plan participants to pay toward emergency room visits and other services. But the details that will need to be supplied in just 50 days are crucial to any plan's success — or even whether the Obama administration would approve it. Just what kind of copays can the state expect from someone earning less than $16,000 a year? And is the real motive just to help as few Floridians as possible?
The bigger irony is that Florida has already won a Medicaid waiver that allows it to transfer all recipients into managed care, which Republican leaders have contended will bend the Medicaid cost curve. But instead, Negron wants to put the state's poorest adults into an untested program cobbled together on the fly.
The sad truth is many Republicans in Tallahassee would like to abolish Medicaid if they could and consign poor Floridians to hospital emergency rooms as their only health care option, leaving hospitals and fee-paying patients to shoulder the cost. And the underlying message remains one of contempt for those who toil in jobs with low pay and no health benefits, a problem that's only grown more severe in the past decade. The Republican answer is: Get a better job or tough luck.
When Scott signaled he would support Medicaid expansion, he said he couldn't reject it "in good conscience." Now his job is to convince his fellow Republicans of the same. Lawmakers can explore other options, but the test must be whether those will return billions of taxpayer dollars to the state, provide health insurance to the poor and protect the solvency of the state's safety net hospitals. Medicaid expansion will do that. Rejecting it, as Scott said, is an unconscionable path to take.