Three years after the Affordable Care Act became law, the nation's greatest expansion of the medical safety net since Medicare is improving private health insurance coverage and making it more accessible, strengthening Medicare and slowing the rising medical costs. Gov. Rick Scott, a fierce opponent, has finally come to terms with the law and endorsed the expansion of Medicaid to 1 million uninsured Floridians. Yet House Speaker Will Weatherford and other Republican lawmakers are resisting and letting ideology trump the best interests of the state. They pledge to come up with their own plan, but time is running short and billions of dollars are at stake.
While Weatherford and other critics argue that health care reform is a luxury the country cannot afford, the Affordable Care Act is proving to be economically wise in the early going. Health care costs are finally stabilizing, in part because the law provides incentives for lower costs of care and new efficiencies. For the first time in more than a decade, health care costs in 2011 grew at a slower rate than the economy. Projected federal spending on Medicare and Medicaid in 2020 is down 15 percent, or $200 billion, according to the nonpartisan Congressional Budget Office. That is real progress.
The law also is plugging holes in coverage. No longer can insurers put lifetime limits on health benefits, an essential new safety net for people stricken with expensive, chronic diseases. When the law is fully effective in 2014, there will be a ban on annual coverage limits. The law also forces insurers to spend at least 80 percent of premium dollars on health care rather than overhead and executive pay. Companies that fail to meet that floor have to reimburse their customers through rebates or lowered premiums. This year alone, more than 1.2 million policyholders in Florida are expected to receive $124 million in rebates from their health insurers. That is also real progress.
Under the Affordable Care Act, preventive care services must be provided by health insurers without deductibles or co-payments, including to recipients of Medicare. Seniors have also been benefiting from Medicare's gradual elimination of the so-called doughnut hole for prescription drugs. The doughnut hole discount on brand-name drugs was 50 percent in 2012, saving Floridians more than $160 million. Yet even with better coverage, the Affordable Care Act is improving Medicare's solvency, extending the life of the Medicare Trust Fund by eight years.
Parents already know how the law is providing heath care security. As of December 2011, an estimated 3.1 million young adults nationwide and 224,000 in Florida gained health insurance because their parents were able to keep them on their insurance plans until age 26. And minor children can no longer be denied coverage for a pre-existing condition.
Many of Florida's nearly 4 million uninsured are expected to obtain coverage in 2014 when online health insurance exchanges make it affordable and accessible, with no hold-backs or extra premiums for a pre-existing condition. Households making between 100 percent and 400 percent of the federal poverty line will be eligible for federal subsidies to help cover the cost. But for adults under 100 percent of poverty federal subsidies are unavailable. That's because the law contemplated those adults would be covered by an expanded Medicaid program paid for entirely with federal dollars for the first three years, with the federal share going no lower than 90 percent in future years.
Scott wants Florida to take the billions of federal dollars offered by Medicaid expansion — a move that studies show would fuel the state's economy, boost job creation and keep poor residents from using hospital emergency rooms as their only health care option. But Republican legislative leaders refuse to expand Medicaid, and Weatherford has been particularly callous in arguing any expansion should not include low-income adults. State senators are debating various alternatives, but there is not much time to work out the details.
Here's something for ostensibly business-minded Republicans to consider: If Florida doesn't expand Medicaid, the state's employers will be on the hook for an additional $146 million to $219 million in Affordable Care Act penalties, according to a study by Jackson Hewitt Tax Service Inc.
If lawmakers are serious about creating an alternative to Medicaid expansion, they should aim to cover at least as many uninsured Floridians as the Medicaid expansion in a subsidized system that would be as easy and as accessible as Medicaid.
The Affordable Care Act always can be improved, but it already is producing benefits by improving coverage and reducing cost. Absent a sudden brainstorm, the Legislature should get out of the way, follow the conservative governor's lead and embrace Medicaid expansion.