The frantic effort by Senate Republicans to repeal and replace the Affordable Care Act with something — anything — ranks raw politics over sound policy and threatens the health care of millions of Floridians. It is a desperate attempt to declare victory by shifting responsibility from the federal government to the states without knowing the full financial and human costs, and the last minute revisions do not make it more palatable. The bill appeared to be one vote short late Monday, and Sen. Marco Rubio also should stand with Sen. John McCain and insist on better.
The bill sponsors scrambled over the weekend to change the bill to try to appease skeptical Republicans such as Sens. Susan Collins of Maine and Lisa Murkowski of Alaska with policy changes and more money for their states. It was a cynical attempt to buy votes for fatally flawed legislation that would not be fully evaluated by the nonpartisan Congressional Budget Office before Saturday's deadline for a vote, and Collins announced she would still oppose it. As McCain said, the more responsible direction would be to develop bipartisan health care reform legislation that would be fully vetted and explained.
The bill sponsored by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would repeal important features of the Affordable Care Act, such as the subsidies that help people afford health insurance, requirements for Americans to have coverage and for large businesses to provide it, and benefits required under current law. Instead, money would be sent in block grants to the states, which would design their own health care programs, and federal spending on Medicaid would be capped for each recipient.
For Florida, the impact of this legislation would be disastrous. More than 1.7 million Floridians enrolled for private coverage through the federal marketplace, the highest enrollment of any state. More than 90 percent of them receive premium subsidies, which reduce the average premium from $442 a month to $118 a month. How in the world would those residents afford to buy private coverage if Congress repealed those subsidies?
Medicaid also would take a terrible hit. More than 3.9 million Floridians are enrolled in Medicaid, including more than 450,000 Tampa Bay residents. The entitlement program covers nearly half of all children and all births, and it covers 60 percent of total nursing home and other long-term care costs. Yet even though Florida did not accept Medicaid expansion money, has one of the nation's most miserly programs and already has forced recipients into managed care, it is one of more than 30 states that would lose federal money under the original Senate legislation. Medicaid already eats nearly one-third of the state's budget, so don't expect Gov. Rick Scott and the Florida Legislature to make up any loss of federal dollars. The only options would be to further limit enrollment or benefits.
While the CBO has yet to fully analyze the Senate bill, the nonprofit Kaiser Family Foundation estimates Florida would lose $7.5 billion in federal money between 2020 and 2026 for subsidies to help buy coverage under the Affordable Care Act. The state would lose another $2 billion from the cap on federal Medicaid spending per recipient. The governor has been a big advocate for Medicaid block grants, but he has been conspicuously quiet about this Senate legislation. No wonder.
The Affordable Care Act obviously needs work, and the continual increase in Medicaid costs is not sustainable. But true health care reform has to make medical care more accessible and affordable for everyone. The Senate legislation fails those basic tests for Floridians, and Rubio and should join Republican Sens. McCain, Collins and Rand Paul in opposing it.