Now that Gov. Rick Scott has agreed to use more realistic cost estimates for the expansion of Medicaid, the benefits should be even clearer. Expanding Medicaid to provide health care coverage to more than 1 million uninsured Floridians is the right choice, and the federal government will cover most all of the cost. Scott's revised 10-year cost to the state of $3 billion still may be high, but it is closer to reality than the $26 billion he cited earlier this week.
When the Affordable Care Act goes into full effect in 2014, it will expand the medical social safety net on a scale not seen since Medicare and Medicaid were established in 1965. Medicaid would be extended to anyone with income up to 133 percent of the federal poverty line, or about $30,000 for a family of four. About 3.3 million Floridians are now covered by Medicaid, but childless adults generally don't qualify. Parents and young adults can make no more than 22 percent of the federal poverty line to qualify.
Scott has argued that expanding Medicaid would be too expensive for Florida taxpayers. The U.S. Supreme Court upheld the Affordable Care Act but allowed states to choose whether to participate in the Medicaid expansion. The financial numbers favor expansion.
For the first three years, the federal government will pick up 100 percent of the cost of the expansion. After that, the percentage declines slowly until it reaches 90 percent in 2020 and beyond. The Kaiser Commission on Medicaid and the Uninsured estimates that this would bring about $66 billion in federal money to Florida from 2013 to 2022 for doctor visits, hospital stays and other health-related services. And this is just the beginning, since the study doesn't account for the positive economic effects of all those federal dollars. Talk about job creation.
Without the expansion, hospitals still would be on the hook to provide millions of dollars annually in uncompensated care to the poor. Those costs are largely shifted to people with private insurance. Families USA estimates that this "hidden tax" added $1,017 to family plan premiums and $368 in individual premiums in 2008. It is no wonder that Patrick Geraghty, chairman and CEO of Florida Blue, one of the state's leading health insurers, supports Medicaid expansion. It would make health insurance more affordable overall.
The state's minimal costs for expanding Medicaid would be reduced even further if significant savings for uncompensated care are considered. A conservative estimate by Kaiser calculates Florida will save $1.3 billion over 10 years from state and local programs that cover health services for people too poor to afford care but who currently don't qualify for Medicaid.
Scott portrays himself as a governor interested in the bottom line and return on investment. Expanding Medicaid would meet any reasonable measure of those goals.