As national politicians feud over "public option'' health insurance, state lawmakers are far more concerned with plans to greatly expand a different government-run health care program: Medicaid.
A state-federal program, Medicaid insures poor children, seniors, pregnant women and the disabled - a total of 2.7 million people in Florida.
And that number could grow to 4 million if the major health care bills calling for nationwide expansion of the program win approval. About 1 in 5 Floridians would then be eligible for Medicaid.
"If there were no federally mandated increases, the ticking time bomb of Medicaid would already be the No. 1 concern for the Florida Legislature for the next three or four years," said Sen. Don Gaetz, a Niceville Republican who helps oversee health spending. "This is a far bigger concern for us than the public option."
Medicaid spending already exceeds undergraduate education funding in Florida. It consumes nearly 27 percent of the state's $66.5 billion budget. Also, the state-funded portion of the program faces a $1.5 billion deficit next year.
Unlike the federal government, Florida is prohibited from deficit spending. So any increases in Medicaid enrollment and costs can mean spending cuts elsewhere - or higher taxes.
But it might not come to that. The leading House bill says the federal government would pick up all the new Medicaid costs until 2014. Thereafter, the feds would pay 90 percent, with the remaining 10 percent costing Florida taxpayers about $430million yearly.
The outline of a bipartisan Senate proposal released this week is far less clear. It says state and federal governments will continue to share the costs. It doesn't specify percentages, but a leading senator, Kent Conrad, D-North Dakota, said Friday that the feds would pick up an "overwhelming share."
Social service advocates say increasing Medicaid coverage would actually lower costs in the long run.
Laura Goodhue, executive director of liberal-leaning Florida Community Health Action Information Network, said there's a "multiplier effect'' from federal Medicaid money pouring into Florida.
"The hospitals actually get paid. Doctors get paid. People are healthy and they can go to work," she said. "Covering a million more people in a state with 4 million uninsured is a good investment, especially if the federal government pays almost all of it. This helps people who would otherwise burden emergency rooms or walk around sick because they can't get care."
President Barack Obama mentioned Medicaid in passing only six times in his Wednesday night address where he reiterated support for a "public option'' health plan to compete with private insurers. Obama said the 10-year, $900 billion plan would not add to the deficit.
"Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan," Obama said.
Even if Obama can keep his pledge, state legislators worry that the president's proposal increases the pressure on Congress to pass more Medicaid costs on to the state.
The leading House and Senate proposals in Washington would increase Medicaid rolls by making nearly everyone eligible if he or she earns less than 133 percent of the poverty level. The new threshold would equate to $29,326 for a family of four or $14,404 for a single person.
Currently, most childless adults can't get on Medicaid. Some aspects of Medicaid set the income eligibility threshold at 100 percent of poverty.
If the changes are made, Medicaid rolls nationwide would grow by 10 million, according to an analysis by the Congressional Budget Office, which found that the House bill would lead to federal deficits. Medicaid had about 50 million recipients in 2007 - before the economy tanked - but a spokeswoman said this week that the federal agency that oversees Medicaid has no idea how many people are now enrolled.
Medicaid expansion is appealing to doctors and insurance companies, who both have the option to participate in Medicaid. About 1.2 million Florida Medicaid recipients are enrolled in managed care plans run by insurance companies and doctor groups. Compared to a new public plan, Medicaid would also more quickly insure more people because it's an existing program with a provider network.
Florida's Medicaid population surged by about 300,000 this fiscal year as the overall budget shrunk and as the state lost population and became a national leader in home foreclosures and unemployment. Experts forecast that another 143,000 people will be added next year, regardless of congressional action.
Rising Medicaid enrollment would have been a budget buster for Florida and other states had Obama and Congress not approved the federal stimulus package that boosted the federal share of the program from 55 percent to 67 percent of every Medicaid dollar spent.
Legislators this spring shifted about $790 million in Medicaid stimulus money out of the program to prevent budget cuts elsewhere. They also transferred another $900 million out of the program after passing a new tobacco tax earmarked for Medicaid.
Without the two budget transfers, Florida would not face a $1.5 billion Medicaid deficit next year, said state Sen. Nan Rich, a Weston Democrat who sits on the Senate's health budget committee with Sen. Gaetz.
"The Medicaid deficit is a problem of the Legislature's making," Rich said. "But I'm very concerned with any talk of expanding Medicaid in Florida. We already don't know what's going to happen with the Medicaid program we have. So it's a big concern when they start talking about growing the program."
Still, Rich said, she supports expanding the Medicaid rolls as an alternative to a public-option plan.
Republican lawmakers say that's a bad move. Rep. Will Weatherford, a Wesley Chapel Republican slated to be Florida House speaker when the Medicaid expansion tab might come due, said he's concerned about the liberal politics at play.
"We're moving more toward socialization of medicine," Weatherford said. "If they can't get a touchdown with the public option, they'll try a few first downs with Medicaid."
Marc Caputo can be reached at mcaputo@MiamiHerald.com.
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By the numbers
From hospitals to nursing homes to doctors, Florida's Medicaid program touches every aspect of the state's health care system including low-income children, seniors and pregnant women. It currently covers almost 1 in 7 Floridians.
18 million Population of state
4 million Number of uninsured
2.7 million Number of Medicaid recipients
310,847 Caseload growth since last year
$17.9 billion Medicaid cost (total federal and state)
$1.7 billion Cost increase since last year(total federal and state)
27 Percent of Floridachildren covered
44 Percent of Florida pregnant women covered
66 Percent of Florida nursing-home beds covered
Sources: Agency for Health Care Administration, Office of Economic & Demographic Research