Will Ron DeSantis’ or Andrew Gillum’s health care plan cover more people? Experts weigh in.

The two candidates discussed health care in their second debate for about five minutes.
Florida Republican gubernatorial candidate Ron DeSantis, left, speaks about his Democratic opponent Andrew Gillum during a CNN debate, Sunday, Oct. 21, 2018, in Tampa, Fla. (AP Photo/Chris O'Meara) FLCO105
Florida Republican gubernatorial candidate Ron DeSantis, left, speaks about his Democratic opponent Andrew Gillum during a CNN debate, Sunday, Oct. 21, 2018, in Tampa, Fla. (AP Photo/Chris O'Meara) FLCO105
Published Oct. 31, 2018

TALLAHASSEE — During last week's final Florida governor's debate between Republican Ron DeSantis and Democrat Andrew Gillum, an ugly back-and-forth over alleged ethical lapses grabbed headlines.

It also overshadowed what might have otherwise been the news of the night: DeSantis announced he had uploaded his long-awaited health care plan to his campaign site.

"The bottom line is we have to make it more affordable for people," he told the audience. "We're focusing on affordability like a laser."

The entire health care segment of the hour-long debate? About five minutes.

That's perhaps emblematic of the Florida governor's race, which, in the days leading up to Nov. 6, has dwelled around a drip-drip-drip of new ethical questions surrounding Gillum's past trips as Tallahassee mayor with lobbyists and undercover FBI agents.

READ MORERecords show FBI agents gave Andrew Gillum tickets to 'Hamilton' in 2016

Yet in a state where more than 1 in 10 people do not have insurance, polls have shown health care is at the top of Floridians' minds.

Policy experts who took a closer look at DeSantis' health care plan said it lacks a clear way to lower costs and would leave more people uninsured than Gillum's proposal to expand Medicaid under the Affordable Care Act.

DeSantis' plan emphasizes that a patient should know how much their health care really costs, vowing to enforce a 2016 law that proposed a state website for patients to view health care costs at different facilities. The plan also suggests encouraging insurance companies to share their savings with customers by making "cash payments" to them — an idea one expert found unsatisfactory to truly reduce cost.

"There's nothing wrong with more transparency but knowing exactly how expensive it is does nothing to help Floridians who can't afford their hypertension medications or a woman who gets diagnosed with breast cancer and needs life-saving treatment quickly," said Joan Alker, a professor at Georgetown University who has published numerous reports about Florida health care policy.

"Everyone already knows that health care is expensive," she said.

As for Gillum's plan, his campaign sent a copy of a more detailed health care plan to the Times/Herald on Tuesday, which reiterated much of Gillum's stump speeches and, notably, called Medicare for All a "North Star" — a lofty aspiration worth pursuing.

But since the primary, Gillum has stepped back from Medicare for All, a Bernie Sanders-endorsed plan with a big price tag that would essentially create universal health care. DeSantis asserts such a plan will result in skyrocketing taxes.

Gillum has instead shifted to a more moderate approach: expanding Medicaid in Florida, an option allowed under the Affordable Care Act that would steer billions of federal dollars to cover an estimated 700,000 Floridians.

Experts said the Medicaid expansion would result in a greater reduction of the uninsured rate in Florida, compared to DeSantis' plan.

"More people would be covered by Medicaid expansion because of the holes in our system currently," said Steven Ullmann, a professor of health sector management and policy and the University of Miami.

As it stands now, able-bodied adults who don't have children are not eligible for Medicaid in Florida. Working parents cannot be covered under Medicaid unless their income is equal to or less than 30 percent of the poverty line. That amounts to about $7,275 in annual income for a family of four, according to the Florida Policy Institute.

Florida's Republican-controlled state Senate voted to expand Medicaid in 2015, but neither the House nor Gov. Rick Scott followed suit. Legislative leaders have already foreshadowed that unless Democrats take over the Florida Senate — which is possible but not likely — lawmakers will not cooperate with Gillum to expand Medicaid.

READ MOREMedicare for All? Even Medicaid expansion is unlikely, Florida Legislature says.

DeSantis has said he would not push to expand Medicaid.

"Expanding Medicaid would extend to able-bodied adults," he said in a statement. "That's not what Medicaid was designed for, that's not what taxpayers pay for, and that's not how healthcare or government should work."

Also at issue in the health care debate are insuring people with costly "pre-existing conditions."

In his more detailed plan, Gillum vows to sign a law "in his first Legislative session" that prohibits insurers from denying coverage or benefits for any pre-existing conditions.

DeSantis, too, has promised that if the Affordable Care Act's protections were removed by federal action, he would step in.

"Ron DeSantis believes that no person should be denied access to medical care based on the existence of a pre-existing condition. Period," wrote Stephen Lawson, a spokesman for DeSantis' campaign.

These statements are part of a national trend of Republicans embracing the protections for pre-existing conditions, arguably the most popular portion of the Affordable Care Act which many in Congress — including DeSantis — have worked to repeal. Their replacement bill, the American Health Care Act, did not pass last summer.

DeSantis' online plan addresses pre-exiting conditions by saying that should Congress repeal the Affordable Care Act, he would work as governor to create a robust insurance market that will provide Floridians insurance before they get sick.

But experts said that could leave some people out — like those who were born with pre-existing conditions.

"If I lived in Florida and I had a pre-existing condition… I would not find any comfort by what he says here," Alker, the Georgetown professor, said. "I would not feel at all protected."

Times/Herald Tallahassee bureau reporter Elizabeth Koh contributed.