Romano: All those reasons against expanding Medicaid? Still wrong

Published Dec. 8, 2013

The question of Medicaid expansion in Florida — Pffft, who needs $51 billion? — returned to the headlines last week.

There was a study released by the Commonwealth Fund, a nonprofit group that researches health policies, that pointed out how you and I are paying for a boatload of health coverage in a bunch of states not named Florida since we're not expanding Medicaid here.

And there was an op-ed piece written by state House Speaker Will Weatherford in response to an uncomplimentary blog post that appeared in the Florida Times-Union.

The Weatherford column led to two interesting thoughts:

1. The Republican from Wesley Chapel is not thrilled about continually being singled out as the man most responsible for denying health coverage to 800,000 or so Floridians.

2. He still can't justify his position.

You might point out that second thought is clearly subjective, and I completely agree. So I'll summarize Weatherford's four reasons for denying Medicaid expansion, and let you decide for yourself if my conclusion is wrong.

Reason No. 1: Medicaid is a flawed system.

This argument has the benefit of being accurate.

But what it gains in accuracy, it loses in relevancy.

To suggest that all uninsured residents living below the poverty level would turn their nose up at health coverage — even flawed coverage — is either clueless or heartless.

This would be like denying a starving person a burger and fries because fast food is too fattening.

Reason No. 2: Promises are unbelievable.

This also will have people nodding their heads. Considering the abysmal rollout of the Affordable Care Act and the president's empty promise about everyone being able to keep their insurance, there's a ton of skepticism out there.

Weatherford argues that he does not trust the federal government will pay for 100 percent of the Medicaid expansion for the first three years, and 90 percent after that. He quotes a congressman who says Medicaid will be vulnerable to spending cuts in Washington.

That sounds ominous except for this:

The Affordable Care Act is law. No matter how much House Republicans have tried to defund it (Anyone for another government shutdown?), it has not gone away.

Even if Republicans regain the White House and the Senate, a Florida plan would have permitted the state to opt out of Medicaid expansion down the road. This, in effect, makes it a risk-free offer.

Reason No. 3: State's struggles.

Paying for Medicaid, Weatherford argues, will cut into the money Florida uses for education, the prison system and the environment.

This argument is faulty on a couple of levels.

First of all, the nonpartisan Congressional Budget Office has determined providing health coverage — even subsidized health coverage — saves money because it eliminates costly hospital safety net fees and provides preventive medicine.

And, once again, if Florida decides after three years that expanded Medicaid isn't working, it is free to opt out without spending a penny.

Reason No. 4: A poor choice.

Weatherford's rationale here is a bit disjointed, but one of his main points was that the federal government was offering an "all or nothing'' approach.

This is what is known as a crock.

State Sen. Joe Negron, R-Stuart, crafted a plan that would accept Medicaid funds to be used to purchase private insurance plans for low-income Floridians. Arkansas had a similar plan with the blessing of the federal government.

This completely eliminated all the squawking about inferior Medicaid coverage, it kept Florida from losing $51 billion in federal funds, it meant all kinds of high-paying jobs in the medical field and, best of all, it provided health coverage for an additional 1 million Floridians.

The Florida Senate approved the plan in a 38-1 bipartisan vote.

Weatherford and the House killed it.

For him to claim otherwise seven months later is revisionist history. It is nonsense. Most of all, it is unseemly for a politician to lack the courage to acknowledge the decisions he continues to make.