Romano: Excuses are running low for Florida lawmakers who won't expand Medicaid

Published Jan. 29, 2015

So another holdout has fallen. Another state has seen the light.

Indiana's plan to use Medicaid expansion funds was approved by the federal government on Tuesday, bringing the total number of participating states to 28.

According to the Kaiser Family Foundation, seven more states are working on expansion plans, leaving Florida among a dwindling minority of health care agnostics.

And it's certainly an interesting crowd to be lumped in.

States that continue to reject federal funding to provide health care for needy residents are mostly Southern, typically rural and not especially cutting-edge.

For instance, what do Florida, Alabama, Oklahoma, North Carolina, Maine and Kansas have in common besides Medicaid rejection? They're all in the bottom half of states in median household income, according to the 2013 Census.

How about Florida, Idaho, South Carolina, South Dakota, Nebraska and Wisconsin? They all lag behind the U.S. average for percentage of residents 25 or older with bachelor's degrees, according to the National Center for Education Statistics.

And how about Florida, Texas, Louisiana, Mississippi and Georgia? They're among the states with the highest number of convictions of public officials in federal court from 1976 to 2010, according to the website

So we're taking a stand among the poor, uneducated and corrupt.

Obviously, I'm being facetious. And clearly, this is not a scientific survey of common characteristics among holdout states.

But the increasing number of states finding creative solutions to Medicaid expansion is making it harder and harder for Florida politicians to trot out excuses.

Once upon a time, former House Speaker Will Weatherford complained about the federal government's inflexibility. Well, it turns out D.C. is quite flexible on this issue. Arkansas, Indiana, Iowa and Michigan have all gotten waivers to use federal funds for health coverage outside the traditional Medicaid model.

So now, incoming House Speaker Steve Crisafulli, R-Merritt Island, is saying the House is philosophically opposed to expanding a broken system. Yet, once again, federal officials have allowed states to use funds to create their own health care systems.

There's also the argument from conservatives that free health care encourages government dependency among lower-income residents. But the Indiana program addresses that by requiring enrollees to contribute monthly payments for their coverage.

The excuses, it seems, are crumbling at the same time the incentives to expand are growing.

Florida businesses could soon be racking up federal fines if their employees do not have any form of health coverage. And a $1 billion fund that subsidizes hospitals for uninsured patients will soon disappear, putting those hospitals in a bind.

This probably explains why hospital groups and the Chamber of Commerce are starting to get more vocal about the (irony alert) inflexibility of Florida lawmakers.

The idea that the House isn't even willing to discuss this issue — which is what Crisafulli said repeatedly on Wednesday — is beyond absurd.

Two years ago, lawmakers insisted they would come up with an alternative solution to the federal Medicaid plan. Plenty of other states have provided excellent examples of alternatives, yet Florida politicians choose to hide behind discredited rhetoric.

Well, here is some rhetoric they might also consider:

If House members do not aggressively pursue health care reform as they said they would in 2013, then they are liars and frauds.