Florida House rejects Senate's health insurance expansion plan

Rep. Richard Corcoran, R-Land O’Lakes, left, confers with Rep. James Grant, R-Tampa, during the debate on Friday.
Rep. Richard Corcoran, R-Land O’Lakes, left, confers with Rep. James Grant, R-Tampa, during the debate on Friday.
Published June 6, 2015

TALLAHASSEE — The Florida House rejected a Senate bill to expand health insurance coverage to thousands of Floridians on Friday, putting a temporary end to a bitter and divisive legislative fight that saw no winners.

Aided by the threatened veto of Gov. Rick Scott, the GOP-majority House voted 72-41 to kill a long-shot attempt by Senate Republicans to find a way to draw down federal Medicaid money to augment health insurance for hundreds of thousands of low-income working Floridians.

After nearly seven hours of debate in special session, House Republicans rejected the plan that required federal approval for a never-before sought waiver under a privately run health insurance plan called the Florida Health Insurance Exchange, or FHIX.

The uncertainty of the waiver's success, and the philosophical opposition to accepting federal dollars for a safety net program for the working poor, was antithetical to the conservative ideals of the lawmakers that run the House.

"This is not the best policy for Florida,'' said Rep. John Wood, R-Winter Haven, who urged lawmakers to reject the bill "not to oppose a president or party, but to oppose an ideology that has failed for decades."

"Medicaid is socialized health care insurance,'' said Rep. Jason Brodeur, R-Sanford, noting the Senate plan creates "permanent dependency" on handouts for "able-bodied childless adults," and props up a broken health care system.

Four Republicans in vulnerable districts, most with large numbers of uninsured, sided with Democrats to support the plan — Reps. Shawn Harrison of Tampa, Rene Plasencia of Orlando, Ray Pilon of Sarasota and Holly Raschein of Key West. None spoke during the lengthy debate.

The House's failure to take up the Senate's call for a long-term solution to the state's uninsured during the regular session led to a stalemate and the need this week to reconvene a special session.

The defeat in the House came despite an intense push in favor of the Senate's plan by consumer groups, business leaders and a television ad campaign run by a consortium of hospitals and health care organizations.

It also came with no alternative plan in place, prompting lawmakers to acknowledge they will be back within months dealing with the burdens of the uninsured in next year's budget. Lawmakers return in January for the 2016 session. It was moved up to accommodate the March 2016 presidential primary.

"Let's come together and let's focus on care reforms that actually make access synonymous with coverage,'' said Rep. James W. Grant, R-Tampa, adding he is "prepared to lose my job" over his vote opposing the bill.

The week began with a last-ditch effort by senators to try to appease opponents in the House by moving away from traditional Medicaid expansion, while shifting incentives for the uninsured from expensive emergency room care to lower-cost prevention through primary care.

Under the FHIX plan, low-income Floridians could have purchased subsidized private insurance from either a new state exchange or the federal exchange under the Affordable Care Act. It would have been paid for with Medicaid expansion money.

Several opponents continued pointing out flaws in the bill, but no one accepted the Senate's invitation to draft amendments to fix them.

Rep. Carey Pigman, R-Sebring, an emergency room doctor, said the bill will do nothing to discourage people from using the emergency room as primary care.

"It's costly for patients. It's costly for providers,'' he said. "It simply expands Medicaid coverage with state and fed money thereby allowing additional borrowed money to flow into a delivery system. Coverage does not necessarily equal access and access does not necessarily equal health improvement."

Others warned that the federal government will never approve the requirement that anyone who obtains the insurance show they are working, getting job training or have an exception to those requirements.

"What's positive about this bill will never be approved, but the taxpayers of this state will have a hook in their mouth for years to come,'' said Rep. Paul Renner, R-Palm Coast.

House Democratic leader Mark Pafford of West Palm Beach said much of the warnings "were battling a demon that doesn't exist."

"If FHIX is not the answer, then what is,'' he asked. "We'll be back and we'll be talking about the same issue because it's going to haunt the state of Florida."

Democrats told personal stories of being uninsured or tales of constituents struggling to get coverage.

Rep. Shevrin Jones, a West Park Democrat, spoke of being hospitalized with a rare blood condition and having no insurance.

"I wanted to work,'' he told his colleagues, who have rejected offering insurance to the "able-bodied" and childless men and women who are among the state's uninsured who could be covered by the Senate plan.

"Trust me, there are individuals that want to work but can't work right now,'' he said. "Yeah, put politics aside, but open your hearts just a tad bit."

Others criticized the governor and House for assuming the federal government won't approve the plan unless they ask.

"It's sort of like not taking your heart medicine because you're waiting for a heart transplant,'' said Rep. José Javier Rodriguez, D-Miami. "We have to deal with what Florida needs."

Rep. Lori Berman, D-West Palm Beach added: "It's disingenuous to reject these federal dollars for health care while requesting federal care for other uses."

The conflict now turns to how much lawmakers will spend in surplus funds to soften the blow for hospitals that provide charity care for the uninsured. Hospitals had relied on what is known as the Low Income Pool.

After warning Florida for more than a year that it was phasing out the LIP fund, the federal Centers for Medicare & Medicaid Services announced May 21 that the state would get only $1 billion of the $2.2 billion it received last year. Hospitals warned that the lost revenue could reduce services and staff at hospitals that serve the uninsured.

House and Senate leaders announced Friday they will begin conference negotiations over the weekend to complete the budget by the June 30 deadline. Each has said the state will have to spend millions in general revenue to offset the lost federal money.

Contact Mary Ellen Klas at Follow @MaryEllenKlas.