PolitiFact Florida: Medicaid expansion would help many of the same people that LIP helps

Gov. Rick Scott doesn’t believe that growing Medicaid under the Affordable Care Act is a better plan than renewing the LIP fund.
Gov. Rick Scott doesn’t believe that growing Medicaid under the Affordable Care Act is a better plan than renewing the LIP fund.
Published May 18, 2015

Washington may favor expanding Medicaid, Gov. Rick Scott argues, but it won't help the people being served by the soon-to-expire Low Income Pool, called LIP.

Speaking to reporters, Scott said he doesn't share the U.S. Department of Health and Human Services' position that growing Medicaid under the Affordable Care Act is a better solution than renewing the current LIP fund. The LIP program, which mostly helps cover hospital costs for uninsured and underinsured patient visits, is set to expire June 30.

"The families that are covered through the Low Income Pool is a different group of individuals than are covered by Obamacare," Scott said.

We decided to check if Scott was right about those being two different sets of potential patients.

Given the context, we're taking "Obamacare" to mean Medicaid expansion. We contacted Scott's office, but it didn't elaborate. One of the chief arguments for Medicaid expansion is that it would cover uninsured Floridians, many of whom receive care at hospitals and clinics that then turn to the LIP program to offset costs.

The debate over Medicaid expansion and the loss of federal matching money for the $2.2 billion LIP fund has roiled the state Legislature this year. While the Senate wants a Medicaid expansion based on private insurance, the House refuses. Adding fuel to the fire is that Washington in 2014 said it would not renew the LIP, a temporary program funded since 2005 by state and federal taxes. That led to a billion-dollar hole in the budget and a standoff that requires a special session in June.

One of the primary arguments for expansion has been that more than 800,000 Floridians would be covered under a broader Medicaid program. The Affordable Care Act allows Florida to cover all adults with incomes below 138 percent of federal poverty level. (100 percent is currently $11,770 for an individual and $24,250 for a family of four.)

The pro-expansion side points out this means the hundreds of thousands of newly eligible Floridians would be able to enroll in Medicaid and have access to the physicians and preventive care it offers. Advocates say this would preclude the need for LIP money, as most of the uninsured who typically turn to emergency room visits for care would then be insured.

But just because you are uninsured doesn't necessarily mean you are poor enough to qualify for an expanded Medicaid.

The LIP fund helps reimburse care providers for services rendered instead of directly covering patients. That means it pays for anyone who is uninsured, whether or not they would qualify for Medicaid.

Experts told the Times that those who don't qualify for Medicaid would include undocumented immigrants and people above 138 percent of the federal poverty level without insurance. But that second group, at least, enjoys the benefit of being able to get subsidized policies if their incomes are less than 400 percent of the federal poverty level. Even if they don't choose to enroll in one of those policies, the option exists.

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It's also not right to say that potential Medicaid beneficiaries and those helped by LIP are mutually exclusive groups, as Scott makes it sound. Chances are that most of the uninsured making these uncompensated ER visits are the poorest patients, Harvard health policy professor Ben Sommers told the Times.

"Technically, yes, some portion of the people potentially served by the LIP would not be identical to the people covered by the ACA (Affordable Care Act)," he said. "But, in broad strokes, the main people who benefit from the LIP would benefit even more from the Medicaid expansion and ACA Marketplace coverage."

Florida has the second-highest total of low-income, uninsured adults in the nation behind Texas, so insuring them through Medicaid would mean hospitals would get paid for their services, those analysts said. It's much more effective than attempting to pay emergency bills after the fact.

"If you have insurance, you may know that you can get preventive care like vaccinations, mammograms or primary care," said Leighton Ku, director of the Center for Health Policy Research at George Washington University. "If there is only uncompensated care, more people are likely to skip preventive and primary care because they will worry about the cost … and only get care when they are quite sick and need emergency or hospital care."

Scott's comments that the families who are covered by LIP are a different group than those "covered by Obamacare" makes it sound as if the people who would qualify for Medicaid under an expansion are completely different from patients who leave hospitals with unpaid bills the LIP fund helps pay to providers. Health policy experts said that plenty of overlap exists between the two, especially at lower incomes. We rate the statement Mostly False.

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