Advertisement
  1. News

PolitiFact Florida: Running the numbers on Medicaid expansion

FILE- In this Jan. 28, 2015 file photo, Florida House Speaker Steve Crisafulli, R-Merritt Island, speaks to the media during a pre-legislative news conference in Tallahassee, Fla. Senate President Andy Gardiner and House Speaker Steve Crisafulli are beginning their first legislative session as their chambers' leaders with a unified front and much in common. Both are conservative Republicans with business backgrounds who list faith and family among their highest values. (AP Photo/Steve Cannon, File) MH201
Published May 3, 2015

Even before the Florida House adjourned early, Speaker Steve Crisafulli laid blame for the session's budget impasse clearly on Medicaid expansion.

In an op-ed printed in the Tampa Bay Times, Crisafulli wrote that the Senate had "partnered with the Obama administration" to demand the expansion. But the House believed the move would drag people into a costly system that didn't work.

"Under federal law, other low-income Floridians have access to health care subsidies to buy private insurance for less than the average cost of a wireless phone bill," said Crisafulli, R-Merritt Island. "In fact, if we choose Obamacare expansion, 600,000 will lose eligibility for their subsidies, of which 257,000 would be forced into Medicaid. "

Estimates say the expansion would cover more than 800,000 people, many of whom are currently uninsured. We wondered where Crisafulli was getting his numbers.

Playing percentages

This subject can make heads spin pretty easily, so before we begin, let's review a few basics about the Affordable Care Act. The law's intent was to expand coverage to the uninsured through two ways. The first was to give subsidies to people who needed help to buy insurance through HealthCare.gov or a new state marketplace. The second way was to expand Medicaid, a state-federal insurance program for the very poor.

Medicaid expansion ended up being optional for the states, thanks to a 2012 Supreme Court ruling. This is what the Florida House and Senate are arguing about. The Senate wants to expand Medicaid so that recipients end up buying heavily subsidized insurance. The House doesn't want to expand Medicaid at all.

Crisafulli's numbers are based on how many Floridians would qualify for the expansion, which would be extended to all adults up to 138 percent of the federal poverty level (100 percent is currently $11,770 for an individual and $24,250 for a family of four). Technically the calculation is actually 133 percent under the law, but a 5 percent deduction is added on top of that.

If a state doesn't expand Medicaid, people who make 100 to 400 percent of the poverty level can get subsidies to buy insurance in a marketplace. These are the subsidies Crisafulli is talking about.

But if you qualify for Medicaid, you're not eligible for the subsidies. His argument is that if the state extends the program, the people between 100 and 133 percent of the federal poverty level will lose their subsidies to buy policies, and the House simply won't let that happen.

Crisafulli is using 2015-16 fiscal year estimates by the Florida Office of Economic and Demographic Research, which we examined. That projection says there are about 609,000 people in the 100 to 133 percent of poverty level range, and a little more than 351,000 of them have insurance of some kind. They get it through employers, Medicare or some other program, or buy insurance on their own (subsidized or not). Those people could enroll in Medicaid if they wanted to.

More than 257,000 have no insurance at all, and these are the ones Crisafulli is saying will be "forced into Medicaid." His office confirmed he meant they will be left without subsidies and will not make enough money to buy policies, so Medicaid will be their only option.

What it means

The Centers for Medicare and Medicaid Services and health policy experts largely agreed the numbers were plausible, but there are some points they said Crisafulli is sidestepping.

Foremost is the idea that 257,000 people would be "forced" to join the program. Ben Sommers, a health policy and economics professor at Harvard, said it's pretty tough for Crisafulli to imply those quarter-million people would be upset by suddenly qualifying for Medicaid.

"Giving uninsured people Medicaid is pretty popular among uninsured people," Sommers said. "There aren't any public opinion surveys I've seen in which low-income adults don't generally support the Medicaid expansion."

Crisafulli neglects to mention there are many Floridians who right now don't qualify for either Medicaid or federal subsidies, an estimated 669,000 people whose income is below 100 percent of federal poverty level. Those uninsured Floridians account for 18 percent of all Americans in the so-called coverage gap — second only to Texas. They would all benefit from Medicaid expansion by gaining coverage.

Overall, Crisafulli's numbers are on the mark. The state estimates that about 609,000 Floridians would lose access to subsidies to buy insurance under an expansion. About 257,000 of those people would be uninsured, likely because they're too poor to buy their own. The rest could enroll in Medicaid if they wanted to. His numbers can be considered accurate.

But experts tell us saying those people would be forced into the program isn't accurate. Many of the very poor would likely see becoming eligible for Medicaid as a benefit. We rate the statement Mostly True.

Read more at PolitiFact.com/florida.

ALSO IN THIS SECTION

  1. Stay with tampabay.com for the latest news and updates. Times
    Seth Monroe Majors, 31, died at Regional Medical Center Bayonet Point.
  2. Building sand mandalas will be offered each day throughout Peace Week at Pasco-Hernando State College's Porter Campus. JONES, OCTAVIO  |  Tampa Bay Times
    Peace Week 2019 will be Sept. 30-Oct. 4
  3. Check tampabay.com for the latest breaking news and developments.
    The shooting happened on the 5100 block of Matanzas Avenue, police said.
  4. Check tampabay.com for the latest breaking news and updates.
    Charges in the incident are pending, the Florida Highway Patrol said.
  5. Florida Gov. Ron DeSantis talks to reporters in Tampa on Aug. 21. Delays in his filling vacancies on the state's five water management district boards have twice led to those agencies canceling meetings to levy taxes and set budgets, which one expert said was unprecedented. OCTAVIO JONES   |   TIMES  |  Times
    Vacancies lead to canceling two agencies’ budget meetings.
  6. Jessica Stoneking, Seven Springs Elementary School art teacher, and a group of kindergarten children enjoy a colorful floor rug during instruction time.  The rug is one of the many flexible seating options art students have in Stoneking's class. Gail Diederich
  7. President Donald Trump listens to music by military musicians during a State Dinner in the Rose Garden at the White House, Friday, Sept. 20, 2019, in Washington. (AP Photo/Alex Brandon) AP
    Allies of Joe Biden, the early front-runner in the Democratic presidential primary, seized on the developments to portray him as the candidate Trump least wants to face next fall.
  8. Imam Askia Muhammad Aquil says religious leaders must be empathetic to the needs of families members of those who die by suicide. SCOTT KEELER  |  Tampa Bay Times
    Attitudes have evolved with understanding about mental illness
  9. Rabbi Reb Tuviah (Paul Schreiber) is rarely seen without his guitar. He will sing at the upcoming Rosh Hashanah and Yom Kippur services at Temple Beth David in Spring Hill. Paul Schreiber
  10. Joshua Michael Nichols, 21, was arrested by Pasco County Sheriff's deputies on Saturday in connection to the early morning shooting death of an unidentified man during an argument outside a Spring Hill home. [Pasco County Sheriff's Office] ANASTASIA DAWSON  |  Pasco County Sheriff's Office
    One person is in custody. The Pasco County Sheriff’s Office is investigating.
Advertisement
Advertisement
Advertisement