1. Opinion

Dockery: Florida Senate shows leadership on Medicaid expansion money

Published Apr. 9, 2015

If you could help 800,000 low-income working Floridians gain health care coverage at no cost to state taxpayers, would you? The Florida Senate would — but they have no dance partner.

The Florida House, or at least the leadership of the House, adamantly refuses to do so and Gov. Rick Scott has reversed course once again on the issue.

Scott is pouting over a recent trip by two influential state senators, Rene Garcia and Garrett Richter, to discuss their version of Medicaid expansion with federal officials at the Centers for Medicare and Medicaid Services.

The senators reported back that their meeting was positive, and they felt optimistic that CMS would show flexibility with the Medicaid guidelines for the $51 billion expansion in Florida. The governor and the Florida Legislature could be well on their way to offering health care coverage to nearly a million working poor in the state.

Wow! Great news! Pop the cork!

Not so fast. Let's review.

We have between 800,000 and a million Floridians who don't currently qualify for Medicaid and fall into a gap where they also don't qualify for subsidized health care coverage under the Affordable Care Act. A provision of the federal law envisioned that states would accept federal dollars to pay for the folks who fall into that gap by expanding Medicaid eligibility. Many states — 28 so far and some with Republican governors — have gratefully and wisely agreed to do so.

Other states, like Florida, have refused to do so despite the fact that many would directly benefit and other Floridians would indirectly benefit through reduced medical costs to treat the uninsured. Hospitals — which cannot turn away the uninsured — would also benefit. They have joined with other health care providers, businesses and business groups to make the case for taking the expansion dollars and creating a market-based program.

The coalition A Healthy Florida Works received a warm welcome in the Florida Senate, where senators saw a problem and found a solution that would allow Florida to access the funding but offer the flexibility to modify how we implement Medicaid coverage.

Taking the federal funds is a no-brainer. While polls show the vast majority of Floridians support taking the federal money to extend health care coverage to the working poor, some of Florida's elected officials in positions of power are dug in against doing so.

And this year the federal Low-Income Pool funding, which has been going to hospitals to reimburse them for treating this same group of people, is being phased out. Shouldn't that factor into their decisionmaking and budget writing?

The Low Income Pool helps pay for uncompensated care. The federal government has said that the program, which expires in June, won't be renewed. Those who think we can't afford to insure more people ignore the fact that we pay anyhow.

Despite the fact that Washington has repeatedly told Florida that $1 billion in LIP funding is going away, the Florida House and the governor continue to include it in their budgets and continue to believe the feds will change their minds.

Interestingly, neither the House nor the governor has a problem taking federal funds to pay hospitals to treat the low-income uninsured. Why then do they have a problem taking federal money to insure those same folks?

Kudos to Senate President Andy Gardiner, President Pro Tempore Garrett Richter, Majority Leader Bill Galvano, Health Care Appropriations Chair Rene Garcia, Health Care Policy Chair Aaron Bean, Rules Chair David Simmons, Appropriations Chair Tom Lee and Minority Leader Arthenia Joyner for crafting, supporting and advancing a bipartisan plan to expand health care coverage.

The Senate — acting responsibly and rationally — passed legislation to fill a $2 billion hole in the state budget and provide a sense of financial security to the working poor. Its actions also help hospitals and businesses that would suffer and perhaps close due to the financial burdens of treating the uninsured without payment or reimbursement.

The House Republicans have painted themselves into a corner. They have maintained the same position since the Medicaid funds were first offered. However, this year the lack of LIP funding — along with the corresponding financial difficulties it presents for many community and not-for-profit hospitals — should have opened the issue up for re-examination.

Instead, one of the most powerful House members declared war on the issue and vowed not to give in to the Senate.

And as for Scott, over his four years in office, he was against it before he was for it before he was against it again.

Sen. Rene Garcia recently said, "The only one that has shown any leadership in this process this session has been the Senate."

I agree.

Paula Dockery is a syndicated columnist who served in the Florida Legislature for 16 years as a Republican from Lakeland. She can be reached at


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