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Editorial: A glimmer of hope on Medicaid expansion

There is a glimmer of hope that the Florida Legislature and Gov. Rick Scott may finally come around and accept billions of federal dollars to extend health care coverage to up to 1 million Floridians.
There is a glimmer of hope that the Florida Legislature and Gov. Rick Scott may finally come around and accept billions of federal dollars to extend health care coverage to up to 1 million Floridians.
Published Dec. 20, 2014

There is a glimmer of hope that Gov. Rick Scott and the Florida Legislature may finally come around and accept billions of federal dollars to extend health care coverage to up to 1 million Floridians. A new proposal backed by a broad alliance of businesses and hospitals to accept the federal Medicaid money and use it to help pay for private insurance holds some promise. And for now, Republican lawmakers who have been the most steadfast opponents are at least willing to listen.

In Florida, that is what amounts to progress. The state should have accepted billions in Medicaid expansion money last year. The Senate voted 38-1 (Republican Sen. Jeff Brandes of St. Petersburg cast the only negative vote) for a plan to use the federal money to subsidize private insurance for low-income Floridians who cannot afford health coverage. Gov. Rick Scott was amenable. But House Speaker Will Weatherford of Wesley Chapel and his Republican colleagues refused to budge in 2013, and the issue was off the table in this election year.

The new proposal backed by the coalition "A Healthy Florida Works" is a version of the original Senate legislation. It would use the federal Medicaid expansion money to help pay for private insurance for Floridians who are now caught in a health care vice. They make too much to qualify for Medicaid now, but they make too little to qualify for federal subsidies that would enable them to better afford coverage on the federal health care exchange. Under the new proposal, Florida would create a state-operated marketplace where these residents could use the public money to choose among health plans. That is a reasonable approach, and the Obama administration has signed off on similar plans in Arkansas and elsewhere.

This latest effort comes as other states with Republican governors are looking past their opposition to the Obama administration and the Affordable Care Act to consider ways to accept the Medicaid money. Earlier this month, Republican Alabama Gov. Robert Bentley said after his re-election that he is open to accepting the Medicaid money to help pay for private insurance. Republican Govs. Matt Mead of Wyoming and Gary Herbert of Utah have offered similar plans since the election. Scott ought to have gotten the message by now that it is safe for Republican governors to act in the best interests of their state no matter how much they despise the president and health care reform. So far, 27 states have expanded Medicaid eligibility, and there is absolutely no reason why Florida should not join them.

In the past, Florida House Republicans have turned a deaf ear to arguments relying on compassion and the right of all residents to have access to health care. So the new effort to convince them to accept the Medicaid expansion money refocuses on the powerful economic argument. A Healthy Florida Works goes beyond pointing out the billions in federal dollars left on the table. It focuses on millions in other federal dollars earmarked for treating the uninsured that Florida hospitals are losing that could be replaced. Even after the state starts contributing to a Medicaid expansion program as the federal contribution declines, the group argues Florida would see a net savings by 2020 of more than $1.7 billion.

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To make the proposal more palatable to conservative lawmakers, the new proposal includes work- or job-training requirements and minimum payments for those who qualify for the subsidized insurance. Similar requirements proposed by other states have been rejected by the Obama administration, and they are not likely to pass muster for Florida. But at least such Medicaid expansion opponents as Rep. Richard Corcoran, R-Land O'Lakes, are now willing to listen to an alternative.

Give the Florida business community and the hospitals credit for not giving up on Medicaid expansion. This issue is too important for too many Floridians to quietly fade away, and the public effort should continue to build to persuade the governor and the Legislature to refocus on it in 2015.