Editorial: Case for Medicaid expansion gets stronger

When the Florida Legislature meets in its June special session, the most responsible action to take is to adopt the Senate’s bipartisan plan for accepting federal Medicaid expansion funds.
When the Florida Legislature meets in its June special session, the most responsible action to take is to adopt the Senate’s bipartisan plan for accepting federal Medicaid expansion funds.
Published May 21, 2015

Now the urgency is even greater for Florida to accept billions in federal Medicaid expansion money and provide private health coverage to more than 800,000 Floridians. The Obama administration signaled Thursday it is prepared to cut by more than half the federal money it sends to an account that helps hospitals cover the cost of treating the uninsured. That reaffirms that the most fiscally and morally responsible action for the Legislature to take in its June special session is to adopt the Senate's bipartisan plan, accept the Medicaid expansion money and transform how poor people get medical care.

The letter to the state from Vikki Wachino, the director of the U.S. Centers for Medicare and Medi­caid Services, provides badly needed clarity in advance of the Legislature's special session. It indicates the federal government is willing to keep sending significant money to a smaller Low Income Pool to help cover hospital costs for treating the uninsured. That's encouraging, but the letter also says the appropriate size of that LIP account for 2015-2016 would be $1 billion, less than half its current size. Left unsaid was the exact federal contribution to the account, which includes local and state money. But using traditional calculations, Washington would contribute about $600 million rather than the $1.3 billion it sent this year.

The bottom line: Hospitals including Tampa General Hospital, Morton Plant Hospital in Clearwater and St. Anthony's Hospital in St. Petersburg still would be hundreds of millions short. The state would have to spend most of its expected surplus revenue to fill the gap if Gov. Rick Scott and House Republicans continue to oppose accepting the Medicaid expansion money.

It's the wrong approach for Florida taxpayers, who should not be backfilling a hole with their state tax dollars that could be filled by federal dollars. It's the wrong approach for uninsured Floridians, who still would be seeking care in expensive emergency rooms rather than using private health insurance to pay for regular doctor visits and preventive care. And it's the wrong approach for anyone who wants Florida to invest more in improving public education, protecting the environment or building infrastructure.

If Scott and the Legislature resort to the quick fix, they would face a bigger problem next year. The CMS letter suggests that the Low Income Pool would further shrink in 2016-2017, to about $600 million. The obvious reason: The federal government estimates the pool would be roughly a quarter of its current size because the rest of the hospital costs for treating the poor could be covered through Medicaid expansion or other ways.

"Coverage rather than uncompensated care pools is the best way to secure affordable access to health care for low-income individuals, and uncompensated care pool funding should not pay for costs that would be covered in a Medi­caid expansion,'' the CMS letter says.

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It does not get clearer than that.

Yet Scott has flip-flopped on Medicaid expansion and now opposes taking the money, sued the federal government (again), suggested hospitals share profits to make up for less Low Income Pool money, appointed a phony commission that includes no hospital executives to investigate hospital finances, and unsuccessfully plotted to keep Medicaid expansion off-limits during the Legislature's special session.

Floridians deserve better. The Senate has a sensible plan to accept Medicaid expansion money and use it to help pay for private coverage for low-income Floridians. The federal government has signaled it will work with the state on a smooth transition by continuing to send significant money to the Low Income Pool. Now it's up to taxpayers, business owners and the medical community to persuade the House to embrace the Senate's proposal — and tell the governor to get out of the way.