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Editorial: Compelling case for taking Medicaid money

 
Published Dec. 15, 2015

Gov. Rick Scott and state legislators portray themselves as responsible stewards of taxpayer money, fiscal conservatives determined to cut costs, spend wisely and help the private sector flourish. Accepting billions in federal Medicaid expansion money to help provide private health coverage to more than 800,000 Floridians would fit nicely with that philosophy. A new coalition of businesses has presented a reasonable way forward, and the governor and state lawmakers should embrace it.

The proposal by A Healthy Florida Works resembles a bipartisan plan approved 38-1 by the Senate two years ago but rejected by the House. It calls for accepting the federal Medicaid expansion money and using it to help pay the cost of private insurance for Floridians who earn too much to qualify for Medicaid now but too little to qualify for a federal subsidy to help pay for private insurance on the federal marketplace. To address lawmakers' concerns about personal responsibility, the proposal calls for modest premium payments and requires those covered to be working, looking for work or enrolled in education programs. Some of these issues would have to be worked out by state legislators and approved by the Obama administration, but the plan is a promising starting point.

The case for taking the money and insuring more Floridians is even more compelling since the Legislature failed to act two years ago. Now 28 states have accepted Medicaid expansion money, including 10 with Republican governors. The demand for health coverage in Florida is even clearer, as more than 1.6 million Floridians have signed up for coverage through the federal marketplace — the most from any state. And this state already has lost out on at least $10 billion in federal Medicaid expansion money by failing to act.

The economic argument has an added sense of urgency. At the end of June, the state will lose more than $1 billion in federal money that is matched by state and local dollars, then used to help cover the cost of treating the uninsured and underinsured at hospitals and community health centers. The Obama administration has made clear it will not extend those payments again, and hospitals such as Tampa General and BayCare, Tampa Bay's largest hospital group, stand to lose tens of millions of dollars. They cannot eat that loss, and it would be foolish for the state to make up the difference when federal Medicaid expansion dollars are available to cover the same residents.

In fact, the Healthy Florida Works coalition estimates accepting the Medicaid expansion money would save the state more than $637 million in 2015-16 by covering existing costs for treating the poor and reducing costs for substance abuse and mental health programs. Over five years, the total savings in state dollars would grow to more than $1.7 billion. That is general tax money that could be spent on public schools, social services and other priorities.

The Floridians who would receive health care through a system funded by the Medicaid expansion money are generally not slackers. They are childless adults who aren't covered by Medicaid now and earn less than $16,138 a year. Or working parents who earn less than $32,923 a year in a family of four. They are tree trimmers and child care workers, restaurant staff and hotel maids working to get by and hoping they don't get sick.

If helping working Floridians stay healthy and productive is not a compelling argument, then legislators should look at the bottom line as the annual session starts. Accepting Medicaid expansion money would bring billions of federal dollars to the state, avoid a financial crisis for hospitals — and save the state a half-billion dollars in the next year. It would be financially foolish for Republicans to keep rejecting the money to make a political point.