Editorial: Good start to conversation on Medicaid

New legislative leaders show a willingness to find ways to get more Floridians covered.
New Senate President Bill Galvano, R- Bradenton, says he wants to consider a Medicaid block grant for covering more Floridians. [Scott Keeler | Times]
New Senate President Bill Galvano, R- Bradenton, says he wants to consider a Medicaid block grant for covering more Floridians. [Scott Keeler | Times]
Published November 30 2018

With new leadership in Tallahassee, there’s fresh hope for Medicaid expansion to cover hundreds of thousands of low-income Floridians. Incoming Senate President Bill Galvano said this week he hopes Gov.-elect Ron DeSantis can leverage his relationship with the president to secure a Medicaid block grant for Florida, and new House Speaker Jose Oliva says he’s open to the idea. Block grants are not without problems, but it’s encouraging that new state leaders are looking for solutions to getting more Floridians insured.

Medicaid expansion has been a sore subject in Florida since a U.S. Supreme Court ruling left it up to states whether to expand the program with federal money under the Affordable Care Act. It’s a great deal that 37 states have embraced, including three red states where ballot measures passed this November. But Florida’s Republican leaders have refused to act, leaving only a stingy program that generally does not cover childless adults and ranks last nationally in Medicaid spending on children. Many doctors refuse to see Medicaid patients because the payments are so low, driving more patients to hospital emergency rooms and pushing up costs Republican lawmakers claim they’re trying to contain.

So it’s a breakthrough in itself that Galvano, a Bradenton Republican who has supported Medicaid in the past, told Politico that Florida should look into extending health coverage through a Medicaid block grant, which would likely require a waiver from the Trump administration. That’s not as good as expanding Medicaid through the normal channels under the Affordable Care Act, which insures more people in Florida than in any other state. And there are structural flaws with block grants, which allot a fixed amount of money that does not adjust for population growth. That can mean too many needy people are excluded from the program, or can lead to limits on care. They also don’t generally account for natural disasters such as hurricanes or the Zika outbreak. Galvano has acknowledged that pitfall, saying the state could “negotiate certain parameters” so the grant would not “ultimately be stagnant.”

It’s imperative that Tallahassee do something. The number of uninsured children in Florida jumped from 288,000 in 2016 to 325,000 last year, a 13 percent increase in just one year. In 2016, the U.S. Department of Health and Human Services reported that more than 300,000 uninsured Floridians suffering from mental health and substance abuse could get access to treatment if Florida would accept federal Medicaid expansion money. With opioid deaths continuing to spiral, the need for addiction treatment is only getting more urgent.

Medicaid expansion is long overdue in Florida, where nearly 800,000 people could be helped by accepting federal dollars. A block grant is by no means the best answer, and legislative leaders should not limit themselves to that option. But above all, finding a way to get more Floridians covered is a conversation worth having.