Editorial: No time to wait for Medicaid, or alternative

The legislative session is half over, and lawmakers have yet to decide if and how they will expand health care to uninsured Floridians of modest means under the Affordable Care Act. All that is at stake is health care for roughly a million low-income Floridians and more than $50 billion in federal money. House Speaker Will Weatherford and his Republican colleagues who are so rigidly opposed to expanding Medicaid have a moral and financial obligation to find an alternative that is at least as responsible.

Sen. Joe Negron, chair of the Senate Appropriations Committee, has offered a promising alternative that would direct low-income adults into government-subsidized private health insurance. The Stuart Republican's approach has pluses and minuses, and it depends on the Obama administration agreeing to redirect federal funding designated for covering new Medicaid enrollees. But if the administration ensures that the plan is a true medical safety net of the sort that Medicaid provides, it would be a reasonable alternative.

Because the U.S. Supreme Court gave states the choice to opt out of Medicaid expansion, Florida and other primarily Republican-led states are refusing to embrace it. There is no reasonable case for rejecting expanded Medicaid. It is so clearly the right policy that Gov. Rick Scott, a staunch opponent of the Affordable Care Act, has endorsed it. Yet Weatherford and his allies in the Legislature have turned their backs on their constituents and refused to expand Medicaid. At least Weatherford now hints he might be open to accepting the federal money for an alternative.

Of the competing substitute plans, only Negron's is palatable. The one sponsored by Sen. Aaron Bean, R-Fernandina Beach, SB 7144, would do little to cover some of the neediest adults in the state and doesn't use the federal money. It is a cheap alternative that offers too few benefits, and it is no substitute for the Medicaid expansion.

Negron's "Healthy Florida" program would use the federal Medicaid expansion dollars, estimated at $55 billion over 10 years. It would almost fully subsidize private health insurance for Floridians who earn up to 138 percent of the federal poverty line, or $15,586 for individuals.

There are some clear benefits to Negron's proposal. Low-income Floridians with government-subsidized private insurance would have access to the same doctors as other privately insured patients. Since some health professionals refuse Medicaid patients due to low reimbursement rates, this might expand access to services.

Negron calls this premium assistance for people who go to work every day. He envisions that patients would pay a modest monthly premium and small co-payments on a sliding scale based on income. The Obama administration seems open to this approach, but the administration should tread carefully and ensure that Florida doesn't require enrollees to contribute beyond their financial ability. Even small sums of $15 or $20 per month could be too expensive for some. That would defeat a key purpose of the federal law, which is to encourage people to get preventive care and seek medical attention before it becomes an emergency.

There are four weeks left in the legislative session, and lawmakers should not leave Tallahassee without expanding Medicaid or agreeing on a reasonable alternative. Floridians who need health care cannot afford to wait any longer.