Editorial: Women, minorities pay for Florida's failure to expand Medicaid

SCOTT KEELER   |   Times (2019) The Florida Capitol.
SCOTT KEELER | Times (2019) The Florida Capitol.
Published May 31, 2019

The practical consequences of the Florida Legislature's partisan opposition to expanding Medicaid are coming into sharper focus, and women of child-bearing age and minority residents are suffering the most. It's a stubborn Republican position that is not family friendly and does not reflect Florida's diversity, and voters should demand better. Now they have even more facts to reinforce their argument.

A study recently released by the Georgetown University Center of Children and Families reflects the stark difference between Florida and the three dozen states that have embraced Medicaid expansion. In the states that have accepted Medicaid expansion, the average uninsured rate for women ages 18 to 44 is 9 percent. In Florida, the uninsured rate for these women is 19 percent. That gap alone should embarrass every state legislator, regardless of party affiliation.

Here's another sobering revelation from the study. As the Tampa Bay Times' Justine Griffin recently reported, states that expanded Medicaid saw a 50 percent greater reduction in infant mortality compared with states such as Florida that did not expand Medicaid. In the 1990s, the late Gov. Lawton Chiles made reducing infant mortality a top priority. It hasn't been much of an issue in Tallahassee since.

The link between better health care for women of child-bearing age and healthier babies has long been established. The Georgetown report cites studies showing better access for prenatal care for poor women in Medicaid expansion states and more opportunities to reduce risk factors such as heart disease and diabetes prior to pregnancy. Maternal mortality rates also have dropped in Medicaid expansion states. Whether greater access to health care for low-income residents produces concrete benefits should not be a question.

The failure to enact Medicaid expansion also disproportionately affects minority residents. The Georgetown report notes the Journal of the American Medical Association says "African-American women are nearly three times as likely to die of complications related to pregnancy and childbirth compared with white women.'' The uninsured rate among nonelderly black residents is 8 percent in Medicaid expansion states but 14 percent in states that do not have Medicaid expansion. This should be a top 2020 election issue for all voters, but particularly for voters in low-income minority neighborhoods.

To be fair, Florida's uninsured rate for women of child-bearing age declined by 10 percentage points between 2013 and 2017. But 13 other states had larger declines, and every one of those states are Medicaid expansion states. Imagine if state legislators did the right thing and embraced Medicaid expansion that would cover an additional 800,000 Floridians and would cost the state just a $1 for every $9 paid by the federal government.

It doesn't have to be this way. Six years ago, the Florida Senate voted 38-1 to accept Medicaid expansion money to subsidize private insurance for low-income residents. Then-Gov. Rick Scott was amenable, but the Republican House leadership refused to budge. That intransigence has cost the state tens of billions in federal dollars.

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Still the standoff continues in Tallahassee, with the Democrats' arguments for supporting Medicaid expansion falling on deaf ears. Instead of embracing Medicaid expansion, House Republicans passed new work requirements for current Medicaid recipients that the Senate fortunately did not take up. Attorney General Ashley Moody has kept Florida as a plaintiff in a federal lawsuit that seeks to overturn the entire Affordable Care Act, which includes Medicaid expansion. The Legislature voted to deregulate new hospital construction and expansions, which will not make health care more affordable or accessible for poor people.

As the Georgetown study reaffirms, Floridians are paying the price for this state's failure to embrace Medicaid expansion. Other states continue to see the light. When will Florida?