1. Opinion

Florida needs Medicaid expansion

Published Jan. 5, 2013

To his credit, Gov. Rick Scott is ready to thaw his relationship with the Obama administration over health care reform. After fighting the Affordable Care Act and losing at the U.S. Supreme Court, Scott is meeting Monday with Kathleen Sebelius, secretary of Health and Human Services, to discuss the law and aspects of its provisions for Medicaid expansion. The Supreme Court gave states the option to accept or decline the expanded entitlement, but if Florida opts out it would deny coverage to more than 1 million residents and give up billions of dollars in federal money. There is only one right answer.

For a large portion of Florida's nearly 4 million uninsured, 2014 cannot come soon enough. People will have access to affordable health insurance options on online exchanges, and under the Medicaid expansion an additional 1.2 million Floridians would qualify for the federal-state program, according to a study by the Kaiser Commission on Medicaid and the Uninsured.

Embracing the Medicaid expansion would be a humane step and a practical one. With a minimum investment from the state, Florida could get more uninsured covered and billions of federal dollars flowing annually into the state's health care sector. Under the health care reform law, the federal government shoulders 100 percent of the cost of Medicaid expansion from 2014 through 2016. After that, the percentage of the federal responsibility slowly drops until it hits 90 percent in 2020 and beyond. Under the law, the states will not be responsible for any more than 10 percent of the cost of Medicaid expansion going forward.

But Scott has argued that Florida cannot afford to expand a program that has been eating an ever larger share of the state budget. Using new numbers from the state Agency for Health Care Administration, Scott claims the cost for taxpayers of the expansion is $63 billion over 10 years, with Florida's share at nearly $26 billion.

This figure is just plain wrong. In August, state economists estimated that Medicaid expansion would cost Florida taxpayers $8 billion over 10 years. It's ridiculous to think that cost estimates have more than tripled since the summer. In fact, Florida legislative staff charged with estimating the cost to the state of the Medicaid expansion question the accuracy of the $26 billion figure. In an email exchange, the budget chief of the House Health Care Appropriations Subcommittee and Amy Baker, the Legislature's chief economist, tell a staffer at the Agency for Health Care Administration that the agency's figure makes a faulty assumption that the federal government won't cover the cost of the Medicaid expansion to the extent the law requires.

Scott has his own opinion on the wisdom of government covering health care for the poor, but he doesn't get to make up his own facts on what it would cost. Expanded Medicaid is a bargain for the state. Sebelius should be wary of the governor's inflated numbers, and Scott should use Monday's meeting to get all of his questions answered and find a way to make this work for Florida.