With many Republicans saying they did not need to expand a “flawed” system, a Senate select committee turned down increasing many Floridians to the Medicaid program under the federal Affordable Care Act.
Senators said they need to look into a different plan that could allocate federal grants to assist uninsured low-income Floridians get coverage via private insurers. The select committee’s vote arrived after a House panel also turned down the Medicaid increase — despite Gov. Rick Scott’s support for the expansion.
“I oppose the Washington plan, and I want a Florida plan,” said Sen. Joe Negron, a Stuart Republican who is chairman of the select committee and offered a different path. “I think we have an opportunity to build a better program than what Washington is trying to force on us.”
The committee turned down the increase in a 7-4 vote. Democrats said the Affordable Care Act, referred to as Obamacare, created an opportunity to assist over a quarter of a million people get health coverage.
“We have a moral and economic responsibility to seize this moment for the good of Floridians,” said Sen. Eleanor Sobel, a Hollywood Democrat and vice-chairwoman of the select committee.
The likelihood of the Republican-dominated Legislature moving forward with the Medicaid expansion was squashed when House Speaker Will Weatherford, R-Wesley Chapel, and a House select committee openly went against it. But senators had not declared a definitive position until the vote.
Weatherford issued a statement giving credit to the Senate move and promising to focus on finding other solutions for offering health insurance to the state’s uninsured. The House speaker, in part, has questioned the future cost to Florida — though the federal government says it will pay all of the increased costs during the first three years.
“I look forward to working with Senate President (Don) Gaetz as we investigate options that will strengthen the safety net while also ensuring that we do not put future funding for our schools, public safety and protection of our beaches and springs at risk,” Weatherford said.
Scott, whose support of Medicaid expansion was strongly criticized by some supporters, gave a short statement quoting he is “confident that the Legislature will do the right thing and find a way to protect taxpayers and the uninsured in our state while the new health-care law provides 100 percent federal funding.”
The Affordable Care Act, which President Obama and congressional Democrats approved in 2010, calls for expanding Medicaid eligibility as a key part of its goal to provide health coverage to most Americans. The law would allow enrollment of people whose incomes are up to 138 percent of the federal poverty level and, in a major change for Florida, allow enrollment of childless adults.
While the federal government would pay 100 percent of the expense during the first three years, its share would eventually drop to 90 percent in 2020, with Florida picking up the rest of the tab. Analysts last week estimated that the expansion would cost the state about $3.5 billion over a decade — with the federal government paying about $51 billion.
Numerous details still need to be talked about the possible alternative plan that Negron presented to the Senate select committee Monday. But wide cast, it would make a voucher-like system for individuals to buy private health insurance.
The plan would target the same people who would be newly eligible under the Medicaid expansion and also would rely on federal money to help subsidize coverage. But instead of enrolling people in Medicaid, it would build on an already-existing program, the Florida Healthy Kids Corp., to offer coverage through private insurers.
Florida Healthy Kids provides subsidized private health-insurance to about 240,000 children of low- and moderate-income families, as part of the federal Children’s Health Insurance Program. Families pay $15 or $20 a month for coverage, with the state and federal governments subsidizing the rest of the costs.
Rich Robleto, executive director of Florida Health Kids, said the program’s structure could be broadened to also include the type of expansion discussed by the Senate select committee.
“It’s the kind of thing that we can do,” Robleto said. “It’s the kind of thing we have been doing for 20-something years.”
Florida lawmakers in 2011 approved a major overhaul of the Medicaid program that eventually will lead to almost all beneficiaries enrolling in HMOs and other types of managed-care plans. But the possible Obamacare alternative would be separate from that effort.
Negron said he will ask Gaetz, the Senate president, to send the possible alternative to another committee to work out details. But among the big questions are whether the federal government would go along with the concept and whether it would approve such moves as requiring enrollees to be charged co-payments for medical services — something Negron said he would like to see.
The Obama administration recently indicated it would allow Arkansas to funnel people into private coverage instead of Medicaid. But the Arkansas proposal, which has not been finalized, includes a crucial difference from the Senate idea: It would use health-insurance exchanges, which are part of the Affordable Care Act, to serve as the vehicle for people to sign up for private coverage.
Despite seeing Republicans vote down the Medicaid expansion, Senate Democrats issued a statement after Monday’s meeting that appeared to indicate support for the possible alternative. That statement noted that the alternative would also address many of the goals of the Medicaid expansion.
“Although Republicans voted against what they called ‘traditional Medicaid expansion’ they turned around and endorsed a program that still relies on the same federal dollars and still extends affordable health care to 1 million Floridians,” Senate Minority Leader Chris Smith, D-Fort Lauderdale, said. “Whatever name they opt to give the program, the bottom line is that money allocated by the federal government for Medicaid expansion will be the mechanism. In the Senate, the remaining question is no longer ‘if,’ but ‘who.’ ”
But Senate Republicans, who have long complained about the costs and size of Medicaid, sought during the meeting to distance themselves from a potential expansion of the program.
“I think fixing health care is not expanding a broken system,” said Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach. “Medicaid … it’s not good.”