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Saturday, Dec 20, 2014
Commentary

Medicaid expansion should be a no-brainer for Florida

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The Florida Medical Association, the politically powerful lobbying organization that represents the state’s doctors, recently approved a resolution endorsing Medicaid expansion for Florida’s low-income uninsured.

What’s mind-boggling is why the FMA didn’t take a stance earlier, like perhaps during the past two legislative sessions, to convince the reluctant governor and legislative leaders to accept federal funding for the expansion.

Perhaps it’s because the Florida House is adamantly opposed to expanding coverage to the large number of low-income adults. Or maybe the FMA didn’t want to offend Gov. Rick Scott, who has been straddling the fence on the issue.

To their credit, Senate leaders were more responsible. They proposed legislation to buy private insurance for those who would be newly eligible. The senators even reached out to the U.S. Department of Health and Human Services to obtain the flexibility to use the federal funds this way.

Nearly a million Floridians who could benefit from health-care coverage are being denied despite the federal government’s proposed infusion of $51 billion to Florida over the next 10 years.

I’m no expert on health care, but let me attempt to provide a basic explanation to clear up some confusion. Unlike Medicare, a federal program that provides health-care coverage to the nation’s elderly, Medicaid is a joint program between the federal and state government to provide health-care coverage to low-income adults.

There is a legitimate concern over the ability of the state to eventually pick up a larger share of the costs, but it has been exaggerated. Federal funds would cover 100 percent of the costs of the expansion for the first three years, and the state would be responsible for a small percentage after that — only 10 percent in 2020.

As unemployment and underemployment continue to decrease, there should be a corresponding decline in enrollees, as many of these newly qualified are among the ranks of the working poor. Medicaid expansion changes the eligibility from those earning 100 percent of the federal poverty level to 110 percent or roughly $16,000 a year.

It’s estimated that 848,000 Floridians are without health insurance because they don’t qualify for Medicaid and are too poor to qualify for the federal tax subsidies available under the Affordable Care Act.

Under the comprehensive legislation often referred to as Obamacare, the states were required to expand Medicaid coverage in order to get more people insured. Those enrolled in Medicaid would not be eligible for private health insurance subsidies.

But something unexpected happened. In the numerous legal challenges to the ACA, the U.S. Supreme Court ruled the insurance coverage mandate was constitutional, but justices did throw the 26 states that were suing a bone: They ruled states could opt out of expanding Medicaid coverage and decline the federal funding.

It’s hard to believe that states would refuse to go along with the health law’s Medicaid expansion when the needs of their people were so great, but two-dozen states decided to do just that. Not surprisingly, politics played a role. The states that declined expansion, or have not yet acted, were generally led by Republican legislatures or governors, like in Florida.

This left a huge number of uninsured in the position of not qualifying for subsidies for private health insurance even though they earned less than those who would qualify for the subsidies. If all the states agreed to expansion, this gap would not exist.

Without coverage, these folks would not be denied care but would likely access it through hospital emergency rooms that are the most expensive delivery system to dispense that care. This also creates a logjam for those in need of emergency care.

From an economics perspective, declining to expand Medicaid just doesn’t make any sense. Hospitals will have to foot the bill or pass it off to Florida taxpayers, and small businesses would be on the hook for providing health insurance to low-wage employees who aren’t covered by Medicaid.

The $51 billion in federal funding would boost our economy and create thousands of jobs. Some estimates say 63,000 jobs would be generated.

Maybe that’s why the Florida Chamber of Commerce, insurance companies, hospitals and now the FMA support Medicaid expansion, as do 58 percent of Florida voters, according to one poll.

It’s time to put aside petty, political, partisan differences. The governor should get off the fence and call his Legislature into session to expand Medicaid. It’s the right — and smart — thing to do.

Paula Dockery is a syndicated columnist who served in the Florida Legislature for 16 years as a Republican from Lakeland. She can be reached at PBDockery@gmail.com.

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