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Monday, Dec 18, 2017
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Fragile peace keeps Medicaid expansion off Legislature’s agenda

Chad Riese is one of more than a million Floridians shut out of affordable health care because state lawmakers are in a stalemate over Medicaid expansion.

Riese, 23, said he was diagnosed with epilepsy two years ago.

But the University of South Florida graduate can’t afford the care he needs for his seizures. He makes too much money to qualify for traditional Medicaid, the joint federal-state health care program for the poor, and not enough to buy health insurance.

As a result, Riese says, he’s now weighed down by about $100,000 in medical care-related debt.

“As someone who just got out of school, I’m just asking for a little bit of help,” he said.

Riese and others likely won’t get help because keeping the peace between the two Republican-controlled chambers of the state Legislature overrides the prospect of an ugly fight in a 60-day session.

The Senate has supported health care expansion for the last couple of years, even passing its own version two years ago. The more conservative House, now led by Speaker Steve Crisafulli, has been staunchly opposed.

Republican Gov. Rick Scott previously has voiced support, though he retreated from the issue during last year’s re-election campaign.

Last weekend, however, the Senate’s Republican leader called on the state to expand Medicaid in a speech to a business-friendly civic group.

Sen. Bill Galvano of Bradenton said funding health care for the working poor is a problem that “cannot be ignored,” according to news reports.

Expanding health care to as many as 1 million residents might be a policy fight worth picking, said state Sen. Tom Lee, a Brandon Republican and chairman of the Appropriations Committee.

Then again, “at some point you make a decision on whether you’re going to let the place melt down over a difference of opinion,” Lee said.

The issue already has caused a meltdown, late in the 2013 session.

House Democrats, upset over the GOP’s refusal to consider Medicaid expansion, pulled a parliamentary move requiring all bills to be read aloud in full before a vote.

Then-Speaker Will Weatherford retaliated by using a program that scanned the bills and read them with a computerized voice. But to save time, he jacked up the playback speed to near “Alvin and the Chipmunks” pitch.

“Medicaid expansion is arguably one of those (issues) worth going to the wall on,” Lee said. “But first we have to know there’s an appetite, how we would do it, and I don’t think there’s any consensus on what the mechanism would be to take federal money.”

Under the Affordable Care Act, commonly known as Obamacare, the federal government agreed to pay 100 percent of the first-year costs and 90 percent for the subsequent three years. Florida would have received close to $51 billion over 10 years.

The Obama administration is pushing Medicaid expansion as it wants to wean states, including Florida, from another federal funding source known as the Low Income Pool, or LIP. The pool reimburses hospitals for charity care.

But federal money has been the main sticking point, with House leadership warning that the federal government could withhold dollars at any time, leaving state taxpayers stuck with the bill.

Close to a third of the state budget already goes to paying for Medicaid.

And Crisafulli has been quick to point out his chamber came up with a plan two years ago to cover about 115,000 residents using more than $200 million in state money.

Lee says the House has a point: “There is a legitimate concern about where we’re going to be when Lucy pulls the football out from Charlie Brown.”

Other concerns, he said, include a challenge to the federal health care law before the Supreme Court this week that could ultimately undo it, and various studies suggesting Medicaid patients are less healthy than the uninsured.

Senate President Andy Gardiner, an Orlando Republican who favors Medicaid expansion, has a different take on the funding argument.

“It’s important to realize 38 percent of our (overall) budget is federal dollars,” said Gardiner, a vice president for the nonprofit Orlando Health hospital system.

That money goes toward transportation and education needs, for example.

With the feds already funding so many initiatives, “do you just walk away from it or do you figure out a way to make it work?” Gardiner said.

Business coalitions, including “A Healthy Florida Works,” also have been lobbying for some version of expansion using private exchanges.

The Healthy Florida Works proposal would use federal money to create a private insurance marketplace and could benefit nearly 115,000 working poor in the Tampa Bay area.

Employers fear the cost to insure workers will go up as hospitals and physicians charge everyone more to subsidize uncompensated care.

Some Capitol watchers surmised recently whether some “grand bargain” could materialize, with the Senate agreeing to some House initiative if it, in turn, OKs expansion.

Darryl Paulson, a Republican and retired professor of government at the University of South Florida-St. Petersburg, said he doesn’t expect House leadership to reverse itself.

“It’s like many things in politics,” he said. “They don’t want to do it unless they absolutely have to do it, and they don’t see that they absolutely have to do anything about it.”

At the same time, Paulson notes that Florida has overtaken California as the state with the most people — 1.6 million enrollees —signing up for health coverage under the Affordable Care Act.

“That in itself is interesting because clearly there’s been no support from the Republican leadership, from the governor,” Paulson said. “It’s ironic at the very least.”

Still, the surge in sign-ups “seems to be some sort of message the public wants something to be done, so you could argue there’s some pressure for the Legislature to do something,” he said.

Chad Riese hopes they do so this session. Lawmakers convene Tuesday.

For those who would benefit, “it would make (them) feel comfortable knowing they wouldn’t have to be afraid to seek treatment when they’re sick,” Riese said.

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