Legislative Standoff Over One Million Uninsured
By Dr. James Palermo // April 17, 2013
Time Running Out For Alternative Solutions To Medicaid Expansion
BREVARD COUNTY • MERRITT ISLAND, FLORIDA–It’s clear that the Florida Legislature is not inclined to proceed with Medicaid expansion as defined in the Patient Protection and Affordable Care Act (PPACA/ “Obamacare”). Republicans in both houses clearly articulated their skepticism that the federal government is capable of reliably coming through over the long haul with the funding for Medicaid expansion, sighting the overwhelming budgetary challenges in Washington D.C. and the precarious state of our economy.
Senate Proposes Private Insurance Plan
Although the Florida legislature’s rejection of Medicaid expansion is a setback to expansion efforts, the body left room for a possible compromise to emerge.
Based in part on their premise that Medicaid coverage is far inferior to private insurance products and programs, the Select Senate Committee on the PPACA proposed to accept the federal money as provided in the PPACA, but use it to place qualified low-income Floridians into private insurance plans that would provide reliable access to primary and preventive healthcare for those hard-working individuals who don’t get coverage on the job because it isn’t provided or they can’t afford it.
Florida state Sen. Joe Negron, an opponent of Medicaid expansion, is chairman of the Florida Senate Appropriations Committee which, last month, on a unanimous and bipartisan vote, approved Negron’s Medicaid alternative to provide healthcare coverage to working low income uninsured Floridians.
The resultant bill has garnered support from a broad swath of industries and leaders of both political parties, including Governor Scott, and proposes an approach that is based on the same platform as the Florida Healthy Kids (FHK) program, the popular non-profit that enrolls low-income children in health plans using a combination of federal and state funds.
If Approved, ‘Healthy Florida’ Worth $51 Billion Over 10 Years To The State
The proposed “Healthy Florida” program would be a privatized plan targeting the same group as PPACA Medicaid expansion, and structured and managed like FHK, with vouchers to nearly one million uninsured Florida adults, who have incomes under 138 percent of the poverty level, to purchase their own private health insurance policies.
The estimated $51 billion in federal funds over 10 years at no net cost to the state available for Medicaid expansion would hopefully flow to it through the federal Medicaid program, but the new plan would not carry that name.
In opting out of expanding Medicaid, Negron said during his committee’s meeting, “We don’t want to do it the Washington way. We want to do it the Florida way.” The plan would require members to take some ownership in the form of modest co-pays for physician and emergency room visits and a portion of premium payments. “We want people to say ‘I have health insurance’ NOT ‘I am on Medicaid.’”
Need Florida House And HHS Approval
The plan would require approval from the Department of Health and Human Services (HHS), which will present a challenge. However, there is optimism that federal health officials are willing to consider the Florida Senate’s plan because the Obama administration is encouraging states resistant to PPACA Medicaid expansion to consider an alternative plan that would rely on private health insurance, and the FHK model is structured specifically to comply with federal rules for alternative Medicaid programs. The state would have to get the plan to HHS by June 14, with an eye toward winning approval in time to start enrollment Oct. 1.
However, the House Select Committee on the Patient Protection and Affordable Care Act is not enamored with the “Healthy Florida” program proposal and has put forth its own plan.
The plan, called Florida Health Choices Plus, would theoretically cover up to 115,700 adults who have minor children or are disabled and have incomes up to the federal poverty level, which is about $11,500 for one person, $15,500 for two people and $19,500 for a family of three. The plan falls far short of covering a majority of Florida’s low-income uninsured, many of whom are either childless or middle-aged with no children under 18 still at home.
The estimated $237 million price tag for the plan would come out of general-revenue funds, while turning down and leaving on the table an average of over $5 billion a year in federal funds that would cover about 10 times as many people if the “Healthy Florida” program was approved through HHS as an alternative to Medicaid expansion.
Timely Resolution of House And Senate Standoff Is Imperative
The Senate’s “Healthy Florida” proposal shows Republicans in Florida and other state capitols that it is possible to abide by their convictions and at the same time come up with alternative solutions to assist Floridians in need.
However, after Republican House members who support the “Healthy Florida” plan unsuccessfully tried to amend the House bill to substitute the Senate’s plan, it appears that the Senate and House are miles apart on this crucial issue and in the midst of a standoff.
While both the House and Senate committees studying PPACA implementation rejected expansion of Medicaid, the Negron plan is generally perceived as an alternative that accomplished the same goals and thus would likely receive federal approval. Senate leaders say they’re searching for middle ground, but a hybrid plan is likely to reduce the number of uninsured covered in order to get the House’s agreement, and could result in Florida receiving no funds from HHS.
With the 2013 legislative session coming to an end in early May there is very little time for our lawmakers to come together for the good of their constituency. Make it known to both your state and federal legislative representatives, Governor Scott and President Obama what you expect of them to commit to a collaborative approach to real feasible solutions that effectively address healthcare access and affordability for all Floridians.