The News Service of Florida
“Senators Study Medicaid Expansion Alternatives”
March 4, 2015
By Margie MenzelFollowing Senate President Andy Gardiner’s opening-day call to begin a discussion about expanding health care coverage, senators on Wednesday looked at possible ways to provide insurance to potentially hundreds of thousands of low-income Floridians.Gardiner, in remarks Tuesday to start the annual legislative session, said the Senate has an “obligation” to look at the coverage issue, which has been tangled in a debate about expanding Medicaid under the federal Affordable Care Act. Gardiner’s remarks also came as the state faces the threat of losing federal money for a program known as the Low Income Pool, which helps hospitals and other health providers care for low-income and uninsured patients.The Senate Health Policy Committee held a workshop Wednesday to discuss possibilities, including a business-backed plan called “A Healthy Florida Works,” which would use federal money to create a private insurance marketplace. The coalition backing the plan includes influential business lobby Associated Industries of Florida and the Florida Hospital Association.The panel also heard from officials in Indiana, which recently got federal approval — and federal funding — for an alternative to expanding Medicaid under the Affordable Care Act. The Indiana plan is expected to cover an additional 350,000 people.”We’re looking at options,” said Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach.. “Florida is looking at losing between $1.2 billion and $1.9 billion in what’s called Low Income Pool money for uncompensated care. That’s going away, and so we’ve got to figure out what we can do as a state to make sure that we compensate providers that treat people that don’t pay.”Bean said all possible plans are on the table, including such options as a work requirement and at least a token premium for participants, “where it’s not just a giveaway program.”Among the options, Bean said, was learning how Indiana got federal approval “to bend the rules like never before” under the Affordable Care Act, known as Obamacare.The Florida Legislature has thus far refused to expand Medicaid coverage under Obamacare, citing mistrust of the federal government to keep a commitment to pay $51 billion over 10 years.That refusal was driven by the House of Representatives, which in 2013 rejected a Senate proposal led by Sen. Joe Negron, R-Stuart, to use the federal money in the form of private-insurance vouchers.But now businesses, at least in part fearing the loss of the Low Income Pool money, are adding their powerful presence to the debate.”We need to do what Congress wouldn’t do, and actually fix our health care system and show the rest of the country how it can be done,” said Mark Wilson, president and chief executive officer of the Florida Chamber of Commerce.The chamber is proposing a 49-page draft bill that would include tort reform and changes to workers’ compensation insurance, while capping the Medicaid portion of the state budget at 32 percent. Currently, Medicaid represents about 30 percent of the state budget.But Bean said after the meeting that the chamber’s proposal would be too controversial.”I don’t think they will have a place in this bill, because it’s going to be hot enough already without those extra, added hot items,” he said.That was borne out when Sal Nuzzo, vice president for policy at the James Madison Institute, a conservative think tank, told the committee that the federal government couldn’t be trusted as a partner. He cited the current threat to the Low Income Pool funding, which the state is trying to negotiate.”If they cannot be trusted to extend a program that assists poor and uninsured Floridians, how then can anyone conclude that we should trust that the federal government is going to cover the cost of Medicaid expansion?” he asked. “I would implore you to think about what the future will hold … when it’s $10 billion or $50 billion that the feds are holding over our heads.”Sen. Don Gaetz, R-Niceville, noted that he had served on the board of the James Madison Institute and didn’t trust the federal government, either. But then he asked Nuzzo what the difference was between taking Low Income Pool money and taking money to expand Medicaid.”Should we give the LIP money back?” Gaetz asked.”I would argue that LIP funding is an issue that should be dealt with separate and apart from the debate of Medicaid expansion, (and) that LIP funding is dollars that are being held hostage by the federal government,” Nuzzo replied. “They’re being held hostage under the threat of Florida not accepting Medicaid money.”After the meeting, Bean said he expected the committee to take up an alternative to Medicaid expansion at its meeting next week.But signs from the House have not been encouraging.”Certainly, we’ve had some conversations to educate especially our newer members on the issue,” House Speaker Steve Crisafulli said after Tuesday’s State of the State address. “We still see that Washington can provide more flexibility and, listen, since two years ago, when we first had this discussion, they have. So we feel like some progress has been made in that arena. But at this point in time, we’re not interested in expanding Medicaid as we know it.”Bean, known for his optimism, said he hoped that by opening the discussion to work requirements and premiums — what he called “skin in the game” for potential enrollees — the Senate could interest the House in a compromise plan.”We’ve got conservative friends in the House of Representatives,” Bean said. “I understand exactly their reasoning.”