Medicaid Expansion Faces Opposition in Florida House

Top Republicans in the Florida House split from Gov. Rick Scott on Monday and said they will oppose a plan to expand Medicaid to 900,000 or more poor Floridians

By Tia Mitchell

Top Republicans in the Florida House split from Gov. Rick Scott on Monday and said they will oppose a plan to expand Medicaid to 900,000 or more poor Floridians, arguing that it would increase the federal deficit, diminish health care delivery to the elderly and drastically grow an already problem-laden program.

A key legislative committee that had been studying the health care law voted along party lines to reject the proposed Medicaid expansion and the billions of dollars in federal funding it would bring. In doing so, Republicans pledged to seek other options to address Florida's 4 million uninsured.

The decision, criticized by Democrats, further isolates Scott among Florida's Republican elected leaders, who largely have dug in their heels against the Medicaid provision. Scott still could find an ally in the Florida Senate, which has yet to make a recommendation.

Comparing the federal government's offer to pay 100 percent of the expansion costs for the first three years and at least 90 percent after that, Rep. Matt Hudson said Florida shouldn't be swayed by a "few pieces of silver" and ignore the long-term implications of adding 900,000 people to the Medicaid rolls.

"We know that it hasn't always worked out so well when people look at short-term gain instead of long-term vision," Hudson, a Republican from Naples, said.

As they pledge to seek other options, Republicans said they were particularly intrigued by the agreement struck between the federal government and Arkansas. That state received permission to use Medicaid expansion dollars to pay for people to buy insurance policies through health exchanges.

"What Arkansas did, it wasn't even a concept; I didn't even think about it," said Rep. Richard Corcoran, the Lake O' Lakes Republican who chairs the House panel.

House Speaker Will Weatherford, R-Wesley Chapel, praised the committee's decision.

"We simply cannot count on the federal government to pay 100 percent of the cost for expansion," he said. "The facts show that health care costs will go up for many Floridians, while access to and quality of health care will go down."

Democratic Minority Leader Perry Thurston, of Plantation, called the decision "morally reprehensible," while Rep. Dwight Dudley said it showed a "lack of vision."

Dudley, of St. Petersburg, said Democrats shouldn't count on Republicans to find a better way to reduce the number of uninsured.

"You didn't hear any solutions, you didn't hear any alternative ideas or plans," Dudley said of the committee's rationale. "That's pretty appalling considering they are willing to kill this, something that is a plan, something real that people can access and have."

The more moderate Senate has seemed more open to expanding Medicaid, though its committee studying the issue decided to postpone a planned discussion on the topic Monday.

Sen. Joe Negron, R-Stuart, said if the House won't back away from its opposition, then an alternative must be sought.

"If we're going to say 'no' to Medicaid expansion, let's say 'yes' to something," Negron said.

The federal government has promised to pay 100 percent of the expansion costs during the first three years and then gradually scale back its share to 90 percent in 2020, with the state responsible for the remainder. The expansion would make coverage available to people whose incomes are up to 138 percent of the federal poverty level, including childless adults -- a group that is now largely ineligible in Florida's Medicaid system.

State economist Amy Baker presented a report Monday that estimated nearly 869,000 people would be part of the Medicaid expansion, though many of those would be shifted into the program from other types of coverage. As an example, children who are currently eligible for a program that offers subsidized health insurance to working families would be shifted into Medicaid if they met the new income qualifications.

The House, Senate and Scott administration have already rejected another part of the Affordable Care Act that could have involved the state running a health-insurance exchange, an online marketplace where people can shop for coverage. In doing so, the state will default to the federal government running the exchange in Florida.

Last month, Scott shocked many conservatives when he endorsed a plan to expand Medicaid after fighting so hard against the law. Scott called for an initial three-year expansion, but most Republicans said it would be impossible to undo health care insurance for the Floridians who would have been covered.

It's unclear how much political capital Scott is prepared to expend pushing a possible expansion. He has said it is not among his top priorities and was not included in excerpts released Monday previewing his State of the State address on Tuesday.

Others may have to pick up the cause. On Monday, a lobbyist for the business-backed Associated Industries of Florida said the state should not just toss aside the billions of federal dollars.

"What we see is that we're already paying, the business community, is already paying for the uninsured, in the most costly setting possible, in the emergency rooms," Slater Bayliss said. "We encourage you to best leverage available federal funding to ensure that we provide coverage to Floridians in a manner that protects the state's financial health."

(c)2013 The Miami Herald

Brian Peteritas is a GOVERNING contributor.