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Florida Governor Flip-Flops on Medicaid Expansion

Gov. Rick Scott threw more cold water Monday on the state Senate's push for expanding health insurance for low-income Floridians, saying it was too risky to rely on support from the federal government.

By John Kennedy

Gov. Rick Scott threw more cold water Monday on the state Senate's push for expanding health insurance for low-income Floridians, saying it was too risky to rely on support from the federal government.

But Senate President Andy Gardiner, R-Orlando, fired back, warning that the governor -- along with House Republicans who also oppose the expansion -- could derail needed work on crafting a state budget. The legislative session is scheduled to end May 1, but the House and Senate remain far apart on their budget proposals largely because of their difference on the health-insurance-expansion issue.

Scott in 2013 announced support for expanding Medicaid under the federal Affordable Care Act. But he has never taken any action to help make it happen. And on Monday he separated himself further from his one-time position.

Scott rooted his latest stance in the current uncertainty over federal dollars to Florida hospitals that treat the poor.

The Obama administration's Centers for Medicare and Medicaid Services has said it plans to revamp funding for the so-called low income pool (LIP), possibly reducing the roughly $2.3 billion that Florida hospitals expected from the program. CMS told the state last year the formula would change and that Medicaid expansion would be the way to go to replace those dollars.

But Scott and the House, ideologically opposed to Medicaid expansion, refuse to endorse the Obama administration's stance.

"Our priority is to cut more than $600 million in taxes this session and get K-12 education funding up to record levels while holding the line on college tuition," Scott said Monday.

"We still have several weeks left for budget negotiations; however, given that the federal government said they would not fund the federal LIP program to the level it is funded today, it would be hard to understand how the state could take on even more federal programs that CMS could scale back or walk away from," he said.

Gardiner responded to Scott by basically saying that without the LIP money -- or cash drawn from enacting the insurance expansion -- the governor can forget about his pitch for $673 million in tax breaks, the biggest being a consumer-friendly cut to phone and television taxes.

"The Senate also shares the Governor's commitment to tax relief and record funding for education; however, if our state is forced to make up the difference of $2.2 billion in hospital funding, every area of our budget will be impacted," Gardiner said.

Scott's stepping out against the Senate plan also brought a response from the Obama administration, with Health and Human Services spokesman Ben Wakana seeking to tout the benefits to Florida of covering the uninsured.

Twenty-eight states and Washington, D.C., have agreed to expand Medicaid coverage under the Affordable Care Act.

"The law is clear: Federal funding for Florida's Medicaid expansion covers 100 percent of the costs of newly eligible individuals through 2016 and will never fall below 90 percent," Wakana said.

He added, "HHS has proven itself willing to work with any state interested in expanding Medicaid, and we have consistently said that a Florida solution would reduce costs for hospitals that are typically passed on to taxpayers and expand access to quality health care for more Floridians. That's a common sense path that's good for taxpayers and the economy of the Sunshine state."

Scott's latest posture isn't much different from where he stood last month at the outset of the legislative session. With the Senate already advancing its Florida Health Insurance Exchange (FHIX) program, Scott said then that the focus should be on extending LIP, not doing more.

The federal government last year extended LIP for one year with the understanding that changes to the program would be coming -- since Medicaid expansion could help many of these same hospitals.

In response, the Senate this spring has included about $5 billion in federal money tied to FHIX and LIP in its budget. The House has none of this cash, a disparity that is stalling budget negotiations.

In March, Scott defended what would become the House stance, saying that state leaders who refuse health-insurance expansion should not be blamed. Instead, the Obama administrators and allies such as Florida Democratic U.S. Sen. Bill Nelson would have to answer as to why LIP money was changed, Scott said.

"I'd be very disappointed in individuals like Senator Nelson if they don't make sure that (LIP) continues," Scott said in March. "I'd be very disappointed in the federal government if they started a program like this for low-income individuals and they didn't continue it."

(c)2015 The Palm Beach Post (West Palm Beach, Fla.)

Caroline Cournoyer is GOVERNING's senior web editor.
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