Count this as an update, of sorts, on the potential progress towards Medicaid expansion in the Sunshine State. With Indiana recently joining the list of conservative-led states reaching a compromise with the Obama administration (a potentially precedent-setting deal), eyes have once more begun looking toward other holdout states for the possibility of any movement towards reform.
Republican Governor Rick Scott has been largely silent in response to his midwestern counterpart’s willingness to reach an accord. He shouldn’t be. According to the Kaiser Family Foundation around 17 percent of those that remain in the Medicaid coverage gap (folks that earn too much to qualify for pre-ACA eligibility standards, but too little to receive subsidies to buy coverage on the federal marketplaces) live in the state of Florida, the second-largest percentage next to Texas.
With Scott’s relative muteness on the matter reporters and activists had started pressuring state-level officials to respond, but after reading this recent Tampa Bay Times report it’s clear the Republican-controlled state legislature isn’t moving quickly to expand insurance coverage to more than 670,000 low-income residents.
The interesting aspect to that avenue of inquiry, though, was that their non-action may not be due to a total lack of desire by some to pursue reform. It’s just that the bar for doing so is embarrassingly low (emphasis mine):
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.
In other words, and given other comments I’ve seen elsewhere, the more moderate Republican state Senate would probably present the state executive office with a workable deal that it would sign if not for the fuss of having to deal with their House counterparts. Sound familiar? (This wouldn’t be the first time I’ve viewed Florida state politics as a potential microcosm of what a Republican-controlled federal government would look like, btw).
Yet despite nearly everyone’s reticence to bring up expanding Medicaid, the exigency of other budget needs this legislative session may actually necessitate “letting the place melt down” after all:
Florida is scheduled to lose $1 billion in federal health funds at the end of June, a hole in the state budget the Legislature must fill in its upcoming session if a settlement isn’t reached between the administrations of Gov. Rick Scott and President Barack Obama.
The state has known for about a year about the impending cut in funding to cover uninsured, low-income hospital patients, but Scott has included the money in his proposed 2015-16 budget, which takes effect July 1. The hospitals are using the issue to bolster arguments to expand Medicaid during the 60-day Legislative session that begins Tuesday.
The funds referred to here are the Low Income Pool (LIP) that the federal government provides to hospitals to help cover the cost of care to indigent patients. That mechanism was originally designed to be phased out, replaced by increased spending when states expanded their Medicaid programs. Yet even though the expansion is now optional Florida will still lose LIP funding, which is currently scheduled to end in July. Apparently the loss of one billion dollars is a daunting-enough prospect that the Senate Health Policy Committee is already beginning to hear proposals on a privatized compromise.
Will that provide enough incentive to overcome the ickiness of potentially provoking House Republicans? There could be a considerable amount of dragging, kicking, and much screaming of tyranny in the process but, probably. In the meantime, in what would be an otherwise humorous turn of perspective, Governor Scott is rather optimistic that the federal government won’t remove LIP funding because that would be just too crazy, right? Perhaps the rest of the party can embrace that eyebrow attitude and accept that federal funding for a Medicaid expansion would also be here to stay. At this point I don’t particularly care what circumstances would precipitate state Republicans to move on health care reform. It just needs to happen.