No sooner were these words typed last week than the budgetary preview of one billion federal dollars being vacuumed out of the state prompted the Republican-controlled Florida Senate Health Policy Committee to put expanding Medicaid on the agenda for the spring legislative session.
As the Associated Press reported:
MIAMI — An alternative to Medicaid expansion is being proposed in the Senate in a bill that would use federal funds to offer health insurance to nearly 1 million low-income Floridians.
Thursday’s proposal from Sen. Aaron Bean’s Health Policy Committee will still allow the state to take billions of federal dollars, but would give consumers vouchers to purchase private insurance. The Republican-led Legislature has been opposed to Medicaid expansion but has been more open to this option.
You can read the bill, “Health Insurance Affordability Exchange,” for yourself, but if you’ve paid attention to any other conservative state compromise it will look very familiar. This would be what is sometimes referred to as the ‘private option,’ or using the increased Medicaid funding to allow qualified individuals, presumably matching the Affordable Care Act’s eligibility thresholds up to 138 percent of the federal poverty line, to purchase private coverage on a newly-established health insurance exchange (which, by the way, would have interesting contingency opportunities in the event of an adverse King v Burwell ruling from SCOTUS).
It would also include monthly premiums, special charges for “inappropriate” emergency department visits, optional health savings accounts, a temporary ‘lock-out’ contingency of six months for missed premium payments, as well as extensive work requirements. (Although I should say that the AP may be erroneously reporting that childless adults cannot receive coverage: see line 192 in the bill, which simply notes that they would have a higher weekly hours worked threshold). I imagine that the last part there on work requirements would be a non-starter with Health and Human Services, which has denied similar requests in other compromises.
Beyond that, though, this is very much something that could be accepted by three of the four players that are needed — the Obama administration, the state Senate, and Governor Rick Scott. The primary uncertainty still remains with the more conservative House body, which rebuffed a similar bill in 2013, but to my knowledge hasn’t officially commented on the lasted proposal. Last week at least one state Senator was quoted as saying that the attempt to compromise on expanding health insurance coverage to over half a million Floridians wasn’t worth letting “the place melt down […],” but clearly the potential loss of federal funding to the state hospital system is enough incentive to risk just watching the world burn.
***Update: According to Florida AP reporter Gary Fineout the Senate Health Policy Committee will be voting on the Health Insurance Affordability Exchange bill today. I’d suggest following him on Twitter if you’re interested (Scripps Matt Dixon too).