Expanded Medicaid unlikely in Florida

TALLAHASSEE — Gov. Ron DeSantis and Florida legislative leaders still aren’t interested in expanding Medicaid under the Affordable Care Act, despite the federal government’s offer to defray the cost to the state for two years as part of the $1.9 trillion COVID-19 relief package signed by President Biden last week.

Democrats and advocates who’ve pushed for expansion say there’s no excuse not to offer coverage to 800,000 more Floridians now that the cost to the state would be less.

Sen. Annette Taddeo, D-Miami, for example, noted that DeSantis doesn’t plan on giving back to the federal government any of the $10 billion in direct aid Florida is getting, as U.S. Sen. Rick Scott requested, so traditional GOP arguments in favor of fiscal restraint seem to have evaporated in Tallahassee, she said.

“Even Gov. DeSantis said to former governor and senator Rick Scott, ‘that’s crazy to turn back money,’ ” Taddeo said Wednesday. “Well, I feel exactly the same way — that’s crazy to turn back money for Medicaid expansion in the middle of a global pandemic, to say to people, ‘you still can’t have insurance.’ ”

Medicaid expansion would provide coverage under the program, which is run jointly by the state and federal government and covers poor families, children and pregnant women, to people who earn up to 138% of the federal poverty line, which stands at $18,000 per year for a person and $37,000 for a family of four.

The federal government would cover the entire cost of expansion at first before their share reduces to 90%, with the state paying the remaining 10%. The usual cost share of the current Medicaid program varies by year but can reach as high as 60% paid by the federal government and 40% paid by Florida.

Under the relief package, for two years the federal government would pay an extra 5% of its share of the main Medicaid program, which is expected to serve nearly 4.6 million Floridians next fiscal year before enrollment drops in future years due to a rebounding economy.

Florida’s Medicaid program is projected to cost $31.6 billion this year, or about one-third of the state’s $92.2 billion budget. State economists estimate the state’s share this year to be $11 billion and it is expected to rise to $13 billion next year.

Florida Policy Institute, a liberal think tank based in Orlando, estimates expanding Medicaid now would save the state $3.5 billion.

That would free up money for other things, such as education and the environment, and advocates argue the savings would be even greater, because the cost of uncompensated care at hospitals would go down, eventually reducing health care premiums across the entire system.

“There is no excuse fiscally for any lawmaker to say it would be fiscally undoable,” said Holly Bullard, FPI chief strategy and development officer. “The fiscal argument isn’t there, it’s really reversed.”

But GOP leaders still have an eye on the 10% cost to the state in future years.

“The president has concerns about the longterm, recurring costs associated with Medicaid expansion,” Katie Betta, spokeswoman for Senate President Wilton Simpson, R-Trilby, stated in an email explaining his opposition.

DeSantis office didn’t return a request for comment Wednesday, but his spokeswoman told the Washington Post this week he “remains opposed to the expansion of Medicaid in Florida.”

House Speaker Chris Sprowls, R-Palm Harbor, is more concerned about allowing more residents coverage, an echo of the criticism from past GOP House leaders that “able-bodied adults” would be eligible for Medicaid under expansion.

“The Speaker will not pursue a Medicaid expansion,” Sprowls spokeswoman Jenna Sarkissian stated in an email. “He believes Medicaid should be reserved for our most vulnerable residents, such as low-income senior citizens, people with disabilities, children and pregnant women.”

Sarkissian added that Sprowls “has expressed a strong desire to address disparities in maternal health care for low-income women and invest in areas like career and higher education help to generate better outcomes for Floridians and put them on a path to employment, financial resilience and prosperity.”

After years of intense debate over Medicaid expansion, the fight over the issue in the Legislature has cooled.

In 2013, Florida House Democrats demanded all bills be read in full, slowing down the chamber to protest the lack of action on the issue, but a Senate plan to allow newly eligible enrollees to receive private health plans paid by the federal government was rebuffed by House Republicans.