Florida Medicaid expansion would show true leadership
Over the past several years, arguments for Medicaid expansion in Florida have been made using sound economic, budgetary and public health rationales, only to collapse under the reflexive antipathy toward the Affordable Care Act of Gov. Rick Scott and conservatives in the state House of Representatives.
So let’s reset the debate and look at Medicaid expansion by itself in the context of the long and successful history of other state/federal partnerships that have been a hallmark of Republican governance for more than a century.
Let’s start with the Land Grant College Act of 1862, sponsored by Congressman Justin Morrill — a founder of the Republican Party — and signed by Republican President Abraham Lincoln.
Under the act, the federal government gave states federal land they could manage or sell to endow colleges specializing in agriculture and engineering. As part of the deal, however, the states would have to pay for the construction and maintenance of the schools.
By any measure, this state/federal partnership has been a success. More than 100 Land Grant colleges have been created in every state and territory, and it made a college education affordable to the people Morrill called “the sons of toil.”
The list of alumni of Florida’s two land grant institutions — the University of Florida and Florida A&M — is a “who’s who” of accomplished men and women: Nobel laureates, astronauts, governors, U.S. senators and representatives, federal judges, generals and admirals, ambassadors and hundreds of business and civic leaders, scientists, writers, artists, musicians and athletes — from the chairman of Microsoft to jazz saxophonist Cannonball Adderley.
Not a bad return on investment for a law passed when the outcome of the Civil War was very much in doubt.
Now let’s look at the Federal Highway Act of 1956, proposed by Republican President Dwight Eisenhower. In 1919, Eisenhower had been part of a motorized military caravan traveling from Washington, D.C., to San Francisco. The trip took 58 days and averaged six miles an hour because of the poor condition of our nation’s roads. Later, as supreme commander of European forces in World War II, Eisenhower saw the German Autobahn and, remembering his previous expedition, decided America needed its own national highway system.
As president, Eisenhower decided creating this network had to be a joint state/federal enterprise. Otherwise our nation “would be a mere alliance of many separate parts,” he said.
The bipartisan bill Eisenhower signed called for the construction of more than 46,000 miles of interstate — about 1,500 in Florida — that would be paid for with a 90/10 split between the federal government and states respectively.
Studies have shown that every $1 invested in the interstate system returned $6 in economic benefits.
Medicaid expansion is in the best tradition of these historic state/federal partnerships. Helping low-income Floridians get health care is an investment in human capital every bit as important to our future as building universities and roads.
Currently in Florida, Medicaid is restricted to children, pregnant women and parents with dependent children whose household incomes are below 30 percent of the federal poverty level — or about $115 a week for a family of three. Medicaid expansion would extend eligibility to nearly all non-elderly adults with incomes at or below 138 percent of the federal poverty level — or about $530 a week for a family of three.
The majority of the expansion population — about 567,000 Floridians — are working men and women who earn too much to qualify for traditional Medicaid, but not enough to be eligible for subsidies on the health care exchange.
The federal government would pay 95 percent of the cost in 2017, sliding to a permanent 90/10 ratio by 2020 — the precise split of the Highway Act.
The Florida Legislature should revisit Medicaid expansion during its upcoming session with an eye, not to short-term election cycles, but instead to the generational cycles that reach far into the future, as great Republican leaders like Lincoln and Eisenhower did.
Ron Pollack is executive director of Families USA.