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Nancy Smith

Why Is the Florida Senate Caving on Medicaid Expansion?

March 9, 2015 - 7:00pm

Has the Florida Senate lost its mind? You have to ask yourself.

Why would a largely conservative body of men and women expand on a poorly devised government entitlement program? But that's what Sen. Aaron Bean's Health Policy Committee did Tuesday when it unanimously approved a plan to accept $50 billion from the federal government over the next 10 years to expand Medicaid.

Watching the committee meeting unfold -- seeing even staunchly conservative former Senate President Don Gaetz, R-Niceville, jump on the Florida Health Insurance Affordability Exchange Program (FHIX) bandwagon -- I had to wonder how conservative resolve in the upper chamber could have evaporated so quickly.

Some of us remain concerned about the growth of federal entitlements and what this will mean. And the ability of the federal government to keep its word. I admit, I'm one of them. So, when Gaetz and Committee Chairman Bean say this bill is going to be a heavy lift to get passed, I'm glad. It means there's still time to fix it.

Bob McClure, president and CEO of the James Madison Institute, spoke Tuesday as one of the few voices of reason. Any time you take $50 billion from the federal government, he said, you're asking for trouble.

"Floridians deserve access to affordable, quality care," McClure said. "(But) the reality is, the federal government has played political games with LIP funding (a program the feds are discontinuing that funded hospitals treating large numbers of uninsured, underinsured and Medicaid patients).

"If they do that," he said, "then how are we to believe it won't happen down the road to this money for Medicaid expansion?Medicaid is already the Pacman of the state budget. All of you all know that. If we increase the program, where will we be when our taxpayers are responsible for a larger bill down the road? ... In three to five years we may be back here having this same conversation, needing to fill another budget hole with fewer federal dollars ..."

The Senate plan as it stands, SPB 7044, creates a health-insurance exchange where people with an income of up to 138 percent of the federal poverty level can go to choose from among a number of private insurance plans. The estimated 800,000 eligible are people who do not qualify for Medicaid right now.

The plan does at least one thing the Florida Chamber of Commerce asked: It includes a provision that recipients have a job or be actively looking for one.

But the Senate needs to do a whole lot more to reshape its bill into something that makes fiscal sense. Both the chamber and the James Madison Institute have noted SPB 7044 is missing these components:

  • Elimination of $1.4 billion in hidden health care taxes -- and it's doable.
  • Return of the 8 percent hospital cost shift back to businesses and employees.
  • Imposition of a 32 percent cap on Floridas health care budget -- that is, 32 percent of the total Florida budget (health care is at 30 percent now).
  • A cleaning up of the millions in fraud and abuse.
  • The addition of innovative technologies like telehealth to serve more people.

Chamber President and CEO Mark Wilson told the committee expanding health care coverage needn't be an all-or-nothing deal. "... We would like to talk more about implementing the chamber's cost-saving recommendations," he said. "The chamber thinks even as we try to expand coverage, we can lower costs so more people can be covered."

Before the vote, committee member Gaetz developed his own rationale. "I don't trust the federal government either. ... (But) we have in this bill a provision that says if the feds don't do what they say, we're out. And I'll be the first one to cast a vote to eliminate eligibles if the feds lie to us or if they change their minds."

He called refusing federal Medicaid money "practicing the doctrine of selective indignation. ... These are Florida dollars. Every study that's been done shows we send more money to Washington than we get back. I want -- in the immortal words of H&R Block -- my millions back."

I have great respect for Don Gaetz. In fact, I believe he's more conservative and thoughtful than most of the conservatives I know. I'm absolutely convinced he gets it. But I have to tell you, I fear the national economic meltdown if all state leaders across the country damn the long-term consequences of expanding an entitlement program the size of this one.

Meanwhile, there's intrigue afoot. At the same time the Senate pushes its Big Numbers bill, others hustling Medicaid expansion are trying to win over Gov. Rick Scott. It's a good strategy. The Senate and the governor together would exert a mighty force on a House that so far remains largely opposed to expansion of any kind. We'll see how Steve Crisafulli's House handles the pressure.


Reach Nancy Smith at nsmith@sunshinestatenews.com or at 228-282-2423. Twitter: @NancyLBSmith

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