For a second day, Gov. Rick Scott sidestepped questions about whether Florida would begin implementing the federal health care law now that it has been upheld by the U.S. Supreme Court.
Florida has yet to set up health care “exchanges,” an Internet-based system for buyers to shop for private insurance plans.
The state also must decide whether to participate in a planned expansion of the Medicaid program. The expansion could add more than 950,000 people to Florida’s Medicaid rolls, with the federal government covering most, but not all, of the cost.
Scott said Friday he will have a plan in the coming weeks.
“What I’m concerned about is that what happened with that bill being declared constitutional is the fact that it’s going to be bad for patients, bad for taxpayers, bad for businesses,” he said Friday after a speech in Tampa. “But we’ll be looking at that — the issue over the exchanges, the issue over whether we can afford to expand Medicaid.”
Republicans in at least four states want to abandon an expansion of Medicaid in President Barack Obama's health care overhaul, and Florida is among more than a dozen states considering the idea in the wake of this week’s high court ruling removing the threat of federal penalties. The states considering whether to withdraw from the expansion include presidential battlegrounds Florida, Ohio, Pennsylvania and Colorado.
For elected officials, the decision presents a stark choice: agree to accept an ambitious expansion of Medicaid or leave behind a vast pile of federal money that could provide health care to millions of poor constituents.
The law signed by Obama in 2010 was projected to provide coverage to more than 30 million Americans, reducing by more than half the number of uninsured people. Of those, about 17 million were supposed to be added to Medicaid, the joint federal and state health care program for the poor. The rest were to be covered by a strengthened and subsidized private insurance market.
The federal government agreed to pay the full tab for the Medicaid expansion when it begins in 2014. But after three years, states must pay a gradually increasing share that tops out at 10 percent of the cost. That may not sound like much, but it translates to a commitment of billions of dollars at a time when many local officials are still anxious about the slow economic recovery.
In Florida, the governor can recommend whether or not the state participates in the Medicaid expansion, but because the program is part of the state budget, much of the work will be left to the Legislature.
Scott spokesman Lane Wright said it would be wrong to interpret Scott’s comments as saying he’s leaning one way or another.
“I think he’s made it clear that he hasn’t made a decision yet,” Wright said. “He’s got policy staff looking at it, he’s got legal staff looking at it. We’re going to make sure we fully understand it before we decide the path that Florida will be taking on these issues.”
A decision not to expand Medicaid could have a major impact on Miami’s Jackson Health System, where 40 percent of revenue at present comes from Medicaid.
About 17 percent of Jackson’s present patients are uninsured, and the system was hoping to get more Medicaid patients under the health care reform act to help offset the $100 million to $150 million in annual funding to cover the uninsured that it expects to lose as the federal government shifts that money to fund expanded Medicaid programs throughout the country.
On Thursday, Jackson Vice President Brian Dean said the fallout of the reform act “could have profound impact.”
On Friday, after it was reported by some news outlets that Scott might not expand Medicaid, a Jackson spokesman said the system would have no further comment, but Bruce Siegel, chief executive of National Association of Public Hospitals and Health Systems, said states opting out of Medicaid expansion could be disastrous for public hospitals because of reduced hospitals funds to pay for the uninsured.
“We hope states choose to do the right thing. But we cannot base federal policy on hope alone,” Siegel said in a statement. “NAPH urges Congress to avert a potentially disastrous outcome for vulnerable populations by immediately reevaluating safety net funding in light of this decision.”
For Scott, the issue is affordability. The state already struggles to pay for Medicaid as it is, he told a Jacksonville talk radio station Friday morning, and Medicaid costs are rising much faster than the state’s general revenue.
“I don’t know how we are going to be able to afford it,” he told WOKV. “Look at how tough our budgets are now.”Herald/ Times staff writer Michael Van Sickler and The Asssociated Press contributed to this report.